Methods: We identified all adult immunocompromised patients with HM, HSCT or SOT in whom norovirus stool antigen or PCR testing was performed from January 1, 2012 to April 28, 2016 by reviewing laboratory data. Clinical characteristics of patients with positive norovirus testing were collected.
Results: 365 samples were tested for norovirus in 335 patients during the study. 30 (9%) had at least one positive test including 10 HSCT, 4 HM and 16 SOT (1 heart, 5 lung, 10 kidney) patients. Median age was 60 years old (range, 25-79); 15 (50%) were men. Norovirus genotype was available in 26: genotype I (1), genotype II (25). Nausea and vomiting were present at illness onset in 20 (66%) and all had diarrhea. 27 (90%) required hospitalization and 12 (40%) had acute kidney injury. Median duration of norovirus-associated diarrhea was 27 days (interquartile range 8-55) overall; 63 days (range 6-390) in allogeneic HSCT versus 20 days (range 2-89) in SOT recipients (P = 0.02, Mann-Whitney Utest). Repeat norovirus testing remained positive in all patients with >3 months of diarrhea. Median weight loss in those with >3 weeks diarrhea was 4 Kg (range, 0-15). 5 (17%) required parenteral nutrition. Concurrent intestinal graft-versus-host disease occurred in 5 of 9 allogeneic HSCT recipients; 2 of 14 on mycophenolate had biopsy-proven enteric mycophenolate toxicity. Concurrent opportunistic infection occurred in 5: Candida esophagitis (1), sacral herpes simplex (1), probable pulmonary aspergillosis (1), recurrent CMV viremia (1), and Pneumocystis pneumonia (1). The latter two opportunists were attributed to poor oral absorption of antimicrobial drugs due to norovirus. 2 HSCT recipients died after 4 and 7 months of norovirus-associated diarrhea but no deaths were attributed to norovirus.
Conclusion: Norovirus causes prolonged diarrhea and morbidity in HM, HSCT and SOT patients. Allogeneic HSCT recipients had a longer duration of norovirus-associated diarrhea than SOT. Decreased absorption of prophylactic antimicrobials due to norovirus may lead to opportunistic infection.
S. P. Hammond,
Ansun Biopharma: Investigator , Research support
N. Issa, None
L. R. Baden, None
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