Townsend TR, Bolyard EA, Yolken RH, Beschorner WE, Bishop (Johannes) CA, Burns WH, Santos GW, Saral R. Outbreak of coxsackie A1 gastroenteritis: a complication of bone-marrow transplantation. Lancet. 1982 Apr 10;1(8276):820-3.

In a three-week period 7 of 14 transplant recipients were infected with coxsackie A1 virus. Diarrhoea and mortality were significantly associated with infection (7 of 7 infected compared with 0 of 7 non-infected, and 6 of 7 infected compared with 1 of 7 non-infected, respectively). Early in the outbreak, the diarrhoea was presumed to be due to acute graft-versus-host disease (AGVHD). However, the distribution of AGVHD among infected and non-infected patients was nearly equal, and at necropsy 3 of 6 infected patients who had had diarrhoea showed no evidence of gastrointestinal involvement with AGVHD. Infection with viral enteric pathogens may be an important factor in the clinical course of transplant recipients.

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