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KMID : 0605820110180010040
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Korean Journal of Pediatric Infectious Diseases
2011 Volume.18 No. 1 p.40 ~ p.47
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Clinical Manifestations of Norovirus Infection in Korean Pediatric Cancer Patients
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Choi Hyun-Shin
Choi Young-Bae
Hwang Ji-Young
Cheon Doo-Sung
Jeong Hye-Sook
Choe Yon-Ho
Yoo Keon-Hee
Sung Ki-Woong
Koo Hong-Hoe
Kim Yae-Jean
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Abstract
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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 immunocompromised patients. Norovirus should be considered in pediatric cancer patients with severe gastrointestinal symptoms.
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KEYWORD
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Human calicivirus, Norovirus, Immunocompromised host, Children
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