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

Gastroenterology. 1994 Nov;107(5):1398-407. doi: 10.1016/0016-5085(94)90542-8.

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 gene-probe 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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adenovirus Infections, Human / complications
  • Adult
  • Bacterial Infections / complications
  • Bone Marrow Transplantation*
  • Chi-Square Distribution
  • Diarrhea / epidemiology
  • Diarrhea / etiology*
  • Female
  • Follow-Up Studies
  • Graft vs Host Disease / complications
  • Humans
  • Incidence
  • Male
  • Mamastrovirus
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Virus Diseases / complications