Korean J Pediatr Infect Dis.  2011 Jun;18(1):40-47.

Clinical Manifestations of Norovirus Infection in Korean Pediatric Cancer Patients

• Choi H
• Choi YB
• Hwang JY
• Cheon DS
• Jeong HS
• Choe YH
• Yoo KH
• Sung KW
• Koo HH
• Kim YJ

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 immunocom-promised patients. Norovirus should be considered in pediatric cancer patients with severe gastrointestinal symptoms.

Keyword

Human calicivirus; Norovirus; Immunocompromised host; Children

MeSH Terms

Brain Neoplasms
Cell Transplantation
Child
Diarrhea
Female
Gastroenteritis
Graft vs Host Disease
Hematologic Neoplasms
Humans
Immunocompromised Host
Korea
Male
Neuroblastoma
Norovirus
Parenteral Nutrition, Total
Polymerase Chain Reaction
Retrospective Studies
Transplants
Virus Shedding

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