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How dangerous are norovirus infections in patients with rheumatic diseases treated with biologics and DMARDs? Follow-up on a local outbreak and comparison with a control cohort
  1. Christoph Fiehn,
  2. Nikolaus Miehle
  1. ACURA Center for Rheumatic Diseases, Baden-Baden, Germany
  1. Correspondence to Professor Christoph Fiehn, ACURA Center for Rheumatic Diseases, Rotenbachtalstr. 5, Baden-Baden 76530, Germany; c.fiehn{at}

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Norovirus causes acute gastroenteritis and is highly contagious. In healthy individuals, the symptoms, which mostly are heavy vomiting and diarrhoea, resolve spontaneously after a couple of days. However, in transplantation medicine norovirus infections attained much attention currently, as it was found that immunocompromised transplant recipients are at risk of developing chronic norovirus infections.1 ,2 Although exact numbers are missing, the estimated rate for this complication is 17%–18% in children and adults after allogeneic haematopoietic stem cell or renal transplantation. These patients show prolonged diarrhoea, eventually with weight loss, and chronic norovirus shedding in the stool for up to years.3–7 The patients often have the need for nutritional support and even fatal outcomes were described.3 ,8 Immune recovery was associated with the eventual clearance of the virus in some patients.3 ,9 So far, no cases of …

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  • Contributors Both authors contributed by planning the study, data sampling and documentation. CF wrote the text of the manuscript.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics Committee, University of Heidelberg, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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