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Nosocomial Norovirus Outbreak Associated with Persistent Norovirus Excretion in a Patient Receiving Corticosteroid Therapy

Naho NAGASAKI1), Hiroyuki TANAKA2), Koichi TOKUDA3), Hideki KAWAMURA4), Yuichi KODAMA4), Naoko IMUTA5) and Junichiro NISHI4)5)
1)Department of Medical Safety Management, Kagoshima Prefectural Satsunan Hospital, 2)Department of General Internal Medicine, Kagoshima Prefectural Satsunan Hospital, 3)Department of Infection Control, Tohoku University Hospital, 4)Department of Infection Control, Kagoshima University Hospital, 5)Department of Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences

Although chronic norovirus infection has been reported in immunocompromized patients receiving chemotherapy or undergoing transplantation, there have been few reports of nosocomial norovirus outbreaks associated with persistent norovirus excretion in a patient receiving corticosteroid therapy. In a medical ward with several patients receiving corticosteroid therapy, an outbreak of norovirus gastroenterocolitis was observed in four patients and one healthcare worker. Two of the four patients shared a room with an asymptomatic patient with idiopathic interstitial pneumonia who was receiving corticosteroid therapy and who had been admitted with norovirus infection 23 days ago. Norovirus sugar-chain-immobilized gold nanoparticle (SGNP) reverse-transcription (RT) quantitative PCR (qPCR) demonstrated the presence of infectious norovirus virions in the patient's stool 35 days after the onset of diarrhea. Thus, the patient was assumed to have excreted norovirus while sharing a room with the two patients who developed norovirus gastroenterocolitis; this suggested that the patient's prolonged excretion of norovirus triggered the outbreak. In addition, norovirus SGNP-RT-qPCR tests of other patients receiving corticosteroid therapy yielded positive results 10 days after the onset. Considering the course of this outbreak, a longer than usual isolation period may be required for norovirus gastroenterocolitis patients receiving corticosteroid therapy. Norovirus SGNP-RT-qPCR tests may be useful in determining the isolation period required for immunocompromised patients with norovirus gastroenterocolitis in the setting of high-risk wards for norovirus infection.

Key words:norovirus enterocolitis, outbreak, corticosteroid, real-time PCR, sugar-chain-immobilized gold nanoparticles


Received: September 9, 2019
Accepted: November 15, 2019

35 (1):63─68,2020

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