Norovirus (NV), rotavirus (RV) and adenovirus (AV) are common causes of self-limiting acute gastroenteritis in children and less commonly in healthy adults. However, these pathogens cause severe morbidity and mortality in immunocompromised patients who have prolonged symptoms and can serve as reservoirs for novel variants. We sought to describe the clinical characteristics and health care acquisition (HCA) of NV, RV and AV associated diarrhea in immunocompromised and cancer patients at a large cancer center.
We conducted a retrospective chart review of patients in whom NV, RV and AV were identified by Polymerase Chain Reaction (PCR) or Enzyme-Linked Immunosorbent assay (ELISA) in stools submitted to the clinical microbiology laboratory between 2005 and 2014. Categorical variables were compared using chi-square; continuous, non-parametric variables were compared by using the Kruskal Wallis test. Logistic regression was used for multivariate analysis.
97 VAD cases were identified: NV (n=49), RV (n=34) and AV (n=14). Majority of VAD were in patients with leukemia and lymphoma. Most cases of NV (59%), RV (73%) and AV (78%) were identified in hematopoietic stem cell transplant (HSCT) recipients. Patients with graft versus host disease were at the highest risk. Diarrhea of ≥ 2 weeks duration was more common in NV (p=0.000) and RV (p=0.001) than with AV, particularly in HSCT, with viral shedding ranging from 46 to 270 days. Vomiting was absent in 39% of NV, 38% of RV and 86% of AV cases. Co-infections with other enteropathogens included C. difficile (7%), E. coli (4%) and Salmonella (2%). 10 cases of NV were genotyped; 6 cases were due to genotype I. 18% cases of NV, 20% cases of RV and 14% cases of AV were considered to be HCA. Patients with immunosuppression (OR 2.6 95% CI 1.15-5.99, P=0.02) and neutropenia (OR 4.8 95% CI 1.27-18.5, P=0.01) were identified as significant risk factors for NV diarrhea when compared to RV and AV associated diarrhea.
In immunocompromised and cancer patients, agents responsible for VAD occur year round but predominate in winter season, cause prolonged illness and frequently present without accompanying upper GI symptoms (nausea, vomiting). Infection control measures are essential to avoid HCA of NV.
P. Okhuysen, None
R. Daver, None
J. Vanichanan, None
L. Carlin, None