Gut infection

Crippling stomach cramps, diarrhea,
nausea and lethargy are some
symptoms of Clostridium difficile, a
bacterial infection of the bowel is easily
treated with antibiotics, but often
misdiagnosed. It is more prevalent in
elderly, sicker people, and those
taking certain antibiotics and anti-reflux
medication, however it is becoming
more common among fit, young people.

Dr. Alexander Khoruts, a
gastroenterologist at the University
Minnesota, used bacteriotherapy to  
cure a patient suffering from a gut
He took on a patient suffering from a
vicious gut infection of Clostridium
difficile. She was crippled by constant
diarrhea, which had left her in a
wheelchair wearing diapers. Dr.
Khoruts treated her with an assortment
of antibiotics, but nothing could stop
the bacteria.
Dr. Khoruts decided his patient
needed a transplant. But he didn’t give
her a piece of someone else’s
intestines, or a stomach, or any other
organ. Instead, he gave her some of
her husband’s bacteria.

Dr. Khoruts mixed a small sample of
her husband’s stool with saline solution
and delivered it into her colon. Writing
in the Journal of Clinical
Gastroenterology, Dr. Khoruts and his
colleagues reported that her diarrhea
vanished in a day. Her Clostridium
difficile infection disappeared as well
and has not returned since.
The procedure — known as
bacteriotherapy or fecal
transplantation — had been carried
out a few times over the past few
decades. But Dr. Khoruts and his
colleagues were able to do something
previous doctors could not: they took a
genetic survey of the bacteria in her
intestines before and after the

Clostridium difficile is a spore-forming
bacterium which is probably most
commonly 'caught' through the mouth
often in hospitals, especially after the
use of antibiotics. It can result in
syndromes of varying severity
including transient diarrhea, a carrier
status, a mild colitis-like illness,
pseudomembranous colitis, and even
toxic megacolon with possible mortality.

Most affected patients can respond to
medical therapy including
discontinuation of the responsible
antibiotic. It is not the antibiotic that
causes the infection but rather the
antibiotic use weakens the defense of
the bowel bacteria so permitting C.
difficile to implant in the bowel.  
However, despite a seemingly
successful initial treatment around
25% or more patients may have a
recurrence of diarrhea following
withdrawal of the antibiotics. This is
thought to occur because the normal
flora may not at this time, possess the
power to eradicate the persisting
Clostridial spores. In many patients the
C. difficile spores remain and a
chronic, relapsing disease can
continue. Treatment of this recurrent
C. difficile diarrhea can be particularly
difficult, mainly because we do not
have the tools to kill spores.

If all medical therapies fail, re-
colonisation of the colon using human
fecal origin probiotics has been used
and reported to be successful in
eradicating spores.

At Probiotic Therapy Research Centre,
Sidney, Australia they focus
particularly on those cases where
other therapies have failed. In such
patients they may initially use a
combination therapy with vancomycin,
rifampicin and metronidazole together
combined with Lactobacillus GG. If all
pharmacological therapies fail, human
probiotic infusion (HPI) is used to
terminate the C. difficile infection since
human fecal flora bacteria appear to
have the capability to permanently
eradicate C. difficile spores - a
treatment not able to be matched by
any other currently known therapy.
Using HPI, the cure rate approaches