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I'm Concerned About My Adult Son - He Is 35
Posted on
Wed, 19 Jun 2019
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Wed, 19 Jun 2019
Answered on
Last reviewed on
Question : I'm concerned about my adult son - he is 35 years old - he had a heart transplant 17 years ago and has had much success with it - very little rejection and/or symptoms related to the transplant. In the past month, he has had severe diarrhea, vomiting, chills and a fever. He went to the hospital (ER) a month ago during the first one - he was dehydrated - sent him home with some meds, explaining it was a virus. Then it happened again last Tuesday (lasted 24 hours); and now again yesterday - no fever this time..... Could this be viruses three times in a 4 week span? Consider he has a suppressed immune system, I am concerned. Thank you.
Just to clarify - the bouts only last 24 hours; then he is fine again, and then it returns. In between times, he is working, able to eat normally, and function fully, etc. thanks
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
I passed carefully through your son's medical history and would like to explain that when in front of a relapsing diarrhea in a transplanted individuals we should consider several causes as follows:
1) immunosuppressive drugs (like Mycophenolate Mofetil, Tacrolimus, mammalian Target of Rapammycin inhibitors (mRORi), etc.)
2) several infections identified in up to 70% of cases with molecular techniques such as:
- bacterial infections (clostridium difficile, Campylobacter, Escherichia coli, etc. as well as
- viral infections (cytomegalovirus, adenovirus infection, rotavirus, norovirus (single positive strand RNA virus) emerging as the leading cause of acute gastroenteritis
in immunocompetent individuals and chronic diarrhea in immunocompromised patients), etc.
- fungal an parasitic infections (microsporidia, cryptosporidia, etc.)
So, it is necessary to diagnose correctly the diarrhea cause in order to properly treat and prevent it.
The microbiological molecular techniques (PCR, etc. to identify the pathogen genome or several antigens, etc.) make it possible for an exact diagnosis.
I recommend discussing with a transplant specialist on the above mentioned issues to guide through a careful differential diagnosis process.
Hope to have been helpful to you!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on - Ask a Doctor - service!
I passed carefully through your son's medical history and would like to explain that when in front of a relapsing diarrhea in a transplanted individuals we should consider several causes as follows:
1) immunosuppressive drugs (like Mycophenolate Mofetil, Tacrolimus, mammalian Target of Rapammycin inhibitors (mRORi), etc.)
2) several infections identified in up to 70% of cases with molecular techniques such as:
- bacterial infections (clostridium difficile, Campylobacter, Escherichia coli, etc. as well as
- viral infections (cytomegalovirus, adenovirus infection, rotavirus, norovirus (single positive strand RNA virus) emerging as the leading cause of acute gastroenteritis
in immunocompetent individuals and chronic diarrhea in immunocompromised patients), etc.
- fungal an parasitic infections (microsporidia, cryptosporidia, etc.)
So, it is necessary to diagnose correctly the diarrhea cause in order to properly treat and prevent it.
The microbiological molecular techniques (PCR, etc. to identify the pathogen genome or several antigens, etc.) make it possible for an exact diagnosis.
I recommend discussing with a transplant specialist on the above mentioned issues to guide through a careful differential diagnosis process.
Hope to have been helpful to you!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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