Of Feces and the Microbiome

How Microbes Defend and Define Us: http://www.nytimes.com/2010/07/13/science/13micro.html?src=me&ref=general


Boggles the mind, no?

Quick precis of article: Lady has massive, uncontrolled Clostridium difficile infection. Antibiotics don't seem to have an effect. Doctors take a small amount of feces from the husband, mix it up in the saline drip that they have on her and voila! Diarrhea stops, woman recovers. Long discussion on the role of microbes in the human body follows.


Ja wohl?

I do not understand the rationale for this fecal transplant. I mean, if they mixed fecal samples into the saline drip, the bacteria would enter the bloodstream, not the gut. How did she NOT end up with sepsis?

Could her existing C.difficile condition have caused some kind of gut permeability, which then leaked C.difficile into her blood stream, leading to initial inflammation and then an exhaustion of the immune system?

Or could it have something to do with the fact that it is not a single strain of bacteria that is being injected but an immensely complex population of bacterial species, which could somehow detract the body from going into septic shock?


If the underlying rationale was to provide competition to the C.difficile, why didn't they use lactobacillus as a safer option to begin with?

Point to note, appreciate and ponder about: they used her husband's fecal samples. Why do I think this is important? Not because I detect (an admittedly dubious) romantic angle to this business, but because of another point of compatibility. If two people live together and cook and eat together, chances are that their gut flora are similar (or at least, more similar than two randomly selected people). So even if this woman had her gut flora cleaned out by the C.difficile, chances are that her husband's flora might be better "suited" to her.

[Of course, this is a big assumption: for all I know, they may not have been together that long, or perhaps they don't eat together, or perhaps one is a vegetarian and the other, a die hard carnivore. Okay, the last point is not so probable- after all, most times, people marry other people who share their value systems, especially when it comes to food. A hard core vegetarian and a carnivore may live together temporarily, but it cannot be a happy coexistence.]

Coming back to the point, I think it is important that they used someone to whom this woman would have continual, long term exposure to. This is a belief not substantiated by any data.

Technicalities: How did they decide just how much feces to add, I wonder? Was it a one shot bolus, or was it a continual drip? How fresh should the feces have been? How in the world did they mix up a bit of feces to a fine enough suspension that it passed through the tiny needle? Maybe they used a low intensity sonicator?

This is a whole new twist on the Morarji Desai angle. Now somebody should shoot some pee into another person and see what happens. Then, we can vindicate Desai saab's beliefs.