Patte Marie, Canioni Danielle, Fenoel Véronique Avettand, Frange Pierre, Rabant Marion, Talbotec Cécile, Lacaille Florence
Gastroenterology-Hepatology-Nutrition Unit, Hôpital Universitaire Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
Pathology Department, Hôpital Universitaire Necker - Enfants malades, AP-HP, Paris, France.
Pediatr Transplant. 2017 Aug;21(5). doi: 10.1111/petr.12930. Epub 2017 May 16.
In immunocompromised patients, the NoV infection is prolonged and severe. We retrospectively studied the severity of the NoV infection in children after an ITx, the treatment, and the long-term evolution. Norovirus PCR in stools was positive for 19 children in 21 separate episodes. The infection was symptomatic in 18 cases. At diagnosis, the median weight loss was 5% (0-11) and the creatinine clearance was 75 mL/min/1.73 m (19-142). On 14 digestive biopsies, the pathological findings were non-specific with a constant mononuclear infiltration, showing signs of rejection in one case. Fifteen children in 17 cases were hospitalized for a median duration of 41 days (0-119) with IV infusions for 33 days (0-120). The viral shedding lasted 78 days (20-360). Nine children with severe or prolonged diarrhea received intravenous IGs and four of them additional NTZ. On follow-up, five other children developed a rejection 12 months (1-33) after NoV infection. Four uncontrolled rejections led to graft removal. Children mostly needed hospital admission and IV rehydration, but the symptoms upon presentation were moderate. Symptoms and shedding durations are prolonged as expected. The treatment efficacy cannot be assessed. The rejection induction by the NoV cannot be excluded.
在免疫功能低下的患者中，诺如病毒（NoV）感染病程延长且病情严重。我们回顾性研究了儿童肾移植（ITx）后NoV感染的严重程度、治疗情况及长期演变。在21次独立发作中，19名儿童粪便中的诺如病毒PCR检测呈阳性。18例感染出现了症状。诊断时，体重减轻的中位数为5%（0 - 11），肌酐清除率为75 mL/min/1.73 m²（19 - 142）。在14次消化活检中，病理结果无特异性，均有持续的单核细胞浸润，其中1例显示排斥迹象。17例中的15名儿童住院，住院时间中位数为41天（0 - 119），静脉输液33天（0 - 120）。病毒排出持续78天（20 - 360）。9名患有严重或持续性腹泻的儿童接受了静脉注射免疫球蛋白（IGs），其中4名还额外接受了硝唑尼特（NTZ）治疗。随访发现，另外5名儿童在NoV感染12个月（1 - 33）后发生排斥反应。4例无法控制的排斥反应导致移植物被移除。儿童大多需要住院及静脉补液，但就诊时症状较轻。症状和病毒排出持续时间如预期的那样延长。无法评估治疗效果。不能排除NoV引发排斥反应的可能性。
