Etiology and outcome of diarrhea after marrow transplantation: A prospective study

George J. Cox, Suzanne M. Matsui, Roger S. Lo, Mary Hinds, Raleigh A. Bowden, Robert C. Hackman, Walter G. Meyer, Motomi (Tomi) Mori, Phillip I. Tarr, Lyndon S. Oshiro, Juan E. Ludert, Joel D. Meyers, George B. McDonald

Research output: Contribution to journalArticle

222 Citations (Scopus)

Abstract

Background/Aims: Acute diarrhea after marrow transplant is usually ascribed to acute graft-vs.-host disease (GVHD) or infection, with a reported 40%-50% incidence of infection. The aim of this study was to determine the incidence of acute diarrhea after transplantation, its causes, and its outcome. Methods: Two hundred ninety-six patients were followed up; patients with diarrhea were studied using standard evaluation of stool plus immunoelectron microscopy; assays for astrovirus, picobirnavirus, and Norwalk virus; and geneprobe methods for toxin-producing Escherichia coli. In 38 patients with diarrhea, intestinal biopsy specimens and duodenal fluid were also analyzed. Results: One hundred fifty acute diarrheal episodes developed in 126 patients (an incidence of 43%). Intestinal infection was found in 20 of 150 episodes: viruses (astrovirus, adenovirus, cytomegalovirus, and rotavirus) in 12 patients, nosocomially acquired bacteria (Clostridium difficile and Aeromonas) in 7 patients, and mixed infection in 1 patient. Acute GVHD was responsible for 72 of 150 episodes (48%). Clinical signs and symptoms of infection and GVHD were similar. In 58 of 150 episodes (39%), no clear etiology could be found for self-limited diarrhea. Conclusions: Intestinal infection accounted for 13% and acute GVHD for 48% of diarrheal episodes. The most common infecting organisms were astrovirus, C. difficile, and adenovirus. Most cases of diarrhea after marrow transplant are not caused by infection.

Original languageEnglish (US)
Pages (from-to)1398-1407
Number of pages10
JournalGastroenterology
Volume107
Issue number5
DOIs
StatePublished - 1994
Externally publishedYes

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Diarrhea
Transplantation
Bone Marrow
Prospective Studies
Adenoviridae
Rotavirus
Infection
Cytomegalovirus
Clostridium difficile
Transplants
Picobirnavirus
Incidence
Norwalk virus
Aeromonas
Immunoelectron Microscopy
Coinfection
Signs and Symptoms
Escherichia coli
Viruses
Bacteria

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Cox, G. J., Matsui, S. M., Lo, R. S., Hinds, M., Bowden, R. A., Hackman, R. C., ... McDonald, G. B. (1994). Etiology and outcome of diarrhea after marrow transplantation: A prospective study. Gastroenterology, 107(5), 1398-1407. https://doi.org/10.1016/0016-5085(94)90542-8

Etiology and outcome of diarrhea after marrow transplantation : A prospective study. / Cox, George J.; Matsui, Suzanne M.; Lo, Roger S.; Hinds, Mary; Bowden, Raleigh A.; Hackman, Robert C.; Meyer, Walter G.; Mori, Motomi (Tomi); Tarr, Phillip I.; Oshiro, Lyndon S.; Ludert, Juan E.; Meyers, Joel D.; McDonald, George B.

In: Gastroenterology, Vol. 107, No. 5, 1994, p. 1398-1407.

Research output: Contribution to journalArticle

Cox, GJ, Matsui, SM, Lo, RS, Hinds, M, Bowden, RA, Hackman, RC, Meyer, WG, Mori, MT, Tarr, PI, Oshiro, LS, Ludert, JE, Meyers, JD & McDonald, GB 1994, 'Etiology and outcome of diarrhea after marrow transplantation: A prospective study', Gastroenterology, vol. 107, no. 5, pp. 1398-1407. https://doi.org/10.1016/0016-5085(94)90542-8
Cox, George J. ; Matsui, Suzanne M. ; Lo, Roger S. ; Hinds, Mary ; Bowden, Raleigh A. ; Hackman, Robert C. ; Meyer, Walter G. ; Mori, Motomi (Tomi) ; Tarr, Phillip I. ; Oshiro, Lyndon S. ; Ludert, Juan E. ; Meyers, Joel D. ; McDonald, George B. / Etiology and outcome of diarrhea after marrow transplantation : A prospective study. In: Gastroenterology. 1994 ; Vol. 107, No. 5. pp. 1398-1407.
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title = "Etiology and outcome of diarrhea after marrow transplantation: A prospective study",
abstract = "Background/Aims: Acute diarrhea after marrow transplant is usually ascribed to acute graft-vs.-host disease (GVHD) or infection, with a reported 40{\%}-50{\%} incidence of infection. The aim of this study was to determine the incidence of acute diarrhea after transplantation, its causes, and its outcome. Methods: Two hundred ninety-six patients were followed up; patients with diarrhea were studied using standard evaluation of stool plus immunoelectron microscopy; assays for astrovirus, picobirnavirus, and Norwalk virus; and geneprobe methods for toxin-producing Escherichia coli. In 38 patients with diarrhea, intestinal biopsy specimens and duodenal fluid were also analyzed. Results: One hundred fifty acute diarrheal episodes developed in 126 patients (an incidence of 43{\%}). Intestinal infection was found in 20 of 150 episodes: viruses (astrovirus, adenovirus, cytomegalovirus, and rotavirus) in 12 patients, nosocomially acquired bacteria (Clostridium difficile and Aeromonas) in 7 patients, and mixed infection in 1 patient. Acute GVHD was responsible for 72 of 150 episodes (48{\%}). Clinical signs and symptoms of infection and GVHD were similar. In 58 of 150 episodes (39{\%}), no clear etiology could be found for self-limited diarrhea. Conclusions: Intestinal infection accounted for 13{\%} and acute GVHD for 48{\%} of diarrheal episodes. The most common infecting organisms were astrovirus, C. difficile, and adenovirus. Most cases of diarrhea after marrow transplant are not caused by infection.",
author = "Cox, {George J.} and Matsui, {Suzanne M.} and Lo, {Roger S.} and Mary Hinds and Bowden, {Raleigh A.} and Hackman, {Robert C.} and Meyer, {Walter G.} and Mori, {Motomi (Tomi)} and Tarr, {Phillip I.} and Oshiro, {Lyndon S.} and Ludert, {Juan E.} and Meyers, {Joel D.} and McDonald, {George B.}",
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T1 - Etiology and outcome of diarrhea after marrow transplantation

T2 - A prospective study

AU - Cox, George J.

AU - Matsui, Suzanne M.

AU - Lo, Roger S.

AU - Hinds, Mary

AU - Bowden, Raleigh A.

AU - Hackman, Robert C.

AU - Meyer, Walter G.

AU - Mori, Motomi (Tomi)

AU - Tarr, Phillip I.

AU - Oshiro, Lyndon S.

AU - Ludert, Juan E.

AU - Meyers, Joel D.

AU - McDonald, George B.

PY - 1994

Y1 - 1994

N2 - Background/Aims: Acute diarrhea after marrow transplant is usually ascribed to acute graft-vs.-host disease (GVHD) or infection, with a reported 40%-50% incidence of infection. The aim of this study was to determine the incidence of acute diarrhea after transplantation, its causes, and its outcome. Methods: Two hundred ninety-six patients were followed up; patients with diarrhea were studied using standard evaluation of stool plus immunoelectron microscopy; assays for astrovirus, picobirnavirus, and Norwalk virus; and geneprobe methods for toxin-producing Escherichia coli. In 38 patients with diarrhea, intestinal biopsy specimens and duodenal fluid were also analyzed. Results: One hundred fifty acute diarrheal episodes developed in 126 patients (an incidence of 43%). Intestinal infection was found in 20 of 150 episodes: viruses (astrovirus, adenovirus, cytomegalovirus, and rotavirus) in 12 patients, nosocomially acquired bacteria (Clostridium difficile and Aeromonas) in 7 patients, and mixed infection in 1 patient. Acute GVHD was responsible for 72 of 150 episodes (48%). Clinical signs and symptoms of infection and GVHD were similar. In 58 of 150 episodes (39%), no clear etiology could be found for self-limited diarrhea. Conclusions: Intestinal infection accounted for 13% and acute GVHD for 48% of diarrheal episodes. The most common infecting organisms were astrovirus, C. difficile, and adenovirus. Most cases of diarrhea after marrow transplant are not caused by infection.

AB - Background/Aims: Acute diarrhea after marrow transplant is usually ascribed to acute graft-vs.-host disease (GVHD) or infection, with a reported 40%-50% incidence of infection. The aim of this study was to determine the incidence of acute diarrhea after transplantation, its causes, and its outcome. Methods: Two hundred ninety-six patients were followed up; patients with diarrhea were studied using standard evaluation of stool plus immunoelectron microscopy; assays for astrovirus, picobirnavirus, and Norwalk virus; and geneprobe methods for toxin-producing Escherichia coli. In 38 patients with diarrhea, intestinal biopsy specimens and duodenal fluid were also analyzed. Results: One hundred fifty acute diarrheal episodes developed in 126 patients (an incidence of 43%). Intestinal infection was found in 20 of 150 episodes: viruses (astrovirus, adenovirus, cytomegalovirus, and rotavirus) in 12 patients, nosocomially acquired bacteria (Clostridium difficile and Aeromonas) in 7 patients, and mixed infection in 1 patient. Acute GVHD was responsible for 72 of 150 episodes (48%). Clinical signs and symptoms of infection and GVHD were similar. In 58 of 150 episodes (39%), no clear etiology could be found for self-limited diarrhea. Conclusions: Intestinal infection accounted for 13% and acute GVHD for 48% of diarrheal episodes. The most common infecting organisms were astrovirus, C. difficile, and adenovirus. Most cases of diarrhea after marrow transplant are not caused by infection.

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