Sacco Keith A, Pongdee Thanai, Binnicker Matthew J, Espy Mark, Pardi Darrell, Khanna Sahil, Joshi Avni Y
Department of Internal Medicine, Mayo Clinic, Jacksonville, FL.
Division of Allergic Diseases, Mayo Clinic, Rochester, MN.
Diagn Microbiol Infect Dis. 2018 Apr;90(4):300-306. doi: 10.1016/j.diagmicrobio.2017.11.020. Epub 2017 Dec 5.
Norovirus is an emerging pathogen causing gastroenteritis. We sought to identify factors associated with clinical outcomes in a cohort of patients with laboratory-confirmed norovirus infection. We performed a retrospective chart review of patients with positive norovirus polymerase chain reaction in stool between October 1, 2015, and May 31, 2016. 128 unique patients were identified during the study period, 64 of whom had immune deficiency, of which only 3 patients had a primary immune deficiency (common variable immune deficiency), while 61 patients had a secondary immune deficiency. 50% of patients with immune deficiency were hospitalized as compared to only 30% of the non-immune-deficient cohort (odds ratio: 2.1 (1.1-4.18, P=0.04). One-third (32.8%) of the patients had a polymicrobial stool infection, and 21.1% had concurrent Clostridium difficile infection. Initial mean total leukocyte count was higher in the hospitalized group at 8.40×109/L versus 6.31×109/L in the nonhospitalized group (P=0.049). All 13 patients presenting with fever had symptomatic resolution (P=0.002). The presence of C. difficile infection was correlated with persistent symptoms (OR 2.30 [0.95-5.58], P=0.067). The overall mortality rate among our cohort was 3.13% (4 patients). All deceased patients had secondary immune deficiency, and none had C. difficile coinfection. Presence of an immune deficiency increases the risk of hospitalization with norovirus infection. Absence of fever is associated with lower resolution and possibly may contribute to a persistent infectious state. Presence of concomitant C. difficile infection is correlated with a lower overall mortality rate.
诺如病毒是一种引发肠胃炎的新出现病原体。我们试图在一组实验室确诊为诺如病毒感染的患者中确定与临床结局相关的因素。我们对2015年10月1日至2016年5月31日期间粪便中诺如病毒聚合酶链反应呈阳性的患者进行了回顾性病历审查。在研究期间共识别出128例独特患者，其中64例有免疫缺陷，其中仅有3例为原发性免疫缺陷（常见变异型免疫缺陷），而61例为继发性免疫缺陷。免疫缺陷患者中有50%住院，相比之下非免疫缺陷队列中仅30%住院（比值比：2.1（1.1 - 4.18，P = 0.04）。三分之一（32.8%）的患者存在混合性粪便感染，21.1%的患者同时感染艰难梭菌。住院组初始平均总白细胞计数较高，为8.40×10⁹/L，而非住院组为6.31×10⁹/L（P = 0.049）。所有13例发热患者症状均缓解（P = 0.002）。艰难梭菌感染的存在与持续症状相关（比值比2.30 [0.95 - 5.58]，P = 0.067）。我们队列中的总体死亡率为3.13%（4例患者）。所有死亡患者均有继发性免疫缺陷，且均无艰难梭菌合并感染。免疫缺陷的存在增加了诺如病毒感染住院的风险。无发热与较低的缓解率相关，可能会导致持续感染状态。合并艰难梭菌感染与较低的总体死亡率相关。
