Chronic Norovirus Infection after Kidney Transplantation: Molecular Evidence for Immune-Driven Viral Evolution
Background. Norovirus infection is the most common cause of acute self-limiting gastroenteritis. Only 3 cases of chronic norovirus infection in adult solid organ transplant recipients have been reported thus far. Methods. This case series describes 9 consecutive kidney allograft recipients with chro...
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| Veröffentlicht in: | Clinical infectious diseases 2010-08, Vol.51 (3), p.307-314 |
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| creator | Schorn, Robert Höhne, Marina Meerbach, Astrid Bossart, Walter Wüthrich, Rudolf P. Schreier, Eckart Müller, Nicolas J. Fehr, Thomas |
| description | Background. Norovirus infection is the most common cause of acute self-limiting gastroenteritis. Only 3 cases of chronic norovirus infection in adult solid organ transplant recipients have been reported thus far. Methods. This case series describes 9 consecutive kidney allograft recipients with chronic norovirus infection with persistent virus shedding and intermittent diarrhea for a duration of 97–898 days. The follow-up includes clinical course, type of immunosuppression, and polymerase chain reaction for norovirus. Detailed molecular analyses of virus isolates from stool specimens over time were performed. Results. The intensity of immunosuppression correlated with the diarrheal symptoms but not with viral shedding. Molecular analysis of virus strains from each patient revealed infection with different variants of GII.4 strains in 7 of 9 patients. Another 2 patients were infected with either the GII.7 or GII.17 strain. No molecular evidence for nosocomial transmission in our outpatient clinic was found. Capsid sequence alignments from follow-up specimens of 4 patients showed accumulation of mutations over time, resulting in amino acid changes predominantly in the P2 and P1–2 region. Up to 25 amino acids mutations were accumulated over a 683-day period in the patient with an 898-day shedding history. Conclusion. Norovirus infection may persist in adult renal allograft recipients with or without clinical symptoms. No evidence for nosocomial transmission in adult renal allograft recipients was found in our study. Molecular analysis suggests continuous viral evolution in immunocompromised patients who are unable to clear this infection. |
| doi_str_mv | 10.1086/653939 |
| format | Article |
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Norovirus infection is the most common cause of acute self-limiting gastroenteritis. Only 3 cases of chronic norovirus infection in adult solid organ transplant recipients have been reported thus far. Methods. This case series describes 9 consecutive kidney allograft recipients with chronic norovirus infection with persistent virus shedding and intermittent diarrhea for a duration of 97–898 days. The follow-up includes clinical course, type of immunosuppression, and polymerase chain reaction for norovirus. Detailed molecular analyses of virus isolates from stool specimens over time were performed. Results. The intensity of immunosuppression correlated with the diarrheal symptoms but not with viral shedding. Molecular analysis of virus strains from each patient revealed infection with different variants of GII.4 strains in 7 of 9 patients. Another 2 patients were infected with either the GII.7 or GII.17 strain. No molecular evidence for nosocomial transmission in our outpatient clinic was found. Capsid sequence alignments from follow-up specimens of 4 patients showed accumulation of mutations over time, resulting in amino acid changes predominantly in the P2 and P1–2 region. Up to 25 amino acids mutations were accumulated over a 683-day period in the patient with an 898-day shedding history. Conclusion. Norovirus infection may persist in adult renal allograft recipients with or without clinical symptoms. No evidence for nosocomial transmission in adult renal allograft recipients was found in our study. Molecular analysis suggests continuous viral evolution in immunocompromised patients who are unable to clear this infection.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/653939</identifier><identifier>PMID: 20575662</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Oxford: The University of Chicago Press</publisher><subject>Adult ; Amino acids ; ARTICLES AND COMMENTARIES ; Biological and medical sciences ; Caliciviridae Infections - diagnosis ; Caliciviridae Infections - virology ; Capsid ; Chronic Disease ; Cluster Analysis ; Correlation analysis ; Diarrhea - diagnosis ; Diarrhea - virology ; Disease transmission ; Evolution, Molecular ; Female ; Gastroenteritis ; Homologous transplantation ; Humans ; Immunocompromised Host ; Infections ; Infectious diseases ; Kidney diseases ; Kidney Transplantation - adverse effects ; Male ; Medical sciences ; Middle Aged ; Molecular Sequence Data ; Mutation ; Norovirus ; Norovirus - classification ; Norovirus - genetics ; Norovirus - immunology ; Norovirus - isolation & purification ; Polymerase chain reaction ; Reverse Transcriptase Polymerase Chain Reaction ; RNA, Viral - genetics ; Sequence Analysis, DNA ; Sequence Homology ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Symptoms ; Transplants & implants ; Viruses</subject><ispartof>Clinical infectious diseases, 2010-08, Vol.51 (3), p.307-314</ispartof><rights>2010 Infectious Diseases Society of America</rights><rights>2015 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Aug 1, 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c493t-c5ba8d7b900f8284ac12c460e04549e6e99b3144f785341dc8e57e1794b7e13c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/20750729$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/20750729$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23019043$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20575662$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schorn, Robert</creatorcontrib><creatorcontrib>Höhne, Marina</creatorcontrib><creatorcontrib>Meerbach, Astrid</creatorcontrib><creatorcontrib>Bossart, Walter</creatorcontrib><creatorcontrib>Wüthrich, Rudolf P.</creatorcontrib><creatorcontrib>Schreier, Eckart</creatorcontrib><creatorcontrib>Müller, Nicolas J.</creatorcontrib><creatorcontrib>Fehr, Thomas</creatorcontrib><title>Chronic Norovirus Infection after Kidney Transplantation: Molecular Evidence for Immune-Driven Viral Evolution</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><description>Background. Norovirus infection is the most common cause of acute self-limiting gastroenteritis. Only 3 cases of chronic norovirus infection in adult solid organ transplant recipients have been reported thus far. Methods. This case series describes 9 consecutive kidney allograft recipients with chronic norovirus infection with persistent virus shedding and intermittent diarrhea for a duration of 97–898 days. The follow-up includes clinical course, type of immunosuppression, and polymerase chain reaction for norovirus. Detailed molecular analyses of virus isolates from stool specimens over time were performed. Results. The intensity of immunosuppression correlated with the diarrheal symptoms but not with viral shedding. Molecular analysis of virus strains from each patient revealed infection with different variants of GII.4 strains in 7 of 9 patients. Another 2 patients were infected with either the GII.7 or GII.17 strain. No molecular evidence for nosocomial transmission in our outpatient clinic was found. Capsid sequence alignments from follow-up specimens of 4 patients showed accumulation of mutations over time, resulting in amino acid changes predominantly in the P2 and P1–2 region. Up to 25 amino acids mutations were accumulated over a 683-day period in the patient with an 898-day shedding history. Conclusion. Norovirus infection may persist in adult renal allograft recipients with or without clinical symptoms. No evidence for nosocomial transmission in adult renal allograft recipients was found in our study. Molecular analysis suggests continuous viral evolution in immunocompromised patients who are unable to clear this infection.</description><subject>Adult</subject><subject>Amino acids</subject><subject>ARTICLES AND COMMENTARIES</subject><subject>Biological and medical sciences</subject><subject>Caliciviridae Infections - diagnosis</subject><subject>Caliciviridae Infections - virology</subject><subject>Capsid</subject><subject>Chronic Disease</subject><subject>Cluster Analysis</subject><subject>Correlation analysis</subject><subject>Diarrhea - diagnosis</subject><subject>Diarrhea - virology</subject><subject>Disease transmission</subject><subject>Evolution, Molecular</subject><subject>Female</subject><subject>Gastroenteritis</subject><subject>Homologous transplantation</subject><subject>Humans</subject><subject>Immunocompromised Host</subject><subject>Infections</subject><subject>Infectious diseases</subject><subject>Kidney diseases</subject><subject>Kidney Transplantation - adverse effects</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Molecular Sequence Data</subject><subject>Mutation</subject><subject>Norovirus</subject><subject>Norovirus - classification</subject><subject>Norovirus - genetics</subject><subject>Norovirus - immunology</subject><subject>Norovirus - isolation & purification</subject><subject>Polymerase chain reaction</subject><subject>Reverse Transcriptase Polymerase Chain Reaction</subject><subject>RNA, Viral - genetics</subject><subject>Sequence Analysis, DNA</subject><subject>Sequence Homology</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the urinary system</subject><subject>Symptoms</subject><subject>Transplants & implants</subject><subject>Viruses</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpd0Ntu1DAQBuAIgegBeAOQhQRcBez4zB3atnRFAaEWqLixHO9EeEnsxU5W9O3xKktBXI2l-WY8-qvqEcEvCVbileBUU32nOiScylpwTe6WN-aqZoqqg-oo5zXGhCjM71cHDeaSC9EcVmHxPcXgHfoQU9z6NGW0DB240ceAbDdCQu_8KsANuko25E1vw2h3zdfofezBTb1N6HTrVxAcoC4mtByGKUB9kvwWAvrik-0LiP20m3pQ3etsn-Hhvh5Xn89Orxbn9cXHt8vFm4vaMU3H2vHWqpVsNcadahSzjjSOCQyYcaZBgNYtJYx1UnHKyMop4BKI1KwthTp6XL2Y925S_DlBHs3gs4O-nA9xykZSKhqtNC_y6X9yHacUynFGYKG1JgwX9HxGLsWcE3Rmk_xg040h2OzyN3P-BT7Zb5vaAVa37E_gBTzbA5ud7bsSqvP5r6OYaMxocY9nt85jTP_skRzLZvdRPfd9HuHXbd-mH0ZIKrk5v_5m9PXXM3756dJo-htQ3aTL</recordid><startdate>20100801</startdate><enddate>20100801</enddate><creator>Schorn, Robert</creator><creator>Höhne, Marina</creator><creator>Meerbach, Astrid</creator><creator>Bossart, Walter</creator><creator>Wüthrich, Rudolf P.</creator><creator>Schreier, Eckart</creator><creator>Müller, Nicolas J.</creator><creator>Fehr, Thomas</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20100801</creationdate><title>Chronic Norovirus Infection after Kidney Transplantation: Molecular Evidence for Immune-Driven Viral Evolution</title><author>Schorn, Robert ; Höhne, Marina ; Meerbach, Astrid ; Bossart, Walter ; Wüthrich, Rudolf P. ; Schreier, Eckart ; Müller, Nicolas J. ; Fehr, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c493t-c5ba8d7b900f8284ac12c460e04549e6e99b3144f785341dc8e57e1794b7e13c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adult</topic><topic>Amino acids</topic><topic>ARTICLES AND COMMENTARIES</topic><topic>Biological and medical sciences</topic><topic>Caliciviridae Infections - diagnosis</topic><topic>Caliciviridae Infections - virology</topic><topic>Capsid</topic><topic>Chronic Disease</topic><topic>Cluster Analysis</topic><topic>Correlation analysis</topic><topic>Diarrhea - diagnosis</topic><topic>Diarrhea - virology</topic><topic>Disease transmission</topic><topic>Evolution, Molecular</topic><topic>Female</topic><topic>Gastroenteritis</topic><topic>Homologous transplantation</topic><topic>Humans</topic><topic>Immunocompromised Host</topic><topic>Infections</topic><topic>Infectious diseases</topic><topic>Kidney diseases</topic><topic>Kidney Transplantation - adverse effects</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Molecular Sequence Data</topic><topic>Mutation</topic><topic>Norovirus</topic><topic>Norovirus - classification</topic><topic>Norovirus - genetics</topic><topic>Norovirus - immunology</topic><topic>Norovirus - isolation & purification</topic><topic>Polymerase chain reaction</topic><topic>Reverse Transcriptase Polymerase Chain Reaction</topic><topic>RNA, Viral - genetics</topic><topic>Sequence Analysis, DNA</topic><topic>Sequence Homology</topic><topic>Surgery (general aspects). 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Graft diseases</topic><topic>Surgery of the urinary system</topic><topic>Symptoms</topic><topic>Transplants & implants</topic><topic>Viruses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schorn, Robert</creatorcontrib><creatorcontrib>Höhne, Marina</creatorcontrib><creatorcontrib>Meerbach, Astrid</creatorcontrib><creatorcontrib>Bossart, Walter</creatorcontrib><creatorcontrib>Wüthrich, Rudolf P.</creatorcontrib><creatorcontrib>Schreier, Eckart</creatorcontrib><creatorcontrib>Müller, Nicolas J.</creatorcontrib><creatorcontrib>Fehr, Thomas</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schorn, Robert</au><au>Höhne, Marina</au><au>Meerbach, Astrid</au><au>Bossart, Walter</au><au>Wüthrich, Rudolf P.</au><au>Schreier, Eckart</au><au>Müller, Nicolas J.</au><au>Fehr, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Chronic Norovirus Infection after Kidney Transplantation: Molecular Evidence for Immune-Driven Viral Evolution</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clinical Infectious Diseases</addtitle><date>2010-08-01</date><risdate>2010</risdate><volume>51</volume><issue>3</issue><spage>307</spage><epage>314</epage><pages>307-314</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. Norovirus infection is the most common cause of acute self-limiting gastroenteritis. Only 3 cases of chronic norovirus infection in adult solid organ transplant recipients have been reported thus far. Methods. This case series describes 9 consecutive kidney allograft recipients with chronic norovirus infection with persistent virus shedding and intermittent diarrhea for a duration of 97–898 days. The follow-up includes clinical course, type of immunosuppression, and polymerase chain reaction for norovirus. Detailed molecular analyses of virus isolates from stool specimens over time were performed. Results. The intensity of immunosuppression correlated with the diarrheal symptoms but not with viral shedding. Molecular analysis of virus strains from each patient revealed infection with different variants of GII.4 strains in 7 of 9 patients. Another 2 patients were infected with either the GII.7 or GII.17 strain. No molecular evidence for nosocomial transmission in our outpatient clinic was found. Capsid sequence alignments from follow-up specimens of 4 patients showed accumulation of mutations over time, resulting in amino acid changes predominantly in the P2 and P1–2 region. Up to 25 amino acids mutations were accumulated over a 683-day period in the patient with an 898-day shedding history. Conclusion. Norovirus infection may persist in adult renal allograft recipients with or without clinical symptoms. No evidence for nosocomial transmission in adult renal allograft recipients was found in our study. Molecular analysis suggests continuous viral evolution in immunocompromised patients who are unable to clear this infection.</abstract><cop>Oxford</cop><pub>The University of Chicago Press</pub><pmid>20575662</pmid><doi>10.1086/653939</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Amino acids ARTICLES AND COMMENTARIES Biological and medical sciences Caliciviridae Infections - diagnosis Caliciviridae Infections - virology Capsid Chronic Disease Cluster Analysis Correlation analysis Diarrhea - diagnosis Diarrhea - virology Disease transmission Evolution, Molecular Female Gastroenteritis Homologous transplantation Humans Immunocompromised Host Infections Infectious diseases Kidney diseases Kidney Transplantation - adverse effects Male Medical sciences Middle Aged Molecular Sequence Data Mutation Norovirus Norovirus - classification Norovirus - genetics Norovirus - immunology Norovirus - isolation & purification Polymerase chain reaction Reverse Transcriptase Polymerase Chain Reaction RNA, Viral - genetics Sequence Analysis, DNA Sequence Homology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Symptoms Transplants & implants Viruses |
| title | Chronic Norovirus Infection after Kidney Transplantation: Molecular Evidence for Immune-Driven Viral Evolution |
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