Norovirus Gastroenteritis

Abstract

A 50-year-old female with a past history of uterus cancer 15 years ago was admitted to the hospital in Tokyo, Japan. She had arrived in Tokyo from the island of Kyusyu with her husband 5 days ago to meet her daughter. Her complaints had started 1 day ago, which were fatigue, thirstiness, and drowsiness. When her daughter came home at night, she found her mother lying on the floor. She also found that her mother had diarrhea and had vomited and then called an ambulance.On admission, her level of consciousness was unclear; Glasgow Coma Scale (GCS) was 11 (E3V2M5). Body temperature was 41 C; blood pressure 86/54 mmHg; heart rate 110 bpm; and respiratory rate 16/min. She had severe watery diarrhea, dry mouth and skin, and general muscle hypertonia. The white blood cell count was 15,600/µL, hemoglobin level 12.9 g/dL, creatinine 1.25 mg/dL, and glucose 136 mg/dL. She underwent a lumbar puncture, which revealed normal initial pressure, nucleated cell count, and glucose level in the CSF. A rapid immunochromatographic test for norovirus was positive in her stool sample. She was diagnosed with norovirus gastroenteritis, but was still suspected of bacterial sepsis. Therefore, a bolus infusion of extracellular fluid was given and ceftriaxone 2 g QD was started empirically. Whole body CT imaging revealed edema of the intestinal wall, but no evidence of other abnormalities.Her consciousness recovered gradually and became clear on the fourth day of hospitalization. Ceftriaxone was stopped on the second day. On the fifth day, she was able to have meals and discharged. Her symptoms were probably caused by norovirus infection. 203Emerging Infectious Diseases.

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