Der Gastroenterologe

, Volume 9, Issue 4, pp 360–365

Norovirus-Gastroenteritis

Schwerpunkt
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Zusammenfassung

Die meisten akuten Gastroenteritiden sind viral. Bei Kindern sind virale Gastroenteritiden häufig durch Rotaviren verursacht. Bei Erwachsenen sind Noroviren sowohl in sporadischen Fällen als auch bei Ausbrüchen führend. Noroviren sind regelmäßig für Epidemien in Krankenhäusern und Pflegeeinrichtungen verantwortlich. Die Klinik ist typisch mit akuten Brechdurchfällen als Hauptsymptom. Immunsupprimierte Patienten präsentieren sich oft mit atypischen Symptomen wie chronischer Diarrhö, Gewichtsverlust oder Mangelernährung. Goldstandard zur Diagnostik sind PCR-basierte Methoden, aufgrund der typischen Klinik ist eine Diagnostik jedoch oft nicht indiziert. Noroviren werden durch Stuhl und Erbrochenes ausgeschieden und sind hochkontagiös. Bereits 10–100 Viruspartikel können zur Ansteckung führen. Die Viruskonzentration im Stuhl ist mit > 106 Viruspartikel/ml extrem hoch. Verdachtsfälle sollten direkt isoliert werden. Die krankenhaushygienischen Maßnahmen beinhalten eine konsequente Händehygiene mit virusaktiven Desinfektionsmitteln, die Kontaktisolation und bei Erbrechen die Tröpfchenisolation. Die Therapie ist symptomatisch; für immunsupprimierte Patienten sollte bei schweren Verläufen eine Reduktion der immunsuppressiven Therapie erwogen werden.

Schlüsselwörter

Virale Gastroenteritis Noroviren Ausbrüche Infektionskontrolle Krankenhaushygienische Maßnahmen 

Norovirus gastroenteritis

Abstract

Viruses are the leading cause of acute gastroenteritis. In adults, noroviruses are the most common cause of gastroenteritis in sporadic cases and also in outbreaks whereas rotaviruses account for the majority of cases of viral gastroenteritis in childhood. Noroviruses are frequently associated with outbreaks in hospitals and nursing homes. The clinical manifestations of gastroenteritis include diarrhea and vomiting as the main symptoms. In immunocompromised patients clinical manifestations may be atypical, such as chronic diarrhea, weight loss and malnutrition. Nucleic acid based PCR tests are the mainstay of diagnosis; however, because of the characteristic clinical symptoms, specific viral diagnosis is usually not required. Noroviruses appear to be readily transmissible at relatively low doses, with an infectious dose even as low as 10–100 viruses and viral shedding can occur at extremely high levels up to > 106 viruses/ml. Patients with symptoms consistent with norovirus gastroenteritis are placed on contact precautions or droplet precautions in case of vomiting. Hand hygiene is the most important means of preventing the spread of infection. Disinfectants with efficacy against noroviruses must be used. Norovirus gastroenteritis is usually self-limiting and is treated with supportive measures. In immunocompromised patients a reduction of immunosuppressive therapy should be considered in severe cases.

Keywords

Gastroenteritis Norovirus Outbreaks Infection control Hospital hygiene 

Literatur

  1. 1.
    Kapikian AZ et al (1972) Visualization by immune electron microscopy of a 27-nm particle associated with acute infectious nonbacterial gastroenteritis. J Virol 10: 1075–1081PubMedCentralPubMedGoogle Scholar
  2. 2.
    Guerrant RL et al (2001) Practice guidelines for the management of infectious diarrhea. Clin Infect Dis 32: 331–351PubMedCrossRefGoogle Scholar
  3. 3.
    Kempe A et al (2009) Adoption of rotavirus vaccination by pediatricians and family medicine physicians in the United States. Pediatrics 124: e809–e816PubMedCrossRefGoogle Scholar
  4. 4.
    Blacklow NR, Greenberg HB (1991) Viral gastroenteritis. N Engl J Med 325: 252–264PubMedCrossRefGoogle Scholar
  5. 5.
    Parashar UD, Glass RI (2009) Rotavirus vaccines – early success, remaining questions. N Engl J Med 360: 1063–1065PubMedCrossRefGoogle Scholar
  6. 6.
    Echeverria P et al (1983) Rotavirus as a cause of severe gastroenteritis in adults. J Clin Microbiol 18: 663–667PubMedCentralPubMedGoogle Scholar
  7. 7.
    Pang XL, Vesikari T (1999) Human astrovirus-associated gastroenteritis in children under 2 years of age followed prospectively during a rotavirus vaccine trial. Acta Paediatr 88: 532–536PubMedCrossRefGoogle Scholar
  8. 8.
    Kotloff KL et al (1989) Enteric adenovirus infection and childhood diarrhea: an epidemiologic study in three clinical settings. Pediatrics 84: 219–225PubMedGoogle Scholar
  9. 9.
    Rockx B et al (2002) Natural history of human calicivirus infection: a prospective cohort study. Clin Infect Dis 35: 246–253PubMedCrossRefGoogle Scholar
  10. 10.
    Patel MM et al (2008) Systematic literature review of role of noroviruses in sporadic gastroenteritis. Emerg Infect Dis 14: 1224–1231PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Widdowson MA, Monroe SS, Glass RI (2005) Are noroviruses emerging? Emerg Infect Dis 11: 735–737PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Hall AJ et al (2013) Norovirus disease in the United States. Emerg Infect Dis 19: 1198–1205PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Ahmed SM, Lopman BA, Levy K (2013) A systematic review and meta-analysis of the global seasonality of norovirus. PLoS One 8: e75922PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Ambert-Balay K et al (2005) Characterization of new recombinant noroviruses. J Clin Microbiol 43: 5179–5186PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Ko G et al (2005) Noroviruses as a cause of traveler’s diarrhea among students from the United States visiting Mexico. J Clin Microbiol 43: 6126–6129PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Dolin R (2007) Noroviruses – challenges to control. N Engl J Med 357: 1072–1073PubMedCrossRefGoogle Scholar
  17. 17.
    Desai R et al (2012) Severe outcomes are associated with genogroup 2 genotype 4 norovirus outbreaks: a systematic literature review. Clin Infect Dis 55: 189–193PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Tan M, Jiang X (2005) Norovirus and its histo-blood group antigen receptors: an answer to a historical puzzle. Trends Microbiol 13: 285–293PubMedCrossRefGoogle Scholar
  19. 19.
    Porter CK et al (2012) Postinfectious gastrointestinal disorders following norovirus outbreaks. Clin Infect Dis 55: 915–922PubMedCrossRefGoogle Scholar
  20. 20.
    Turcios RM et al (2006) Reevaluation of epidemiological criteria for identifying outbreaks of acute gastroenteritis due to norovirus: United States, 1998–2000. Clin Infect Dis 42: 964–969PubMedCrossRefGoogle Scholar
  21. 21.
    Battaglioli G et al (2012) Evaluation of the RIDAQuick norovirus immunochromatographic test kit. J Clin Virol 53: 262–264PubMedCrossRefGoogle Scholar
  22. 22.
    Kampf G, Grotheer D, Steinmann J (2005) Efficacy of three ethanol-based hand rubs against feline calicivirus, a surrogate virus for norovirus. J Hosp Infect 60: 144–149PubMedCrossRefGoogle Scholar
  23. 23.
    Gehrke C, Steinmann J, Goroncy-Bermes P (2004) Inactivation of feline calicivirus, a surrogate of norovirus (formerly Norwalk-like viruses), by different types of alcohol in vitro and in vivo. J Hosp Infect 56: 49–55PubMedCrossRefGoogle Scholar
  24. 24.
    Robert Koch-Institut (2013) http://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Desinfektionsmittel/Desinfektionsmittelliste/Google Scholar
  25. 25.
    Bok K, Green KY (2012) Norovirus gastroenteritis in immunocompromised patients. N Engl J Med 367: 2126–2132PubMedCrossRefGoogle Scholar
  26. 26.
    Schwartz S et al (2011) Norovirus gastroenteritis causes severe and lethal complications after chemotherapy and hematopoietic stem cell transplantation. Blood 117: 5850–5856PubMedCrossRefGoogle Scholar
  27. 27.
    Schorn R et al (2010) Chronic norovirus infection after kidney transplantation: molecular evidence for immune-driven viral evolution. Clin Infect Dis 51: 307–314PubMedCrossRefGoogle Scholar
  28. 28.
    Roos-Weil D et al (2011) Impact of norovirus/sapovirus-related diarrhea in renal transplant recipients hospitalized for diarrhea. Transplantation 92: 61–69PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Klinik für Infektionskrankheiten und SpitalhygieneUniversitätsSpital ZürichZürichSchweiz

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