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Rotavirus Infection in Pediatric Allogeneic Hematopoietic Cell Transplant Recipients: Clinical Course and Experience Using Nitazoxanide and Enterally Administered Immunoglobulins

Flerlage, Tim*; Hayden, Randall; Cross, Shane, J.; Dallas, Ronald*; Srinivasan, Ashok§; Tang, Li; Sun, Yilun; Maron, Gabriela*

The Pediatric Infectious Disease Journal: February 2018 - Volume 37 - Issue 2 - p 176–181
doi: 10.1097/INF.0000000000001740
Immunology Report

Background: Rotaviruses may produce prolonged and severe disease in allogeneic hematopoietic cell transplant (HCT) recipients. Nitazoxanide and enterally administered human immunoglobulins are potential therapeutic options. This retrospective study describes the clinical course of rotavirus infection in pediatric allogeneic HCT recipients and a single-center experience with nitazoxanide and oral immunoglobulins as potential treatment options.

Methods: We identified 36 patients who had positive stool rotavirus antigen assays after allogeneic HCT from May 30, 2012, to July 31, 2015. Clinical, microbiologic and treatment data were collected and analyzed using descriptive statistics.

Results: Forty-nine discrete episodes of rotavirus infection were identified among these 36 patients for a cumulative incidence of 19.7%. For these 49 episodes, the median day to infection after HCT was day 82, and the median duration of diarrhea was 17.5 days (range 4–122). Nitazoxanide and enteral immunoglobulins were prescribed for 41 episodes. The median duration of clinical symptoms after initiation of nitazoxanide was 11 days (range 2–85), 23 days (range 10–107) after enteral immunoglobulins and 26 days (range 6–90) after a combination of nitazoxanide and enteral immunoglobulins (P = 0.1). No adverse effects of either treatment were documented, but efficacy could not be assessed in this patient population.

Conclusions: In pediatric HCT recipients, the clinical illness produced by rotaviruses is prolonged compared with otherwise healthy children. Nitazoxanide appears safe, but its efficacy for this indication requires further study.

From the *Department of Infectious Diseases, Department of Pathology, Department of Pharmaceutical Sciences, §Department of Bone Marrow Transplantation and Cellular Therapy, and Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee.

Accepted for publication June 27, 2017.

Supported by the American Lebanese Syrian Associated Charities.

The authors have no conflicts of interest or funding to disclose.

Address for correspondence: Timothy Flerlage, MD, 262 Danny Thomas Place Mail Stop 320, Memphis, TN 38105. E-mail:

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