Chronic norovirus infections in cardiac transplant patients: Considerations for evaluation and management

Paul T. Jurgens, Larry A. Allen, Amrut V. Ambardekar, Colleen K. McIlvennan

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Norovirus is a common self-limiting gastrointestinal infection, but in transplant recipients, symptoms can last for months and result in serious health complications. As there is currently no established treatment for chronic norovirus infection in transplant patients, management has been directed at symptom control, trial of various antivirals, and ultimately reductions in immunosuppression. We present 3 cases of chronic norovirus infection in cardiac transplant patients to illustrate various approaches to diagnosis, the prolonged nature of disease symptoms, and treatment options. When managing a transplant recipient with chronic diarrhea, considering a broad differential as well as maintaining a high suspicion for infectious etiologies is key. A stepwise approach to management includes termination of diarrhea-causing medications, trials of nitazoxanide and immunoglobulin, and reductions in immunosuppressive therapies. Although brief discontinuation of immunosuppression is often required to achieve symptom, graft rejection is often a complication.

Original languageEnglish (US)
Pages (from-to)69-72
Number of pages4
JournalProgress in Transplantation
Issue number1
StatePublished - Mar 2017
Externally publishedYes

Bibliographical note

Funding Information:
Allen is funded by K23HL105896 from National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health (NIH).

Publisher Copyright:
© 2016, NATCO. All rights reserved.


  • Chronic diarrhea
  • Immunosuppression
  • Norovirus infection
  • Orthotopic heart transplant


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