Kaufman Stuart S, Chatterjee Nando K, Fuschino Meghan E, Morse Dale L, Morotti Raffaella A, Magid Margret S, Gondolesi Gabriel E, Florman Sander S, Fishbein Thomas M
Departments of Pediatrics, Pathology, and Surgery, The Mount Sinai School of Medicine, New York, NY, USA.
J Pediatr Gastroenterol Nutr. 2005 Mar;40(3):328-33. doi: 10.1097/01.mpg.0000155182.54001.48.
The human caliciviruses, which include Norwalk-like viruses (or Noroviruses) and Sapporo viruses, commonly cause epidemic and endemic viral gastroenteritis of short duration in healthy individuals. However, the impact of human calicivirus in immunosuppressed populations has not been established. The authors report five pediatric patients who developed human calicivirus enteritis after intestinal transplantation.
Infection was documented with repetitive reverse transcription polymerase chain reaction testing with nucleotide sequencing of tissue and lumen fluid specimens.
A single strain, type Miami Beach, affected all patients in the hospital with an apparent index case. A potential mode of transmission was not defined. Severe osmotic or secretory diarrhea necessitated intravenous fluid therapy for 40 days or more in three of the five infants. Concurrent or recent subclinical allograft infection with adenovirus in two patients was associated with more severe symptoms. Virus excretion exceeded 80 days in two patients. Differentiation of human calicivirus enteritis from allograft rejection was difficult, as both disorders were associated with increased enterocyte apoptosis and inflammation. Intensification of immunosuppressive therapy because of suspected rejection appeared to prolong symptoms.
These findings demonstrate that human calicivirus can be a significant pathogen in intestinal transplant recipients and potentially in other immunocompromised patients.
人杯状病毒，包括诺如样病毒（或诺如病毒）和札幌病毒，通常在健康个体中引起短期的流行性和地方性病毒性胃肠炎。然而，人杯状病毒在免疫抑制人群中的影响尚未明确。作者报告了5例肠道移植后发生人杯状病毒肠炎的儿科患者。
通过对组织和肠腔液体标本进行核苷酸测序的重复逆转录聚合酶链反应检测来记录感染情况。
单一毒株，迈阿密海滩型，感染了医院内所有患者，存在一个明显的指示病例。未确定潜在的传播方式。5名婴儿中有3名因严重的渗透性或分泌性腹泻需要静脉补液治疗40天或更长时间。两名患者同时或近期发生腺病毒亚临床同种异体移植感染，症状更严重。两名患者的病毒排泄超过80天。人杯状病毒肠炎与同种异体移植排斥反应难以区分，因为这两种疾病都与肠上皮细胞凋亡增加和炎症有关。因疑似排斥反应而强化免疫抑制治疗似乎会延长症状持续时间。
这些发现表明，人杯状病毒可能是肠道移植受者以及其他免疫功能低下患者的重要病原体。
