Intest Res.  2018 Jan;16(1):142-146. 10.5217/ir.2018.16.1.142.

Fecal microbiota transplantation for recurrent Clostridium difficile infection in a patient with ulcerative colitis

• Nanki K
• Mizuno S
• Matsuoka K
• Ono K
• Sugimoto S
• Kiyohara H
• Arai M
• Nakashima
• Takeshita
• Saigusa K
• Senoh M
• Fukuda T
• Naganuma M
• Kato H
• Suda W
• Hattori M
• Kanai T

• KMID: 2402658
• DOI: http://doi.org/10.5217/ir.2018.16.1.142

Abstract

Fecal microbiota transplantation (FMT) has been reported as a safe and effective therapy in patients with refractory and recurrent Clostridium difficile infection (CDI). FMT has also been reported as a promising therapy in patients with ulcerative colitis (UC). Both, CDI and UC, are believed to be caused by dysbiosis, such as altered compositions or decreased diversity of the intestinal microbiota. This report describes a patient with UC in remission with a second recurrent episode of CDI, who was treated with FMT. A single FMT performed via colonoscopy completely resolved the patient's diarrhea and eradicated C. difficile bacteriologically without any severe complications. Molecular biological analysis of the patient's fecal microbiota showed that FMT could dramatically change the altered composition of intestinal microbiota and restore its diversity. Despite the restoration of the intestinal microbiota, FMT could not prevent a relapse of UC in this patient. However, it improved the intestinal symptoms of CDI and could prevent further recurrences of CDI.

Keyword

Fecal microbiota transplantation; Clostridium difficile; Colitis, ulcerative

MeSH Terms

Clostridium difficile*
Clostridium*
Colitis, Ulcerative*
Colonoscopy
Diarrhea
Dysbiosis
Fecal Microbiota Transplantation*
Gastrointestinal Microbiome
Humans
Microbiota
Recurrence
Ulcer*

Figure

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  Fig. 1 Colonoscopic images before fecal microbiota transplantation. (A) Descending A B colon and (B) sigmoid colon.

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  Fig. 2 The clinical course of the patient. C. difficile, Clostridium difficile; FMT, fecal microbiota transplantation.

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  Fig. 3 PCR ribotyping patterns of Clostridium difficile isolated from the present patient and 4 ribotype strains (toxin A-positive, toxin B-positive, and binary toxin-negative) endemic in Japan. Lane M, molecular size marker (100 bp ladder); lane 1, C. difficile isolated from the present patient; lane 2, PCR-ribotype 001; lane 3, PCR-ribotype 002; lane 4, PCR-ribotype 014; lane 5, PCR-ribotype 018.

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  Fig. 4 Composition and diversity of the gut microbiome. (A) Phylum level taxonomic profiles of the donor and recipient, before and at 1, 2, 4, 8, and 12 weeks after fecal microbiota transplantation (FMT). (B) Microbiota diversity (Shannon index, circle) and total number of operational taxonomic unit (OTUs, bar) of the donor and recipient, before and at 1, 2, 4, 8, and 12 weeks after FMT.

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