P4383 - Clinical Outcomes of Hospitalized Patients With Inflammatory Bowel Disease Who Test Positive for Norovirus During Admission

Meredith Kline, MD¹, Evan N. Fear, BA², Alex J. Mathew, MA³, Sriya Muralidharan, MD², David T.. Rubin, MD, FACG^2
1University of Chicago Medicine, Chicago, IL; ²University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL; ³University of Chicago Medicine, Philadelphia, PA

Introduction: Patients with inflammatory bowel disease (IBD) are hospitalized due to medically resistant disease or complications such as infection. Patients with IBD are particularly vulnerable to infection due to compromised immune systems from the disease itself or immune-altering medications. Norovirus (NoV), a highly contagious virus, can exacerbate symptoms of IBD. Here we present the clinical outcomes of 15 patients with IBD who tested positive for NoV during hospitalization.

Methods: We retrospectively reviewed the cases of 15 patients with IBD (5 Crohn’s Disease (CD), 10 Ulcerative Colitis (UC)) who tested positive for NoV during hospitalization at our quaternary institution between February 2022 and March 2024. Disease characteristics, prior IBD therapy, reason for admission, management while admitted, Nitazoxanide administration, and complications were assessed.

Results: Among the patients with CD, none were in their first year of diagnosis. Three of the five had concomitant bacterial infections requiring antibiotics including C difficile, Campylobacter, and one with an intra-abdominal abscess. The two patients with CD without bacterial infections were treated with Nitazoxanide; one due to concern for tertiary adrenal insufficiency.

All patients with UC had pan-colonic disease. Two had prior colectomies. Three of the eight patients with a colon on presentation underwent colectomy during hospitalization, including the only two who received Nitazoxanide. The average length of stay was 7 days for CD and 11.2 days for UC.

Discussion: This review highlights the importance of considering NoV in hospitalized patients with active IBD. The clinical outcomes varied between CD and UC, though NoV appeared to exacerbate symptoms in all cases.

CD patients had longer disease duration at NoV diagnosis suggesting prolonged immunosuppression may increase susceptibility to diarrheal infections. The development of bacterial infections in CD patients suggests the importance of considering multi-organism infections. Patients with UC with NoV had longer hospital stays compared with CD patients and higher colectomy rates, indicating more severe disease exacerbated and hastened by NoV. Evidence of other causes of infectious diarrhea in some UC patients highlights the complexity of managing symptoms in this population and the importance of comprehensive diagnostic evaluation.

Further investigation into NoV infections in patients with IBD is needed, including comparing outcomes in outpatients and those without IBD.


Disclosures:


Meredith Kline, MD¹, Evan N. Fear, BA², Alex J. Mathew, MA³, Sriya Muralidharan, MD², David T.. Rubin, MD, FACG². P4383 - Clinical Outcomes of Hospitalized Patients With Inflammatory Bowel Disease Who Test Positive for Norovirus During Admission, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.