title: Chronic Norovirus Infections in Cardiac Transplant Patients.
abstract: Norovirus is a common self-limiting gastrointestinal infection, but in transplant recipients, symptoms can last for months and result in serious health complications. As there is currently no established treatment for chronic norovirus infection in transplant patients, management has been directed at symptom control, trial of various antivirals, and ultimately reductions in immunosuppression. We present 3 cases of chronic norovirus infection in cardiac transplant patients to illustrate various approaches to diagnosis, the prolonged nature of disease symptoms, and treatment options. When managing a transplant recipient with chronic diarrhea, considering a broad differential as well as maintaining a high suspicion for infectious etiologies is key. A stepwise approach to management includes termination of diarrhea-causing medications, trials of nitazoxanide and immunoglobulin, and reductions in immunosuppressive therapies. Although brief discontinuation of immunosuppression is often required to achieve symptom, graft rejection is often a complication.
authors.affiliation: 1 School of Medicine, University of Colorado, Aurora, CO, USA.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Jurgens
authors.affiliation: 2 Division of Cardiology, Section of Advanced Heart Failure and Transplantation, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.affiliation: 2 Division of Cardiology, Section of Advanced Heart Failure and Transplantation, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Amrut V
authors.initials: AV
authors.lastname: Ambardekar
authors.affiliation: 2 Division of Cardiology, Section of Advanced Heart Failure and Transplantation, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Colleen K
authors.initials: CK
authors.lastname: McIlvennan
mesh_terms: D000328:Adult; D000930:Antidiarrheals / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D017250:Caliciviridae Infections / Q000175:diagnosis* / Q000188:drug therapy; D002908:Chronic Disease; D004157:Diphenoxylate / Q000008:administration & dosage; D004338:Drug Combinations; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008139:Loperamide / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D066027:Transplant Recipients
chemical_list: D000930:Antidiarrheals; D004338:Drug Combinations; D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; C002534:atropine sulfate-diphenoxylate hydrochloride drug combination; D008139:Loperamide; D004157:Diphenoxylate; D001285:Atropine
keywords: chronic diarrhea; immunosuppression; norovirus infection; orthotopic heart transplant