Prevention, treatment of infectious diarrhea in pediatric transplant patients warrants improvement

MEMPHIS, Tenn. — Infectious diarrhea among pediatric solid organ transplant patients requires improved prevention, diagnostic and treatment methods as these patients have significant morbidity from routine gastrointestinal infections, according to data presented at the St. Jude/PIDS Pediatric Transplant ID Symposium.

“Diarrhea can lead to significant morbidity in solid organ transplant patients, including poor nutrition, weight loss, dehydration, acute kidney injury and difficulty maintaining target medication concentrations,” study researcher Claire Bocchini, MD, of Baylor College of Medicine, and colleagues wrote.

Researchers reviewed medical records during all of 2014 for pediatric heart and lung transplant patients who experienced diarrhea, defined as at least three stools daily for 7 days or at least three stools a day plus fever, weight loss or required hospitalization.

Fifteen transplant patients experienced diarrhea; 14 received heart transplants, and one received a lung transplant.

Viral pathogens identified by PCR testing included norovirus (n = 2), adenovirus and cytomegalovirus. Four patients had Clostridium difficile, one had a Shiga toxin-producing organism, and another had cryptosporidium.

Thirty-three percent of patients required hospitalization, while 93% needed adjustments to immunosuppression medication.

One patient experienced six bouts of C. difficile diarrhea, which was responsive to antibiotics. Ultimately the patient received a fecal microbiome transplant and did well, but relapsed after receiving amoxicillin for sinusitis. The patient received a second fecal microbiome transplant and is doing well, according to the researchers.

Another patient experienced refractory cryptosporidium for 3 months, despite receiving Alinia (nitazoxanide, Romark Laboratories). After a 12-week course of a nitazoxanide, azithromycin and paromomycin, the patient improved.

“Our understanding of infectious causes of diarrhea in pediatric SOT patients is changing with the use of improved diagnostic techniques,” the investigators wrote. “SOT patients have significant morbidity from routine gastrointestinal infections, and therefore efforts to improve prevention, early diagnosis and treatment should be pursued.”

Reference:

Bocchini C, et al. Abstract T1504. Presented at: St. Jude/PIDS Pediatric Infectious Diseases Research Conference; Feb. 20-21, 2015; Memphis, Tennessee.

Disclosure: Infectious Diseases in Children was unable to confirm financial disclosures at the time of publication.