Treatment of rotavirus-associated diarrhea using enteral immunoglobulins for pediatric stem cell transplant patients

Abstract

Diarrhea is a common complication associated with allogeneic and autologous stem cell transplant patients. One potential cause of viral diarrhea is rotavirus gastroenteritis. This study represents a single-center experience of using multiple daily doses of enteral immunoglobulins in four pediatric hematopoietic stem cell transplant patients with confirmed rotavirus infections. Four courses of enteral immunoglobulin administration were included for analysis. Clinical characteristics recorded included duration of diarrhea symptoms, frequency of bowel movements, and consistency of stool. Four single courses of enteral immunoglobulins in four patients were included for analysis. Patient age range was from 10 months to 14 years. Three out of four courses observed displayed an improvement in diarrhea frequency and/or stool consistency. Median time from therapy initiation to symptom improvement was three days. At a median 22-month follow-up, one patient was diagnosed with gastrointestinal graft-versus-host disease. The time to rotavirus symptom resolution was decreased, compared to historical controls, and improvement in stool frequency and consistency was observed in three of four courses. One case of gastrointestinal graft-versus-host disease was observed after nearly two years of follow-up. Enteral administration of immunoglobulins may represent a valid clinical option for hematopoietic stem cell transplant patients with rotavirus diarrhea.