Kaleb’s journey: Treating C-diff with fecal microbiota transplantation

BlueEyes (1)

Bath time and bubbles, snuggling with Mom and playing hockey with his big brother are just a few of Kaleb’s favorite things.

But for the bright-eyed three-year-old from Massachusetts, things weren’t always so carefree.

Kaleb’s health changes: Battling ear infections and diarrhea

As an infant, Kaleb was a healthy baby boy. He was eating well and growing by leaps and bounds.

At six months, his health began to change. Multiple ear infections followed by numerous antibiotic treatments became a painful part of Kaleb’s young life.

As his first birthday approached, a second, unrelated condition emerged. Bouts of diarrhea were frequent. And as the days turned to weeks, the diarrhea intensified and his condition worsened.

“He wasn’t eating and was having up to 14 loose stools per day,” recalls Kaleb’s mother, Christine, a licensed practical nurse at an area medical center.

Stool cultures examined by Kaleb’s local pediatrician confirmed the toddler was battling more than ear infections. He was also battling Clostridium difficile, or C-diff, an infectious disease that causes debilitating diarrhea and is often prolonged with antibiotic use.

“As a nurse myself I was familiar with this infection. And though I was saddened by the news, I knew it was treatable,” Christine says.

Unfortunately, it wasn’t that easy.

Managing C-diff and ear infections

In an effort to stop the ear infections, Kaleb had bilateral ear tubes inserted and underwent a partial adenoidectomy at a local hospital.

unnamed
(Kaleb’s first surgery: bilateral ear tubes and partial adenoidectomy, 19 months old)

“Local doctors weren’t willing to remove the tonsils until after he turned three years old. They felt his ear infections would be resolved by removing most of the adenoids and placing tubes along with ear drops,” Christine says.

But the ear infections continued and the antibiotic treatment that followed exacerbated the C-diff.

According to Boston Children’s Dr. George Russell, Kaleb’s pediatric gastroenterologist in the Inflammatory Bowel Disease Center, the antibiotic treatment prescribed for Kaleb’s ongoing ear infections were killing both good and bad bacteria and disrupting the healthy gut bacterial environment. This prompted persistent and consistent antibiotic disruption of Kaleb’s gut microbiota (or bacteria.)

“This made it impossible for him to eradicate the C-diff infection because the healthy bugs that normally live in the gut were not there to protect the intestine from infection,” Russell adds.

In an effort to eradicate the C-diff, Russell opted to perform a fecal microbiota transplant (FMT).

“This was when I finally began to see hope,” Christine recalls.

What is Fecal Microbiota Transplantation or FMT?

Fecal transplantation is prescribed as an effective alternative to long-term antibiotic use in treating infectious diseases such as C-diff. The procedure, which is performed under anesthesia, delivers pre-screened, healthy human donor stool to a patient via colonoscopy or by nasogastric tube .

For Kaleb, the procedure was successful; however, his C-diff returned a few months later after he was re-exposed to antibiotics given to treat his ongoing and unresolved ear infections.

It was time to take on both the C-diff and ear infections.

Tackling Kaleb’s C-diff and ear infections

Russell reached out to his colleague Dr. Mark Volk, a Boston Children’s ear, nose and throat specialist. After meeting Kaleb and reviewing his medical history, Volk agreed to remove the remaining adenoids and enlarged tonsils.

20150913_180852 copyVolk and Russell worked together to coordinate and conduct all procedures, including a second FMT, on the same day.

“It was essential to minimize unnecessary anesthesia and repeated trips to the operating room for Kaleb,” Russell says. “By completing these procedures in one day, we were able to get the best outcome for Kaleb and limit the chance of needing another FMT in the future.”

Since his March 2015 procedure, Kaleb has been free of C-diff and ear infection. And his Mom couldn’t be happier.

“I am beyond grateful to Dr. Volk and Dr. Russell for all of their hard work and care,” says Christine. “Dr. Russell was absolutely our saving grace in a time of desperation. It was a very long, stressful and emotional year until we met Dr. Russell.”

Ongoing FMT research

New research, conducted by Russell and published in the Journal of the American Medical Association says, in addition to nasogastric tube and colonoscopy, there is a third, less invasive, less expensive option to treat C-diff.

And it comes in the form of a frozen poop pill.

“This ground-breaking paper shows that with encapsulated, frozen donor stool, fecal transplantation can be used to successfully treat recurring C-diff infection in 90 percent of cases,” says Russell, co-author of the Massachusetts General Hospital-sponsored study.

Though the poop pill is still in the experimental therapy stage, Russell says this cutting-edge technology is spurring further clinical research at Boston Children’s, specifically for use in other disease states, such as inflammatory bowel disease (IBD).

 

Read more about Dr. Russell’s ongoing FMT clinical research in Boston Children’s science and clinical innovation blog, Vector.