Norovirus-related severe and chronic diarrhoea in renal transplant adult recipients
Abstract number: O246
Roos-Weil D., Pothier P., Lanternier F., Mamzer-Bruneel M-F., Ambert-Balay K., Snanoudj R., Lecuit M., Thervet E., Legendre C., Lortholary O., Zuber J.
Objectives: Noroviruses (NoV) and Sapoviruses (SpV) are two separate genera in the Caliciviridae family. NoV are an increasingly recognized cause of transient gastroenteritis in immunocompetent individuals and have been recently implicated in chronic diarrhea in immunocompromised patients. However, clinical and epidemiological spectrum of Caliciviridae infections in renal transplant recipients is still poorly defined.
Methods: We undertook a single-center retrospective analysis of the clinical and virologic features of Caliciviridae infection, diagnosed by reverse transcription polymerase chain reaction (RT-PCR) from July 2008 to September 2009. Genotypes and variants were identified by genome sequencing. Other infectious agents were ruled out.
Results: Eleven renal transplant adult recipients were identified as having Caliciviridae infection, including 10 NoV and 1 SpV. All of them were given an induction immunosuppressive therapy relayed by a triple maintenance therapy. The median time from transplantation to symptoms and from then to diagnosis were 21 months (range: 183) and 30 days (range: 9154), respectively. All patients had protracted diarrhea, requiring hospitalization and IV rehydration. Vomiting and fever were present in 5 (45%) and 2 (18%) patients, respectively. All but one experienced weight loss with an average loss of 4.5±2.2 kg, 8 (72%) of them presented with acute renal failure. Patient-to-patient nosocomial transmission was very likely in two patients who shared the same hospital room and in whom the same variant was identified. All others had community-acquired-norovirus infection and one in the context of a family outbreak. NoV genotypes found were GI-3, GII-2, GII-4, GII-6 variants in 1, 1, 6 and 2 patients, respectively. Diarrhea was lasting more than 4 weeks in 10 of them with a median duration of 56 days (range: 8261). Strikingly, diarrhea resolved after mycophenolate tapering or withdrawal in 5 (46%) and 4 (36%) patients, respectively. All patients survived and none experienced a relapse of diarrhea with a median follow-up of 5 months (range: 117).
Conclusion: NoV is a likely underestimated cause of severe and chronic diarrhea in renal transplant recipients. This may delay effective therapeutic intervention that mostly consists in reducing immunosuppression. Prospective studies are warranted to assess the correlation between immunosuppressive regimens, resolution of diarrhea and virus clearance.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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