Norovirus Stool Loads in Cancer Patients With Norovirus Gastroenteritis
Bibliographic record
Abstract
Background. Norovirus (NoV) infections are associated with substantial morbidity in immunocompromised patients. The relationship between stool norovirus viral loads (VLs) on immediate and long-term complications of NoV gastroenteritis in cancer patients has not been previously examined. We developed a real-time quantitative polymerase chain reaction (NoV-qPCR) assay to determine NoV genogroup GI and GII VL in stool. The VL at the time of diagnosis was determined and correlated with clinical characteristics as well as outcomes associated with NoV gastroenteritis patients with cancer. Methods. From March 2014 until January 2016, NoV PCR-positive stool specimens as determined by the Luminex xTAG Gastrointestinal Pathogen Panel (GPP) were included and subsequently tested by the NoV-qPCR assay. Each specimen was tested in duplicate, and geometric mean copies per gram of stool (GMC) were calculated. Electronic medical records were reviewed to extract relevant information on clinical severity of NoV infections based on modified Vesikari scores (MVS). Results. During the 23-month study period, 6918 stool specimens were submitted for testing by GPP. A total of 234 specimens (3.4%) from 154 patients were positive for NoV (GI, 33; GII, 201). The NoV-GII GMC ± standard deviation was 5.35 ± 1.59, which was significantly higher than that of NV-GI (3.94 ± 1.57, odds ratio [OR] = 7.87, p = 0.001). Based on the MVS criteria, 210 episodes were divided into mild (n = 122, GMC = 4.28 ± 1.49), moderate (n = 33, GMC = 5.55 ± 1.32), and severe (n = 55, GMC = 6.66 ± 0.86) clinical severity groups, respectively. In univariate analysis, higher stool NoVs were associated with GII infections, longer diarrhea duration, and more diarrhea frequency, longer vomiting duration, and more vomiting frequency, higher fever, as well as more total parenteral nutrition and deeper dehydration. In multivariate analysis, higher stool NoV VL at the time of diagnosis correlated with GII infections (OR = 3.25, 95% confidence interval [CI] = 1.18–8.97, P = 0.023) and predicted clinical severity (OR = 6.56, 95% CI = 2.35–18.36, P = 0.001). Conclusion. Norovirus GII infections are associated with a higher VL compared with GI. Regardless of infecting NoV genogroup, higher VL at diagnosis is associated with severe clinical disease and poor outcome. This quantification method may have utility for clinical monitoring. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".