Infectious Gastroenteritis in Bone-Marrow-Transplant Recipients

We prospectively evaluated infections with several gastrointestinal pathogens in patients undergoing bone-marrow transplantation, in an attempt to correlate infection with morbidity and mortality. Thirty-one of 78 patients (40 per cent) were infected with one or more of the following enteric pathogens during the study: adenovirus (12 infections), rotavirus (nine), coxsackievirus (four), or Clostridium difficile (12). Several patients were infected with more than one pathogen. Infection correlated with the occurrence of diarrhea and abdominal cramps. The mortality rate among the infected patients was 55 per cent—significantly higher than the rate (13 per cent) among the noninfected patients (P<0.001). This study indicates that enteric pathogens that often cause mild diarrhea in normal populations can cause serious infections in marrow-transplant recipients. Measures aimed at preventing or treating such infections might reduce the morbidity and mortality associated with marrow transplantation. (N Engl J Med. 1982; 306: 1009–12.), BONE-MARROW transplantation is effective therapy in patients with severe aplastic anemia or acute leukemia. One of the major deterrents to successful marrow engraftment is the occurrence of infections during the period of extended granulocytopenia.¹,² Past studies have documented the susceptibility of marrow-transplant recipients to systemic bacterial infections and to infections with herpesviruses. However, the occurrence of infections with other groups of viruses has not been as well documented.^{3 4 5 6 7} The development of diarrhea in marrow-transplant recipients has been noted in previous studies. ⁸,⁹ In many cases, the cause of diarrhea has been attributed to noninfectious events, such as acute graft-versus-host disease, since.