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

Wed Dec 21 10:03:35 EST 2016

Over the years I have treated five children with IGIV 500-1000mg/kg/dose
once a month for three months with resolution of C. diff colitis. Each had
failed "state of the art" treatment at the time. Each of these patients was
immunologically normal. My last use was about 7-8 years ago. I would
consider IGIV when other things have failed. It is certainly benign.
Richard Wasserman
Dallas

On Tue, Dec 20, 2016 at 11:59 AM, CIS-PIDD <cis-pidd at lists.clinimmsoc.org>
wrote:

> 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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-- 
Richard L. Wasserman, MD, PhD
Allergy Partners of North Texas
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211

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