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NDT Advance Access originally published online on December 10, 2008
Nephrology Dialysis Transplantation 2009 24(3):1051-1053; doi:10.1093/ndt/gfn693
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Chronic norovirus infection in renal transplant recipients

Timm H. Westhoff1,*, Maria Vergoulidou2,*, Christoph Loddenkemper3, Stefan Schwartz2, Jörg Hofmann4, Thomas Schneider5, Walter Zidek1 and Markus van der Giet1

1 Department of Nephrology 2 Department of Hematology 3 Department of Pathology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin 4 Department of Virology, Charité University Medicine, Charitéplatz 1, 10117 Berlin 5 Department of Gastroenterology and Infectiology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany

Correspondence and offprint requests to: Timm H. Westhoff, Department of Nephrology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. Tel: +49-30-8445-641420; Fax: +49-30-8445-4235; E-mail: timm.westhoff{at}charite.de



  Abstract

Norovirus infection is the most common cause of acute gastroenteritis. In immunocompetent subjects, norovirus infection is a self-limiting disease of short duration. The present report provides first evidence that norovirus can cause chronic infection in renal transplant recipients. Two patients showed persisting norovirus excretion for >7 months and 3 months, respectively. The first patient was asymptomatic after an acute episode of gastroenteritis and eliminated the virus spontaneously. The second patient developed severe symptomatic chronic infection with diffuse abdominal discomfort, fever, transient transplant dysfunction, recurrent episodes of diarrhoea, weight loss and histological signs of chronic intestinal inflammation. Norovirus elimination and relief of symptoms occurred only after reduction of immunosuppression. Thus, norovirus can evoke asymptomatic and symptomatic chronic infection in renal transplant recipients. Norovirus should therefore be considered in the differential diagnosis of both acute and chronic diarrhoea after transplantation. Reduction of immunosuppression may be indicated to allow virus elimination in symptomatic cases.

Keywords: gastroenteritis; immunosuppression; norovirus; transplantation

* Contributed equally to the work.

Received for publication: 24. 7.08
Accepted in revised form: 20.11.08


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