[CIS PIDD] [cis-pidd] VS: Chronic norovirus enteritis in CVID

[Pere Soler Palacin]

Dear all, in a recent meeting S. Jolles proposed a therapeutic aproach with oral ribavirin plus IFN-gamma. Please consider contacting him for more information. 

P. 


----- Missatge original -----

De: "Nacho Gonzalez" <nachgonzalez at gmail.com> 
Per: "CIS-PIDD" <cis-pidd at lists.clinimmsoc.org> 
Enviats: Dijous, 17 de Juliol 2014 10:00:48 
Assumpte: Re: [cis-pidd] VS: Chronic norovirus enteritis in CVID 

Dear Mikko and Panida, 
I can only add one recent experience with oral ribavirin 2.5mg/kg every 12 h following advice from Great Ormord Judith Breuer( j.breuer at ucl.ac.uk ), they also use scalating doses with RBV through levels. After one month the patient cleared the infection (the underlying condition is severe T-cell deficiency). I think you should contact with them. 
Best regards, 
Luis Ignacio Gonzalez Granado 
Immunodeficiencies Unit 
Hematology and Oncology Unit. 
Hospital 12 octubre 
Madrid. Spain 

2014-07-17 8:20 GMT+02:00 Seppänen Mikko < Mikko.Seppanen at hus.fi > : 





Dear Sriaroon, 



We have thus far used enteral IgG (nasojejunal tube, see J Clin Virol, 2013, 58:306-8) to one patient. While it may be too early to judge, it does not seem promising and I have heard of failed similar attempts from other centers. 



We have altogether 3 CVID patients who would - truly desperately - need effective treatment (extremely severe enteropathy and malnutrition despite substitution, low troughs due to severe PLE, chronic noroviral enteritis), and I wonder if anyone has attempted combinations of the newer systemic antivirals? My guess is that somewhere someone is already studying this (and we would have 3 study subjects, and the rest of Finland more...). What we need is a multinational, multicenter effort? 



Sorry that I can be of no proper help, 



Mikko 





dos Mikko Seppänen, LKT 

Immuunipuutosv-o, HYKS 



Mikko Seppänen, MD, PhD, Associate professor/Senior Lecturer 

Specialist in Internal Medicine and Infectious Diseases 

Senior Consultant, Physician in charge (PIDD) 



Immunodeficiency Unit 

Division of Infectious Diseases 

Department of Medicine 

Helsinki University Central Hospital 

Hospital District of Helsinki and Uusimaa 

Aurora Hospital, Ward 4-2 and Outpatient Clinic 

P.O.Box 348 

FI-00029 HUS, Helsinki 

FINLAND 

phone +358 9 47175923 , fax +358 9 47175945 














Lähettäjä: Sriaroon, Panida [mailto: psriaroo at health.usf.edu ] 
Lähetetty: 17. heinäkuuta 2014 5:40 
Vastaanottaja: CIS-PIDD 
Aihe: [cis-pidd] Chronic norovirus enteritis in CVID 





Dear colleagues, 





We have a 15yo boy with CVID who presents with chronic norovirus enteritis for over 3 months now. He is on SCIG weekly with IgG level around 800s. Past history includes biopsy-proven GLILD treated with rituximab and Imuran a few years ago. He also has lymphopenia and low mitogen responses. 





Aside from enteritis, he is doing fine infection-wise. We check his stool every few weeks and he is still shedding the virus. We plan on increasing his SCIG dose to raise the IgG level. In the meantime, his diarrhea is still ongoing (5x or more/d) and he is now losing weight. 





I understand that the infection can persist for a prolonged period of time and was wondering if anyone has suggestion for the treatment for norovirus enteritis in CVID. There are several reports of oral Ig therapy given in divided doses for 1-2 days (extrapolated from treatment for rotavirus enteritis) with variable success, but most cases are s/p transplant or on immunosuppression. 





We plan on building a case and requesting an authorization for oral Ig use from his insurance--which might not be easy since it is not a proven therapy. 





Does anyone have any suggestions for the management of chronic norovirus infection in CVID? 





Best, 


Panida 





Panida Sriaroon, MD 

Assistant Professor 

Associate Director, Fellowship Program 

Associate Director, USF/All Children's Hospital Allergy/Immunology clinic 

Beeper 727.825.4379 

Office 727.553.3521 

E-mail:psriaroo at health.usf.edu 


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