Fecal Transplant for Treatment of Toxic Megacolon Associated With Clostridium Difficile Colitis in a Patient With Duchenne Muscular Dystrophy

Abstract

Clostridium difficile (C diff) colitis infection is the most common cause of nosocomial infectious diarrhea and the prevalence is increasing worldwide. Toxic megacolon is a severe complication of C diff colitis associated with high mortality. Gastrointestinal (GI) comorbidity and impaired smooth muscle contraction are risk factors for the development of C diff-associated toxic megacolon. We present a case of fulminant C diff colitis with toxic megacolon in a patient with Duchenne muscular dystrophy (DMD) in the intensive care unit. C diff colitis was diagnosed by clinical presentation and positive C diff DNA amplification test (polymerase chain reaction). The impairment of GI tract due to DMD predisposes these patients to severe C diff infection and toxic megacolon, as observed in this case report. For the same reason, the recovery of GI function in these patients can be prolonged. While surgery was conducted for relieving the pressure from toxic megacolon, fecal microbiota transplantation through colonoscopy resulted in successful resolution of the C diff symptoms, although the recovery is prolonged due to DMD.

Fecal microbiota transplant in severe and severe-complicatedClostridium difficile: A promising treatment approach

“…In 1958, the first published medical report of FMT described rapid recovery of 4 patients with fulminant pseudomembranous colitis, after given stool enemas by Eiseman and colleagues. 22 Since then, only a few case reports, [23][24][25][26][27][28][29][30] and 2 small albeit impressive case series have been published: a retrospective multicenter experience of 17 patients with 88% cure rate 31 and a single center study of 14 patients with 79% success rate following administration of a single FMT. 32 In contrast to the remarkable case series, there have been 4 examples where a single FMT in severe CDI was only transiently effective with implications that holding the anti-CDI antibiotic may have led to a poor clinical outcome.…”

Intestinal Microbiota as Modulators of the Immune System

“…Therefore, not surprisingly the gut microbiota modulation (via pre/probiotics or through faecal microbiota transplants) appears a very promising area of research aiming to modulate the outcome of the immune system looking for an impact in the clinics. In this context, several clinical trials are underway to assess the true efficacy of faecal microbiota transplantations [ 10 ] as well as their long term effects [ 11 , 12 ]. In agreement with that, there are still many factors regarding the host/microbiota cross talk which remain obscure and that have to be addressed to further our understanding about how the microbiota can modulate the outcome of the immune responses in the host.…”

Megacolon Tóxico De Origen Idiopático: Reporte De Caso

“…Los antibióticos más comunes asociados con C. difficile son la clindamicina, las cefalosporinas y las fluoroquinolonas (20). La vancomicina asociada con metronidazol debe administrarse como terapia de primera línea de acuerdo con las directrices actuales emitidas por la Society for Healthcare Epidemiology of America y la Infectious Disease Society of America.…”