Non-invasive fecal microbiota transplantation for recurrent Clostridium difficile infection in a patient presenting with hypertensive disorder post interventionem

Abstract

Fecal microbiota transplantation has gathered much attention due to its high efficacy in resolving recurrent Clostridium difficile infection. Until today, it is recognized as a safe procedure without any severe side effects. Patients with impaired conscious states suffering from recurrent episodes of aspiration are at increased risk by endoscopic interventions needed during standard approaches for fecal microbiota transplantation application.

Here, we illustrate the case of a tetraplegic patient undergoing fecal microbiota transplantation due to his fifth recurrent episode of Clostridium difficile infection using a self-advancing nasal jejunal feeding tube as effective minimal-invasive option of fecal microbiota transplantation application. Persistent aggravation of arterial hypertension, which developed post-intervention in this patient, could be interpreted as a hitherto unknown side effect of fecal microbiota transplantation in this setting. Moreover, this is a further hint for a link between the intestinal microbiome and arterial hypertension in general.

Zusammenfassung

Die fäkale Mikrobiota-Transplantation erfährt aufgrund ihrer hohen Wirksamkeit in der Therapie von rekurrierenden Clostridium difficile Infektionen eine zunehmende Beachtung. Sie wird heutzutage als sicherer Therapieansatz ohne schwerwiegende Nebenwirkungen angesehen. Patienten, die aufgrund einer neurologischen Bewusstseinsstörung rezidivierende Aspirationsereignisse aufweisen, sind einem erhöhten Risiko durch endoskopische Interventionen ausgesetzt, die bei Standardapplikationswegen der fäkalen Mikrobiota-Transplantation Anwendung finden.

In dieser Kasuistik schildern wir den klinischen Verlauf eines tetraplegischen Patienten, welcher bei seiner fünften rekurrierenden Clostridium difficile Infektion einer fäkalen Mikrobiota-Transplantation zugeführt wurde. Die Applikation erfolgte als minimal-invasive Option über eine selbst-vorwandernde nasojejunale Sonde. Postinterventionell war eine anhaltende Verschlechterung eines zuvor stabil kontrollierten arteriellen Hypertonus bei unserem Patienten auffällig. Dies kann als Hinweis für eine zuvor nicht beachtete Nebenwirkung der fäkalen Mikrobiota-Transplantation in dieser Konstellation dienen. Zusätzlich deutet diese Beobachtung auf eine relevante Verbindung zwischen dem intestinalen Mikrobiom und arterieller Hypertension hin.

Schlüsselwörter

Clostridium difficile Infektion - Fäkale Mikrobiota-Transplantation - Intestinales Mikrobiom - Arterielle Hypertension

Key words

Clostridium difficile infection - fecal microbiota transplantation - intestinal microbiome - arterial hypertension

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