Chong Pearlie P, van Duin David, Sonderup Jessica L, Grant Wendy J, Kalil Andre C, Florescu Diana F
Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
University of Nebraska Medical Center, Omaha, NE, USA.
Clin Transplant. 2016 Nov;30(11):1488-1493. doi: 10.1111/ctr.12844. Epub 2016 Oct 6.
Solid organ transplant (SOT) recipients may develop protracted diarrheal illness from norovirus. We performed a retrospective chart review between January 2010 and April 2014 to identify predictors of persistent diarrhea in transplant recipients with norovirus enteritis. A total of 152 SOT recipients with mean age of 31.5 years (SD 23.1) were included: 43.4% male, 34.2% pediatric patients. Allograft types were abdominal 136 (89.5%) (kidney [39.5%], liver-small bowel [23%], other [27%]) and thoracic 16 (10.5%). The median time to diagnosis of first norovirus enteritis episode from date of transplantation was 1.7 (0.3-5.3) years. At time of presentation, diarrhea was present in 141 (93%). Thirty percent had persistent diarrhea at 2 weeks. Hospitalization was required for treatment in 121 (80%) of episodes with the mean length of stay of 10±15.2 days. Most (91%) infections were due to norovirus genogroup II, and gastrointestinal coinfections were seen in 23 (19%) norovirus enteritis episodes. Nausea at time of diagnosis (P=.002) and cytomegalovirus (CMV) infection in the preceding 90 days (P=.036) were identified as independent risk factors for persistent diarrhea using univariate and multivariable logistic regression. Our study shows that nausea on presentation and prior CMV infection were associated with persistent diarrhea in patients with norovirus enteritis.
实体器官移植（SOT）受者可能会因诺如病毒而患上迁延性腹泻病。我们在2010年1月至2014年4月期间进行了一项回顾性病历审查，以确定诺如病毒肠炎移植受者持续性腹泻的预测因素。共纳入152名SOT受者，平均年龄31.5岁（标准差23.1）：男性占43.4%，儿科患者占34.2%。同种异体移植类型为腹部移植136例（89.5%）（肾脏[39.5%]、肝脏-小肠[23%]、其他[27%]）和胸部移植16例（10.5%）。从移植日期到首次诊断诺如病毒肠炎发作的中位时间为1.7（0.3 - 5.3）年。就诊时，141例（93%）有腹泻症状。30%的患者在2周时仍有持续性腹泻。121例（80%）发作需要住院治疗，平均住院时间为10±15.2天。大多数（91%）感染是由诺如病毒II基因组引起的，23例（19%）诺如病毒肠炎发作中出现了胃肠道合并感染。使用单变量和多变量逻辑回归分析，诊断时的恶心（P = 0.002）和前90天内的巨细胞病毒（CMV）感染（P = 0.036）被确定为持续性腹泻的独立危险因素。我们的研究表明，就诊时的恶心和先前的CMV感染与诺如病毒肠炎患者的持续性腹泻有关。
