[CIS PIDD] [cis-pidd] FMT for C.Diff in CTLA4

[CIS-PIDD]

Including stool transplant? :-)
This is what I would try... not that we have ever done this, but it sounds most appealing to me :-)
Best, Bodo

****************************************
Univ.-Prof. Dr. med. B. Grimbacher

Scientific-Director
CCI-Center for Chronic Immunodeficiency
UNIVERSITÄTSKLINIKUM FREIBURG
Tel.: 0761 270-77731  Fax: -77744
Breisacherstraße 115, 79106 Freiburg
bodo.grimbacher at uniklinik-freiburg.de<mailto:bodo.grimbacher at uniklinik-freiburg.de>
www.uniklinik-freiburg.de/cci

and

Consultant Immunologist
Institute of Immunity & Transplantation
Dept of Immunology
Royal Free Hospital
UNIVERSITY COLLEGE LONDON
Pond Street
London NW3 2QG
b.grimbacher at ucl.ac.uk<mailto:b.grimbacher at ucl.ac.uk>
www.centreforimmunodeficiency.com


Von: CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>>
Antworten an: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Datum: Monday 19 December 2016 21:15
An: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Betreff: Re: [cis-pidd] FMT for C.Diff in CTLA4

There is an old body of literature using high dose IVIG to treat recurrent C diff.

It's worth a try.

Kate Sullivan, MD PhD
Wallace Chair
Chief of Allergy Immunology
ARC 1216 CHOP
3615 Civic Center Blvd.
Philadelphia, PA 19104
(p) 215-590-1697
(f) 267-426-0363




On Dec 19, 2016, at 3:05 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> wrote:

Dear all

We are managing a 70yr man with CTLA4 haploinsufficiency who has refractory clostridium difficile (ribotype 078) infection. We have tried 6 months oral vancomycin, 2 weeks oralmetronidazole, and multiple courses of fidaxomicin, but with no success. He has a background of hypogammaglobulinaemia (on IVIG with trough levels 11g/l), lymphocytic colitis, interstitial lung disease, and bronchiectasis. The initial C.Diff infection was probably due to courses of antibiotics for infective exacerbations of bronchiectasis.

Lymphocyte counts currently are;

CD3+ 1500 (cells/mm3)
CD4+ 440
CD8+ 1020
CD19+ 20
NK (CD16/56+) 120

IgG 11.4g/l
IgA <0.07
IgM <0.2

We are now considering a faecal microbiome transplant (FMT) via NJ tube. We feel the risk/benefit of infection from the FMT is less than that of the longterm C.Diff, and knock-on effects on quality of life and nutritional status.

Has anyone had any experience of FMT in patients with PIDD? Are there any additional precautions you would advise?

Many thanks

Will



Dr William Rae
Clinical Immunology Specialist Registrar
NIHR RD-TRC Immunology Clinical Research Fellow
University Hospital Southampton, UK




********************************************************************************************************************

Disclaimer
This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they are addressed.
Any views or opinions presented are solely those of the author and do not necessarily represent those of the Trust unless explicitly stated otherwise.
If you have received this e-mail in error please delete it and contact the University Hospital Southampton NHS Foundation Trust Helpdesk on:- 023 8120 6000
The information contained in this e-mail may be subject to public disclosure under the Freedom of Information Act 2000.
Unless the Information is legally exempt from disclosure, the confidentiality of this e-mail and your reply cannot be guaranteed.
This footnote also confirms that this email message has been checked for computer viruses.
Please visit our website at http://www.uhs.nhs.uk

Think of the environment.  Please avoid printing this e-mail unnecessarily.

---
You are currently subscribed to cis-pidd as: sullivank at email.chop.edu<mailto:sullivank at email.chop.edu>.
To unsubscribe click here: http://cts.dundee.net/u?id=99424140.0252c6305bcec2418e0f99fbf64e026c&n=T&l=cis-pidd&o=4076978
or send a blank email to leave-4076978-99424140.0252c6305bcec2418e0f99fbf64e026c at lyris.dundee.net<mailto:leave-4076978-99424140.0252c6305bcec2418e0f99fbf64e026c at lyris.dundee.net>


---

You are currently subscribed to cis-pidd as: bodo.grimbacher at uniklinik-freiburg.de<mailto:bodo.grimbacher at uniklinik-freiburg.de>.

To unsubscribe click here: http://cts.dundee.net/u?id=96396431.4f2a33ac30bfa58d3a76b5fb5b03d33a&n=T&l=cis-pidd&o=4076998

(It may be necessary to cut and paste the above URL if the line is broken)

or send a blank email to leave-4076998-96396431.4f2a33ac30bfa58d3a76b5fb5b03d33a at lyris.dundee.net<mailto:leave-4076998-96396431.4f2a33ac30bfa58d3a76b5fb5b03d33a at lyris.dundee.net>

---
You are currently subscribed to cis-pidd as: pagid at list.clinimmsoc.org.
To unsubscribe click here: http://cts.dundee.net/u?id=96396833.5a9591ccd1e327fe6bc4d1543298c482&n=T&l=cis-pidd&o=4077088
or send a blank email to leave-4077088-96396833.5a9591ccd1e327fe6bc4d1543298c482 at lyris.dundee.net
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <https://pairlist7.pair.net/pipermail/pagid/attachments/20161219/8a1dd45f/attachment-0001.html>