Astrovirus and norovirus infections and their association with diarrheal symptoms in immunocompromised children

Human astroviruses are a common cause of viral gastroenteritis and are often underdiagnosed. While infections are typically mild or asymptomatic in immunocompetent hosts, astrovirus can cause prolonged and severe disease in immunocompromised individuals. Here, we conducted a case-control study to evaluate the clinical presentation of astrovirus infections in pediatric oncology patients. Our findings were compared to two groups: (1) norovirus infections in the same immunocompromised cohort, and (2) a cohort of immunocompetent children with and without diarrheal symptoms. Astrovirus was detected in 9.8% of immunocompromised patients, with prolonged shedding seen in multiple cases. Astrovirus infection was associated with an increased odds of diarrhea, although this association weakened when adjusting for co-infections. In contrast, norovirus was not significantly associated with diarrhea in immunocompromised patients, despite prolonged shedding in 24% of the cohort. High rates of co-infection with adenovirus and Clostridium difficile may have influenced symptom patterns. In the immunocompetent cohort, astrovirus was not associated with diarrhea, while norovirus showed a strong association with symptoms. These findings indicate that astrovirus infections are more likely to cause diarrhea in immunocompromised pediatric patients, while often asymptomatic in immunocompetent children. Norovirus showed the opposite trend, highlighting distinct roles of host immune status in shaping clinical outcomes. These findings highlight the importance of considering astrovirus as a potential contributor to gastrointestinal symptoms in immunocompromised children and call for broader diagnostic testing and further research on viral co-infections and persistence.