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Case Report

Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infections in a Cystic Fibrosis Child Previously Screen Positive, Inconclusive Diagnosis (CFSPID): A Case Report

by
Riccardo Marsiglia
1,
Stefania Pane
2,
Federica Del Chierico
1,
Alessandra Russo
2,
Pamela Vernocchi
1,
Lorenza Romani
3,
Sabrina Cardile
4,
Antonella Diamanti
4,
Luisa Galli
5,6,
Agnese Tamborino
6,
Vito Terlizzi
7,
Paola De Angelis
4,
Giulia Angelino
4 and
Lorenza Putignani
8,*
1
Immunology, Rheumatology and Infectious Diseases Research Area, Unit of Research Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
2
Unit of Microbiomics, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
3
Infectious Diseases Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
4
Unit of Gastroenterology and Nutrition, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
5
Department of Health Sciences, University of Florence, 50121 Florence, Italy
6
Infectious Disease Unit, Meyer Children’s Hospital IRCCS, 50121 Florence, Italy
7
Department of Pediatric Medicine, Meyer Children’s Hospital IRCCS, Cystic Fibrosis Regional Reference Center, Viale Gaetano Pieraccini 24, 50139 Florence, Italy
8
Unit of Microbiomics and Unit of Research of Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy
*
Author to whom correspondence should be addressed.
Microorganisms 2024, 12(10), 2059; https://doi.org/10.3390/microorganisms12102059
Submission received: 25 September 2024 / Revised: 10 October 2024 / Accepted: 11 October 2024 / Published: 12 October 2024
(This article belongs to the Special Issue State of the Art of Gut Microbiota in Italy (2023, 2024))
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Abstract

Clostridioides difficile infection (CDI) is generally treated with vancomycin, metronidazole or fidaxomicin, although fecal microbiota transplantation (FMT) represents a promising therapeutic option for antibiotic-resistant recurrent C. difficile infections (rCDIs) in adults. In pediatric cystic fibrosis (CF) patients, CDIs are generally asymptomatic and respond to treatment. Here, we present the case of an 8-year-old female, initially diagnosed as “CFTR-related metabolic syndrome/cystic fibrosis screen positive, inconclusive diagnosis” (CMRS/CFSPID), who then progressed to CF at 12 months. In the absence of CF-related symptoms, she presented multiple and disabling episodes of bloody diarrhoea with positive tests for C. difficile antigen and A/B toxin. After conventional treatments failed and several CDI relapses, FMT was proposed. Donor screening and GM donor–receiver matching identified her mother as a donor. Metataxonomy and targeted metabolomics provided, through a pre- and post-FMT time course, gut microbiota (GM) profiling to assess GM engraftment. At first, the GM map revealed severe dysbiosis, with a prevalence of Bacteroidetes and Proteobacteria (i.e., Klebsiella spp., Escherichia coli), a reduction in Firmicutes, a GM nearly entirely composed of Enterococcaceae (i.e., Enterococcus) and an almost complete depletion of Verrucomicrobia and Actinobacteria, mostly represented by Veillonella dispar. Post FMT, an increment in Bifidobacterium spp. and Collinsella spp. with a decrease in V. dispar restored intestinal eubiosis. Consistently, four weeks after FMT treatment, the child’s gut symptoms cleared, without CDI recurrence.
Keywords: cystic fibrosis (CF); cystic fibrosis screen positive; inconclusive diagnosis (CFSPID); recurrent Clostridioides difficile infections (rCDIs); fecal microbiota transplantation (FMT); gut microbiota (GM) cystic fibrosis (CF); cystic fibrosis screen positive; inconclusive diagnosis (CFSPID); recurrent Clostridioides difficile infections (rCDIs); fecal microbiota transplantation (FMT); gut microbiota (GM)

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MDPI and ACS Style

Marsiglia, R.; Pane, S.; Del Chierico, F.; Russo, A.; Vernocchi, P.; Romani, L.; Cardile, S.; Diamanti, A.; Galli, L.; Tamborino, A.; et al. Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infections in a Cystic Fibrosis Child Previously Screen Positive, Inconclusive Diagnosis (CFSPID): A Case Report. Microorganisms 2024, 12, 2059. https://doi.org/10.3390/microorganisms12102059

AMA Style

Marsiglia R, Pane S, Del Chierico F, Russo A, Vernocchi P, Romani L, Cardile S, Diamanti A, Galli L, Tamborino A, et al. Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infections in a Cystic Fibrosis Child Previously Screen Positive, Inconclusive Diagnosis (CFSPID): A Case Report. Microorganisms. 2024; 12(10):2059. https://doi.org/10.3390/microorganisms12102059

Chicago/Turabian Style

Marsiglia, Riccardo, Stefania Pane, Federica Del Chierico, Alessandra Russo, Pamela Vernocchi, Lorenza Romani, Sabrina Cardile, Antonella Diamanti, Luisa Galli, Agnese Tamborino, and et al. 2024. "Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infections in a Cystic Fibrosis Child Previously Screen Positive, Inconclusive Diagnosis (CFSPID): A Case Report" Microorganisms 12, no. 10: 2059. https://doi.org/10.3390/microorganisms12102059

APA Style

Marsiglia, R., Pane, S., Del Chierico, F., Russo, A., Vernocchi, P., Romani, L., Cardile, S., Diamanti, A., Galli, L., Tamborino, A., Terlizzi, V., De Angelis, P., Angelino, G., & Putignani, L. (2024). Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infections in a Cystic Fibrosis Child Previously Screen Positive, Inconclusive Diagnosis (CFSPID): A Case Report. Microorganisms, 12(10), 2059. https://doi.org/10.3390/microorganisms12102059

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