Is there a role for oral human immunoglobulin in the treatment for norovirus enteritis in immunocompromised patients?

Abstract

No treatment for NVE is available. Immunocompromised patients with NVE treated with OHIG (12 cases) were retrospectively identified and matched 1:1 by age and gender with immunocompromised patients with NVE not treated with OHIG (12 controls). Chi-squared test, t-test, bivariate conditional linear regression analyses, and Kaplan-Meier curve were performed. A total of 58.3% patients were small bowel transplant (SBT) recipients. Although not statistically significant, cases compared with controls were more likely to have had induction therapy (p = 0.25, OR = 65.3), higher peak tacrolimus levels (p = 0.43, OR = 1.04), SBT (p = 0.30, OR = 65.3), prior NVE (p = 0.42, OR = 2.0), TPN support (p = 0.42 OR = 2.0), and decrease in immunosuppression (p = 0.14, OR = 5.0). Treatment with OHIG favored resolution of diarrhea (p = 0.078, OR = 65.3) and decreased stool output seven days after treatment compared with controls (mean difference 11.95 mL/kg/day, p = 0.09). OHIG did not impact total time to resolution of diarrhea (mean 12.08 vs. 11.91 days; p = 0.63), length of hospital stay (p = 0.31, OR = 1.05), or cost of hospitalization (p = 0.32, OR = 1.0). We show a potential role of OHIG treatment for NVE. Resolution of diarrhea and decreased stool output were observed at seven days; no benefit was found for length of hospital stay or hospital cost.

Norovirus

“…Florescu and colleagues performed a matched case-control study to evaluate the potential benefit of orally administered human immunoglobulin in the treatment of symptomatic norovirus infection in immunocompromised patients. Cases received 25 mg/kg of body weight of human immunoglobulin (Gamunex; Talecris Biotherapeutics, Inc., NC, USA) every 6 h for a total of 8 doses (58). Although the median age of 24 total cases plus controls was 2 years, one-third were adults, and 20 were solid organ transplant recipients.…”

Diarrhea in solid organ transplant recipients

“…Several strategies have been tried in limited numbers of patients: oral or intravenous immunoglobulin, breast milk, ribavirin, and nitazoxanide. Several case series have suggested that oral human immunoglobulin improves diarrheal symptoms; however, a recent cohort study failed to demonstrate improvements in total time to resolution of diarrhea, length of hospital stay, or cost with administration of oral human immunoglobulin [40,53,62,63]. Systemic administration of immunoglobulin has also provided conflicting evidence on clinical impact [40].…”

Opportunistic viral infections in intestinal transplantation

“…Norovirus may present in transplant recipients as severe or protracted diarrheal illness requiring admission to the hospital for supportive therapy, and may even cause recurrent or relapsing infection [139]. IT recipients usually present with severe diarrhea that requires prolonged intravenous fluid replacement and nutritional support, while vomiting is not a primary symptom [139][140][141].…”