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1106. Infectious Etiologies of Acute Gastroenteritis in Children during the First 100 Days Post-Allogeneic Hematopoietic Cell Transplant

BACKGROUND: Acute gastroenteritis (AGE) is a frequent sequela in children undergoing hematopoietic cell transplant (HCT). Although rotavirus and norovirus have been implicated as important causes of AGE, the frequency of other pathogens is unknown. Little data exist on longitudinal prevalence of inf...

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Autores principales: Schuster, Jennifer, Johnston, Samantha, Piya, Bhinnata, Dulek, Daniel, Wikswo, Mary E, Browne, Hannah, Vinje, Jan, Payne, Daniel C, Azimi, Parvin H, Selvarangan, Rangaraj, Halasa, Natasha B, Englund, Janet
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253402/
http://dx.doi.org/10.1093/ofid/ofy210.940
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author Schuster, Jennifer
Johnston, Samantha
Piya, Bhinnata
Dulek, Daniel
Wikswo, Mary E
Browne, Hannah
Vinje, Jan
Payne, Daniel C
Azimi, Parvin H
Selvarangan, Rangaraj
Halasa, Natasha B
Englund, Janet
author_facet Schuster, Jennifer
Johnston, Samantha
Piya, Bhinnata
Dulek, Daniel
Wikswo, Mary E
Browne, Hannah
Vinje, Jan
Payne, Daniel C
Azimi, Parvin H
Selvarangan, Rangaraj
Halasa, Natasha B
Englund, Janet
author_sort Schuster, Jennifer
collection PubMed
description BACKGROUND: Acute gastroenteritis (AGE) is a frequent sequela in children undergoing hematopoietic cell transplant (HCT). Although rotavirus and norovirus have been implicated as important causes of AGE, the frequency of other pathogens is unknown. Little data exist on longitudinal prevalence of infectious AGE in HCT. METHODS: From February 2015 to May 2016, subjects <18 years undergoing allogeneic HCT were enrolled at four CDC-NVSN sites: Oakland, Kansas City, Seattle, and Nashville. Stool samples were collected at enrollment, weekly until discharge or day 100 (whichever occurred earliest), during re-admissions within the first 100 days, and day 100. AGE was defined as unexplained ≥3 episodes diarrhea and/or ≥1 episode vomiting/24 hours. Specimens were tested using Luminex xTAG Gastrointestinal Pathogen Panel (Austin, TX) and real-time PCR for adenovirus, astrovirus, norovirus, and sapovirus. RESULTS: Thirty-one patients were enrolled at four sites (Seattle: 13, Kansas City: 8, Oakland: 6, Nashville: (4) with median age 5 (IQR 3–10) years. Two hundred sixteen samples were obtained with median 7 samples/subject. During the first 100 days, 29 (94%) subjects met the AGE definition. Thirty-six single pathogen detections occurred in 16 (52%) subjects. Clostridium difficile was the most frequent pathogen (Figure 1), with 14 detections in nine patients, all ≥3 years; 50% of detections were asymptomatic. Seven (50%) detections occurred at HCT onset and none received targeted C. difficile therapy. Sapovirus was detected nine times in four patients, with seven (78%) detections associated with AGE symptoms. Rotavirus was detected nine times, during five symptomatic episodes, in three patients. Adenovirus was detected four times in three patients and all were symptomatic. CONCLUSION: We longitudinally characterized the etiology of infectious AGE in children undergoing HCT. Despite the majority of patients meeting the definition for AGE, only half had a pathogen detected, suggesting that differentiating infectious vs. noninfectious AGE (e.g., medication induced) in this population is difficult. Although all subjects with adenovirus and most with sapovirus were symptomatic, asymptomatic C. difficile detection was common. Interestingly, norovirus was not detected. Further investigation of AGE is warranted in this population. DISCLOSURES: All authors: No reported disclosures.
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spelling pubmed-62534022018-11-28 1106. Infectious Etiologies of Acute Gastroenteritis in Children during the First 100 Days Post-Allogeneic Hematopoietic Cell Transplant Schuster, Jennifer Johnston, Samantha Piya, Bhinnata Dulek, Daniel Wikswo, Mary E Browne, Hannah Vinje, Jan Payne, Daniel C Azimi, Parvin H Selvarangan, Rangaraj Halasa, Natasha B Englund, Janet Open Forum Infect Dis Abstracts BACKGROUND: Acute gastroenteritis (AGE) is a frequent sequela in children undergoing hematopoietic cell transplant (HCT). Although rotavirus and norovirus have been implicated as important causes of AGE, the frequency of other pathogens is unknown. Little data exist on longitudinal prevalence of infectious AGE in HCT. METHODS: From February 2015 to May 2016, subjects <18 years undergoing allogeneic HCT were enrolled at four CDC-NVSN sites: Oakland, Kansas City, Seattle, and Nashville. Stool samples were collected at enrollment, weekly until discharge or day 100 (whichever occurred earliest), during re-admissions within the first 100 days, and day 100. AGE was defined as unexplained ≥3 episodes diarrhea and/or ≥1 episode vomiting/24 hours. Specimens were tested using Luminex xTAG Gastrointestinal Pathogen Panel (Austin, TX) and real-time PCR for adenovirus, astrovirus, norovirus, and sapovirus. RESULTS: Thirty-one patients were enrolled at four sites (Seattle: 13, Kansas City: 8, Oakland: 6, Nashville: (4) with median age 5 (IQR 3–10) years. Two hundred sixteen samples were obtained with median 7 samples/subject. During the first 100 days, 29 (94%) subjects met the AGE definition. Thirty-six single pathogen detections occurred in 16 (52%) subjects. Clostridium difficile was the most frequent pathogen (Figure 1), with 14 detections in nine patients, all ≥3 years; 50% of detections were asymptomatic. Seven (50%) detections occurred at HCT onset and none received targeted C. difficile therapy. Sapovirus was detected nine times in four patients, with seven (78%) detections associated with AGE symptoms. Rotavirus was detected nine times, during five symptomatic episodes, in three patients. Adenovirus was detected four times in three patients and all were symptomatic. CONCLUSION: We longitudinally characterized the etiology of infectious AGE in children undergoing HCT. Despite the majority of patients meeting the definition for AGE, only half had a pathogen detected, suggesting that differentiating infectious vs. noninfectious AGE (e.g., medication induced) in this population is difficult. Although all subjects with adenovirus and most with sapovirus were symptomatic, asymptomatic C. difficile detection was common. Interestingly, norovirus was not detected. Further investigation of AGE is warranted in this population. DISCLOSURES: All authors: No reported disclosures. Oxford University Press 2018-11-26 /pmc/articles/PMC6253402/ http://dx.doi.org/10.1093/ofid/ofy210.940 Text en © The Author(s) 2018. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Schuster, Jennifer
Johnston, Samantha
Piya, Bhinnata
Dulek, Daniel
Wikswo, Mary E
Browne, Hannah
Vinje, Jan
Payne, Daniel C
Azimi, Parvin H
Selvarangan, Rangaraj
Halasa, Natasha B
Englund, Janet
1106. Infectious Etiologies of Acute Gastroenteritis in Children during the First 100 Days Post-Allogeneic Hematopoietic Cell Transplant
title 1106. Infectious Etiologies of Acute Gastroenteritis in Children during the First 100 Days Post-Allogeneic Hematopoietic Cell Transplant
title_full 1106. Infectious Etiologies of Acute Gastroenteritis in Children during the First 100 Days Post-Allogeneic Hematopoietic Cell Transplant
title_fullStr 1106. Infectious Etiologies of Acute Gastroenteritis in Children during the First 100 Days Post-Allogeneic Hematopoietic Cell Transplant
title_full_unstemmed 1106. Infectious Etiologies of Acute Gastroenteritis in Children during the First 100 Days Post-Allogeneic Hematopoietic Cell Transplant
title_short 1106. Infectious Etiologies of Acute Gastroenteritis in Children during the First 100 Days Post-Allogeneic Hematopoietic Cell Transplant
title_sort 1106. infectious etiologies of acute gastroenteritis in children during the first 100 days post-allogeneic hematopoietic cell transplant
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6253402/
http://dx.doi.org/10.1093/ofid/ofy210.940
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