Risk groups for clinical complications of norovirus infections: an outbreak investigation
Risk groups for clinical complications of norovirus infections: an outbreak investigation
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DOI：
10.1111/j.1469-0691.2005.01299.x
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发表时间：
2006-01-01
影响因子：
14.2
通讯作者：
Koopmans, M
中科院分区：
文献类型：
--
作者：
Mattner, F;Sohr, D;Koopmans, M
诺如病毒感染被描述为持续时间较短的自限性疾病。对一所大学医院诺如病毒爆发的调查为患有多种基础疾病的患者提供了严重临床特征的证据。定义了诺如病毒感染的临床结果。使用多变量分析进行针对基础疾病和药物治疗的危险因素分析。在五个爆发病房中，有 84 名患者和 60 名护士被感染（患者总体感染率为 32%，护士总体感染率为 76%）。病原体是新变种格里姆斯比病毒。在肾移植患者中观察到严重的临床特征，包括急性肾功能衰竭、心律失常和急性移植器官排斥反应的体征，其中 7 名（8.3%）患者出现这种情况。在多变量分析中，心血管疾病（OR 17.1，95% CI 2.17-403）和肾移植（OR 13.0，95% CI 1.63-281）是血钾下降>20%的危险因素。年龄>65岁（OR 11.6，95% CI 1.89-224）是腹泻持续>2天的危险因素。免疫抑制（OR 5.7，95% Cl 1.78-20.1）是肌酐升高>10%的危险因素。患有心血管疾病、肾移植和免疫抑制治疗等基础疾病的患者感染诺如病毒可能会导致严重的后果，其典型症状是钾水平降低、C反应蛋白和肌酸磷酸激酶水平升高。对于老年人，诺如病毒感染可能会导致腹泻持续时间延长。因此，有风险的患者应尽早住院并经常监测。应尽早实施严格的预防措施，最大限度降低院内暴发风险。
Norovirus infections have been described as self-limiting diseases of short duration. An investigation of a norovirus outbreak in a university hospital provided evidence for severe clinical features in patients with several underlying diseases. Clinical outcomes of norovirus infection were defined. Risk-factor analysis targeting underlying diseases and medication was performed using multivariate analyses. In five outbreak wards, 84 patients and 60 nurses were infected (an overall attack rate of 32% in patients, and 76% in nurses). The causative agent was the new variant Grimsby virus. Severe clinical features, including acute renal failure, arrhythmia and signs of acute graft organ rejection in renal transplant patients, were observed in seven (8.3%) patients. In multivariate analyses, cardiovascular disease (OR 17.1, 95% CI 2.17-403) and renal transplant (OR 13.0, 95% CI 1.63-281) were risk-factors for a potassium decrease of >20%. Age >65 years (OR 11.6, 95% CI 1.89-224) was a risk-factor for diarrhoea lasting >2 days. Immunosuppression (OR 5.7, 95% Cl 1.78-20.1) was a risk-factor for a creatinine increase of >10%. Norovirus infections in patients with underlying conditions such as cardiovascular disease, renal transplant and immunosuppressive therapy may lead to severe consequences typified by decreased potassium levels, increased levels of C-reactive protein and creatine phosphokinase. In the elderly, norovirus infection may lead to an increased duration of diarrhoea. Therefore patients at risk should be hospitalised early and monitored frequently. Strict preventional measures should be implemented as early as possible to minimise the risk of nosocomial outbreaks.