Two cases of Norwalk virus enteritis following small bowel transplantation treated with oral human serum immunoglobulin

Florescu, Diana F.; Hill, Lisa; McCartan, Megan A.; Grant, Wendy J.

doi:10.1111/j.1399-3046.2007.00875.x

Cited by 63 publications

(47 citation statements)

References 13 publications

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“…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].…”

Section: Norovirusmentioning

confidence: 94%

Diarrhea in solid organ transplant recipients

Angarone

Ison²

2015

Current Opinion in Infectious Diseases

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Section: Norovirusmentioning

confidence: 94%

Diarrhea in solid organ transplant recipients

Angarone

Ison²

2015

Current Opinion in Infectious Diseases

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“…Siebenga et al [10] reported prolonged illness and viral shedding (21-182 days) in hospitalized patients. Chronic norovirus infection has been reported in pediatric intestinal transplant recipients and in a child with cartilage hair hypoplasia after bone marrow transplantation [11][12][13]. Ludwig et al [14] found a prolonged shedding over a maximum of 433 days in pediatric patients with cancer.…”

mentioning

confidence: 97%

Chronic Norovirus Infection after Kidney Transplantation: Molecular Evidence for Immune‐Driven Viral Evolution

et al. 2010

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“…Unfortunately, there are no approved therapeutics or vaccines for controlling norovirus infections. Attempted methods to control chronic infection have included treatment with drugs effective against other diarrheal diseases (27), adjustment of the immunosuppressive drug type or dosage (28), and oral or enteral administration of human IgG (29)(30)(31)(32). Although reduction in immunosuppression coupled with IgG administration has shown promise for some transplant patients, IgG therapy has failed in other studies, and reduction of immunosuppression is not always possible.…”

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confidence: 99%

Within-Host Evolution Results in Antigenically Distinct GII.4 Noroviruses

Debbink

Lindesmith

Ferris

et al. 2014

J Virol

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Genogroup II, genotype 4 (GII.4) noroviruses are known to rapidly evolve, with the emergence of a new primary strain every 2 to 4 years as herd immunity to the previously circulating strain is overcome. Because viral genetic diversity is higher in chronic than in acute infection, chronically infected immunocompromised people have been hypothesized to be a potential source for new epidemic GII.4 strains. However, while some capsid protein residues are under positive selection and undergo patterned changes in sequence variation over time, the relationships between genetic variation and antigenic variation remains unknown. Based on previously published GII.4 strains from a chronically infected individual, we synthetically reconstructed virus-like particles (VLPs) representing early and late isolates from a small-bowel transplant patient chronically infected with norovirus, as well as the parental GII.4-2006b strain. We demonstrate that intrahost GII.4 evolution results in the emergence of antigenically distinct strains over time, comparable to the variation noted between the chronologically predominant GII.4 strains GII.4-2006b and GII.4-2009. Our data suggest that in some individuals the evolution that occurs during a chronic norovirus infection overlaps with changing antigenic epitopes that are associated with successive outbreak strains and may select for isolates that are potentially able to escape herd immunity from earlier isolates. IMPORTANCENoroviruses are agents of gastrointestinal illness, infecting an estimated 21 million people per year in the United States alone. In healthy individuals, symptomatic infection typically resolves within 24 to 48 h. However, symptoms may persist for years in immunocompromised individuals, and development of successful treatments for these patients is a continuing challenge. This work is relevant to the design of successful norovirus therapeutics for chronically infected patients; provides support for previous assertions that chronically infected individuals may serve as reservoirs for new, antigenically unique emergent strains; and furthers our understanding of genogroup II, genotype 4 (GII.4) norovirus immune-driven molecular evolution.

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Two cases of Norwalk virus enteritis following small bowel transplantation treated with oral human serum immunoglobulin

Abstract: Protracted diarrhea is a challenging problem after small bowel transplantation. We report two patients who developed Norwalk virus enteritis after small bowel transplantation. Both received oral HSIG with resolution of diarrhea within 48 h.

Cited by 63 publications

References 13 publications

Diarrhea in solid organ transplant recipients

Diarrhea in solid organ transplant recipients

Chronic Norovirus Infection after Kidney Transplantation: Molecular Evidence for Immune‐Driven Viral Evolution

Within-Host Evolution Results in Antigenically Distinct GII.4 Noroviruses

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