Successfully Treated Norovirus- and Sapovirus-Associated Diarrhea in Three Renal Transplant Patients

Noha Ghusson,Gustavo Vasquez

doi:10.1155/2018/6846873

Noha Ghusson, Gustavo Vasquez

Open Access

https://doi.org/10.1155/2018/6846873

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Abstract

Objectives To examine the burden of norovirus- and sapovirus-related diarrhea in renal transplant patients and to propose the use of nitazoxanide as a therapeutic option for treatment. Methods We reviewed three renal transplant patients with viral diarrhea requiring hospitalization due to acute renal failure and signs of graft rejection. All three patients were treated with nitazoxanide. We examined their clinical courses after therapy and compared time to resolution of symptoms and viral shedding. Results In all three renal transplant patients, improvement of diarrheal illness was witnessed within one week of nitazoxanide initiation. Conclusions Infectious diarrhea remains an underestimated yet significant cause of morbidity in solid organ transplant patients. Norovirus and sapovirus are often responsible for this presentation. Nitazoxanide was used as a treatment modality with success in reduction of symptoms, decreased duration of illness, and cessation of viral shedding.

Highlights

Sapovirus and norovirus are frequent causes of self-limited diarrheal illnesses in healthy hosts
While norovirus is the most common cause of viral gastroenteritis in adults [4], accounting for 90% of viral gastroenteritis worldwide [2], sapovirus remains a major cause of enteric infections within the solid organ transplant population
Infectious diarrhea remains an underestimated yet significant cause of morbidity in solid organ transplant patients. Viral etiologies, such as norovirus and sapovirus make up a high percentage of severe, chronic diarrhea and dehydration requiring hospitalization in this population

Summary

Introduction

Sapovirus and norovirus are frequent causes of self-limited diarrheal illnesses in healthy hosts. In solid organ transplant patients, these viral infections are a frequent cause of chronic and intermittent diarrhea [1], causing significant morbidity and often requiring hospitalization in this population. With that comes an increased risk for serious disease and an inherent risk of dehydration, acute renal failure, and lower graft/patient survival [1]. Decreasing immunosuppressants increase the risk of acute transplant rejection. If an immunosuppressed patient does overcome the diarrheal illness, they remain at risk of prolonged asymptomatic viral shedding [2], putting themselves and others at risk of reinfection. We discuss three cases of renal transplant patients with diarrhea and the use of nitazoxanide in the treatment of norovirus or sapovirus gastroenteritis

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