{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:14:20Z","timestamp":1790795660005,"version":"4.1.0"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,3,16]],"date-time":"2017-03-16T00:00:00Z","timestamp":1489622400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Norovirus (<jats:styled-content style=\"fixed-case\">NV<\/jats:styled-content>) infection has been reported as a cause of severe chronic diarrhea in transplant recipients, but this entity remains under\u2010recognized in clinical practice, leading to diagnostic delays. Transplant clinicians should become familiar with this syndrome in order to facilitate early detection and management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Demographic, clinical, and outcomes variables were summarized from a series of transplant recipients with positive stool <jats:styled-content style=\"fixed-case\">NV<\/jats:styled-content> reverse transcription polymerase chain reaction (<jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PCR<\/jats:styled-content>) assays at Johns Hopkins in 2013\u20102014. Factors associated with longer duration of symptoms were compared using random forest analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010one of 193 (16%) transplant recipients who were tested for <jats:styled-content style=\"fixed-case\">NV<\/jats:styled-content> had positive stool <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">PCR<\/jats:styled-content>s. Symptoms included diarrhea (100%), nausea\/vomiting (58%), abdominal pain (52%), and wasting (35%). Acute kidney injury occurred in 23%, and persisted in 21% after 6\u00a0months. Median duration of diarrheal symptoms was 4\u00a0months (range, &lt;1\u201020) and 11\/31 (35.4%) patients had relapses after improvement. Wasting, incompatible kidney transplant status, and plasmapheresis were associated with longer diarrhea durations. Treatments included nitazoxanide (in 74%), reduction of immunosuppression (58%), and intravenous immunoglobulin (32%). Six patients died, but no deaths were attributed to <jats:styled-content style=\"fixed-case\">NV<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>It is important for clinicians to recognize that <jats:styled-content style=\"fixed-case\">NV<\/jats:styled-content> can cause severe chronic diarrhea in transplant recipients. In this series, receipt of a human leukocyte antigen\u2010 and\/or blood type\u2010incompatible kidney transplant, and plasmapheresis were associated with longer symptom duration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.12674","type":"journal-article","created":{"date-parts":[[2017,2,8]],"date-time":"2017-02-08T01:35:38Z","timestamp":1486517738000},"source":"Crossref","is-referenced-by-count":51,"title":["Severe chronic norovirus diarrheal disease in transplant recipients: Clinical features of an under\u2010recognized syndrome"],"prefix":"10.1111","volume":"19","author":[{"given":"Robin K.","family":"Avery","sequence":"first","affiliation":[{"name":"Division of Infectious Disease Department of Medicine Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bonnie E.","family":"Lonze","sequence":"additional","affiliation":[{"name":"Division of Transplantation Department of Surgery Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward S.","family":"Kraus","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Medicine Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kieren A.","family":"Marr","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease Department of Medicine Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Division of Transplantation Department of Surgery Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,3,16]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"55","article-title":"Notes from the field: Emergence of a new norovirus strain GII.4 Sydney\u2010 United States, 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