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Prevalence of human norovirus and Clostridium difficile coinfections in adult hospitalized patients

Authors Stokely JN, Niendorf S, Taube S, Hoehne M, Young VB, Rogers MAM, Wobus CE

Received 16 February 2016

Accepted for publication 13 April 2016

Published 28 June 2016 Volume 2016:8 Pages 253—260

DOI https://doi.org/10.2147/CLEP.S106495

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Professor Henrik Toft Sorensen

Janelle N Stokely,1 Sandra Niendorf,2 Stefan Taube,1 Marina Hoehne,2 Vincent B Young,1,3 Mary AM Rogers,4 Christiane E Wobus1

1Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI, USA; 2Department of Infectious Diseases, Consultant Laboratory for Noroviruses, Robert Koch Institute, Berlin, Germany; 3Department of Internal Medicine, Division of Infectious Diseases, 4Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

Objective: Human norovirus (HuNoV) and Clostridium difficile are common causes of infectious gastroenteritis in adults in the US. However, limited information is available regarding HuNoV and C. difficile coinfections. Our study was designed to evaluate the prevalence of HuNoV and C. difficile coinfections among adult patients in a hospital setting and disease symptomatology.
Study design and setting: For a cross-sectional analysis, 384 fecal samples were tested for the presence of C. difficile toxins from patients (n=290), whom the provider suspected of C. difficile infections. Subsequent testing was then performed for HuNoV genogroups I and II. Multinomial logistic regression was performed to determine symptoms more frequently associated with coinfections.
Results: The final cohort consisted of the following outcome groups: C. difficile (n=196), C. difficile + HuNoV coinfection (n=40), HuNoV only (n=12), and neither (n=136). Coinfected patients were more likely to develop nausea, gas, and abdominal pain and were more likely to seek treatment in the winter season compared with individuals not infected or infected with either pathogen alone.
Conclusion: Our study revealed that patients with coinfection are more likely to experience certain gastrointestinal symptoms, in particular abdominal pain, suggesting an increased severity of disease symptomatology in coinfected patients.

Keywords:
human norovirus, C. difficile, gastroenteritis, coinfection

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