Chronic norovirus infection in pediatric hematopoietic stem cell transplant recipients: A cause of prolonged intestinal failure requiring intensive nutritional support

• Published in: Pediatric transplantation Vol. 15; no. 5; pp. 505 - 509
• Main Authors: Saif, M. A., Bonney, D. K., Bigger, B., Forsythe, L., Williams, N., Page, J., Babiker, Z. O., Guiver, M., Turner, A. J., Hughes, S., Wynn, R. F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2011; Blackwell
• Subjects: Biological and medical sciences; Caliciviridae Infections - complications; Caliciviridae Infections - diagnosis; Case reports; Child; Child, Preschool; Children; Chronic infection; diarrhea; Diarrhea - pathology; Digestive tract; Excretion; Feces; Female; Flow Cytometry - methods; Gastroenteritis; Gastroenteritis - virology; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; hematopoietic stem cell transplantation; Hematopoietic Stem Cell Transplantation - methods; Humans; Immunosuppressive Agents - therapeutic use; Infant; Intestine; Lymphocytes T; Male; Medical sciences; Norovirus; Norovirus - genetics; Nutrition; Nutritional Sciences; Nutritional Support; Other diseases. Semiology; Parenteral nutrition; Pediatrics; Peripheral blood; Polymerase chain reaction; RNA, Viral - metabolism; Self; stem cell transplantation; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; T-Lymphocytes - cytology; Transplantation Conditioning - methods; Human; Pediatrics; intestinal failure; Norovirus; Nutrition; Norwalk like virus; Stem cell; Hematopoietic cell; Diarrhea; Recipient; Feeding; Virus; Infection; Calicivirus; Chronic; Diet; Caliciviridae; Cause; Digestive diseases; Intestinal disease; Child; Hematopoietic stem cell transplantation; Food supplement; Prolonged
• DOI: 10.1111/j.1399-3046.2011.01500.x
• ISSN: 1397-3142

Saif MA, Bonney DK, Bigger B, Forsythe L, Williams N, Page J, Babiker ZO, Guiver M, Turner AJ, Hughes S, Wynn RF. Chronic norovirus infection in pediatric hematopoietic stem cell transplant recipients: A cause of prolonged intestinal failure requiring intensive nutritional support. 
Pediatr Transplantation 2011: 15: 505–509. © 2011 John Wiley & Sons A/S. :  Norovirus infection is a major cause of nonbacterial gastroenteritis. In immunocompetent individuals the illness caused by norovirus is mostly self limiting. Excretion of norovirus has been reported to be prolonged in the immunocompromised including adult HSCT recipients. We report a case series of 13 children who received HSCT and required prolonged parenteral and enteral nutrition due to severe gut dysfunction accompanying protracted norovirus excretion that was monitored by RT‐PCR. The median duration of viral excretion was 150 days (range 60‐380) and the eventual clearance of norovirus from feces was closely associated with donor T cell recovery in the peripheral blood. There was no disease manifestation beyond the gut but the severity and length of norovirus associated illness suggests that HSCT should be delayed where possible in patients excreting the virus prior to conditioning therapy.