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

[CIS-PIDD]

Dear Will,

One of our pediatric patients with XLA and inflammatory bowel disease received FMT by NG for refractory C. Diff. and did not tolerate the procedure, developing immediate emesis followed by fever. He had failed multiple courses of vancomycin and metronidazole (standard and taper regimens). We tried standard 10 day course of fidaxomicin w/o success. He also failed 10 day course of oral immunoglobulin. 
C. Diff has been controlled on fidaxomicin taper and have not attempted stopping it due to recent IBD flare. 

Please keep us posted on your patient's outcome.  

Regards, 

Araceli 

Araceli Elizalde, MD
Assistant Professor of Clinical Pediatrics
Immunology Clinic Director 
Children's Hospital of San Antonio
Baylor College of Medicine 

Sent from my iPhone

> On Dec 19, 2016, at 2:40 PM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org> wrote:
> 
> There is some new evidence to suggest you can use fecal filtrate instead of exposing the patient to FMT.  I've not tried this, but it seems like a promising approach in immunocompromised patients.
> 
> https://www.ncbi.nlm.nih.gov/pubmed/27866880
> 
> Ben
> 
> Benjamin L. Wright, MD | Assistant Professor | Allergy, Asthma & Clinical Immunology
> Office Tel: 480.301.4284 | Fax: 480.301.9066| Pager 127 or (79)1-5302
> wright.benjamin at mayo.edu
> Mayo Clinic | 13400 East Shea Boulevard | Scottsdale, AZ 85259
> 
> ________________________________________
> From: CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
> Sent: Monday, December 19, 2016 1:05 PM
> To: CIS-PIDD
> Subject: [cis-pidd] FMT for C.Diff in CTLA4
> 
> 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
> 
> 
> 
> 
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