Clinical Manifestations of Norovirus Infection in Korean Pediatric Cancer Patients.
- Author:
Hyunshin CHOI
1
;
Young Bae CHOI
;
Ji Young HWANG
;
Doo Sung CHEON
;
Hye Sook JEONG
;
Yon Ho CHOE
;
Keon Hee YOO
;
Ki Woong SUNG
;
Hong Hoe KOO
;
Yae Jean KIM
Author Information
1. Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul, Korea. yaejeankim@skku.edu
- Publication Type:Original Article
- Keywords:
Human calicivirus;
Norovirus;
Immunocompromised host;
Children
- MeSH:
Brain Neoplasms;
Cell Transplantation;
Child;
Diarrhea;
Female;
Gastroenteritis;
Graft vs Host Disease;
Hematologic Neoplasms;
Humans;
Immunocompromised Host;
Korea;
Male;
Neuroblastoma;
Norovirus;
Parenteral Nutrition, Total;
Polymerase Chain Reaction;
Retrospective Studies;
Transplants;
Virus Shedding
- From:Korean Journal of Pediatric Infectious Diseases
2011;18(1):40-47
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Norovirus infection, a common cause of community-acquired gastroenteritis, can also lead to severe illness in immunocompromised patients. We investigated clinical manifestations of norovirus infection in pediatric cancer patients. METHODS: Stool specimens were collected from pediatric patients with gastrointestinal symptoms between November 2008 and September 2009 at Samsung Medical Center, Seoul, Korea. Norovirus infection was identified by reverse-transcription polymerase chain reaction (RT-PCR). A retrospective chart review was performed in pediatric cancer patients who were diagnosed with norovirus infection. RESULTS: Ten patients were diagnosed with norovirus infection by RT-PCR in stool samples. The median age was 0.83 years (range 0.25-5.5 years) and the male to female ratio was 1.5:1 (6 males and 4 females). Underlying diseases were hematologic malignancies (4/10, 40%), neuroblastoma (4/10, 40%), and brain tumors (2/10, 20%). Three patients were infected before hematopoietic cell transplantation (HCT) and four patients after HCT. All patients had diarrhea (10/10, 100%), with a median frequency of diarrhea of 8.5 times/day (range 4-22 times/day). Median virus shedding duration was 72.5 days (range 19-299 days). Four patients with pneumatosis intestinalis were conservatively treated with bowel rest and total parenteral nutrition. One patient with severe diarrhea and bloody stool had concomitant chronic gut graft-versus-host disease (GVHD). Norovirus infection-related mortality was not observed. CONCLUSION: Norovirus infection can cause significant clinical manifestations with prolonged viral shedding in immunocom-promised patients. Norovirus should be considered in pediatric cancer patients with severe gastrointestinal symptoms.
