Loma Linda University School of Medicine, Loma Linda, California, USA.
UCSF Benioff Children's Hospital Oakland, Oakland, California, USA.
Pediatr Transplant. 2022 Dec;26(8):e14390. doi: 10.1111/petr.14390. Epub 2022 Sep 10.
Norovirus is a common cause of gastroenteritis in both immunocompetent and immunocompromised hosts. In transplant recipients, it can lead to prolonged shedding and chronic diarrhea. Treatment with nitazoxanide, oral immunoglobulin, or mammalian target of rapamycin inhibitors has shown varying degrees of benefit in case reports and case series. Prior studies have shown that the commensal gastrointestinal bacterial flora may influence the pathogenesis of norovirus infection. Metronidazole is often used to modulate gastrointestinal flora and was trialed in our hospital for norovirus in some immunocompromised patients after observing an association with anecdotal improvement.
We retrospectively reviewed episodes of norovirus in the stool of 38 patients with a history of solid organ or stem cell transplantation between July 2014 and March 2019.
There were 85 positive norovirus tests among the 38 patients. In 25 of the 85 positive norovirus tests, nitazoxanide was given, with clinical improvement in 15 of these episodes (60%). Eight positive tests were treated with metronidazole alone, in all cases after a course of nitazoxanide had been used. Improvement was observed for 6 of these episodes (75%).
Further investigation of the use of metronidazole for norovirus gastroenteritis in transplant recipients is warranted.
诺如病毒是免疫功能正常和免疫功能低下宿主中胃肠炎的常见病因。在移植受者中，它可导致持续排毒和慢性腹泻。在病例报告和病例系列中，硝唑尼特、口服免疫球蛋白或哺乳动物雷帕霉素靶蛋白抑制剂的治疗显示出不同程度的益处。先前的研究表明，共生胃肠道细菌菌群可能影响诺如病毒感染的发病机制。甲硝唑常用于调节胃肠道菌群，在观察到与轶事改善相关后，我们医院在一些免疫功能低下的患者中对诺如病毒试用了甲硝唑。
我们回顾性分析了 2014 年 7 月至 2019 年 3 月期间 38 例有实体器官或干细胞移植史的患者粪便中诺如病毒的发作情况。
38 名患者中有 85 名检测到诺如病毒阳性。在 85 次阳性诺如病毒检测中，有 25 次给予硝唑尼特，其中 15 次（60%）临床症状改善。8 次阳性检测单独用甲硝唑治疗，均在使用硝唑尼特后使用。其中 6 次（75%）观察到改善。
有必要进一步研究甲硝唑在移植受者中治疗诺如病毒胃肠炎的用途。
