Norovirus causing severe gastrointestinal disease following allogeneic hematopoietic stem cell transplantation: A retrospective analysis

Transpl Infect Dis. 2018 Apr;20(2):e12847. doi: 10.1111/tid.12847. Epub 2018 Feb 26.

Abstract

Background: Norovirus (NV) can cause chronic and severe gastroenteritis with possible lethal outcome in immunocompromised patients. The knowledge of NV infections in allogeneic hematopoietic stem cell transplantation (HSCT) recipients is limited. The aim of this study was to clarify the clinical importance of NV in a large cohort of HSCT recipients.

Methods: All patients undergoing HSCT and diagnosed with NV at Karolinska University Hospital from 2006-2012 were included in the study (63 patients). Clinical data were collected from medical records, and statistics were performed using the logistic regression method.

Results: The majority of patients (70%) had short-term symptoms (≤14 days). However, 54% of all patients required admission or prolonged hospitalization owing to the infection. In 16% of the patients the symptoms were chronic (>30 days), and in all but one of these patients the clinical picture also was severe, with malnutrition requiring long-term TPN, or serious dehydration. Severe combined immune deficiency (SCID) diagnosis was associated with chronic symptoms of NV infection (OR 30.3, CI 2.5-368).

Conclusion: NV is an important pathogen in the HSCT setting, although the infection seems to be mild in most patients. Increased knowledge is needed to further identify risk factors for a severe course of NV infection in HSCT patients.

Keywords: allogeneic stem cell transplantation; calici; gastroenteritis; norovirus; severe combined immunodeficiency.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Caliciviridae Infections / complications*
  • Child
  • Child, Preschool
  • Female
  • Gastroenteritis / virology*
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Norovirus / isolation & purification*
  • Retrospective Studies
  • Young Adult