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Clinical Manifestations of Norovirus Infection in Korean Pediatric Cancer Patients  

Choi, Hyunshin (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
Choi, Young Bae (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
Hwang, Ji-Young (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
Cheon, Doo-Sung (Division of Enteric Viruses, Center for Infectious Diseases, Korea National Institute of Health Korea Centers for Disease Control and Prevention)
Jeong, Hye Sook (Division of Enteric Viruses, Center for Infectious Diseases, Korea National Institute of Health Korea Centers for Disease Control and Prevention)
Choe, Yon Ho (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
Yoo, Keon Hee (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
Sung, Ki Woong (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
Koo, Hong Hoe (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
Kim, Yae-Jean (Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical Center)
Publication Information
Pediatric Infection and Vaccine / v.18, no.1, 2011 , pp. 40-47 More about this Journal
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 immunocompromised patients. Norovirus should be considered in pediatric cancer patients with severe gastrointestinal symptoms.
Keywords
Human calicivirus; Norovirus; Immunocompromised host; Children;
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