Background: Acute gastroenteritis (AGE) is a frequent sequela in children undergoing hematopoietic cell transplant (HCT). Although rotavirus and norovirus have been implicated as important causes of AGE, the frequency of other pathogens is unknown. Little data exist on longitudinal prevalence of infectious AGE in HCT.
Methods: From 2/2015-5/2016, subjects <18 years undergoing allogeneic HCT were enrolled at 4 CDC-NVSN sites: Oakland, Kansas City, Seattle, and Nashville. Stool samples were collected at enrollment, weekly until discharge or day 100 (whichever occurred earliest), during re-admissions within the 1st 100 days, and day 100. AGE was defined as unexplained ≥3 episodes diarrhea and/or ≥1 episode vomiting /24 hours. Specimens were tested using Luminex xTAG Gastrointestinal Pathogen Panel (Austin, TX) and realtime PCR for adenovirus, astrovirus, norovirus, and sapovirus.
Results: Thirty-one patients were enrolled at four sites (Seattle: 13, Kansas City: 8, Oakland: 6, Nashville: 4) with median age 5 (IQR 3-10) years. 216 samples were obtained with median 7 samples/subject. During the 1st 100 days, 29 (94%) subjects met the AGE definition. Thirty-six single pathogen detections occurred in 16 (52%) subjects. Clostridium difficile was the most frequent pathogen (Figure 1), with 14 detections in 9 patients, all ≥3 years; 50% of detections were asymptomatic. Seven (50%) detections occurred at HCT onset and none received targeted C. difficile therapy. Sapovirus was detected 9 times in 4 patients, with 7 (78%) detections associated with AGE symptoms. Rotavirus was detected 9 times, during 5 symptomatic episodes, in 3 patients. Adenovirus was detected 4 times in 3 patients and all were symptomatic.
Conclusion: We longitudinally characterized the etiology of infectious AGE in children undergoing HCT. Despite the majority of patients meeting the definition for AGE, only half had a pathogen detected, suggesting that differentiating infectious versus non-infectious AGE (e.g medication induced) in this population is difficult. Although all subjects with adenovirus and most with sapovirus were symptomatic, asymptomatic C. difficile detection was common. Interestingly, norovirus was not detected. Further investigation of AGE is warranted in this population.
Figure 1. Pathogens detected during the first 100 days post-HCT.
B. Piya, None
D. Dulek, None
M. E. Wikswo, None
H. Browne, None
J. Vinje, None
D. C. Payne, None
P. H. Azimi, None
R. Selvarangan, None
N. B. Halasa, None
J. Englund, None