Medical Library for DVMs
Restoring Balance with Fecal Microbiota Transplants
- October 5, 2021
- by Carey Hemmelgarn, DVM, DACVECC, BluePearl Paramus, NJ
This treatment is effective for helping puppies with canine parvovirus.
Fecal microbiota transplants have been performed in human medicine and veterinary medicine for quite some time now, but new research has shown there is a new population of patients that might benefit from this – parvo puppies. While fecal transplants may not sound appealing, a number of students in veterinary school have participated in this procedure without even knowing! Many veterinary schools have a cow with a rumen fistula. This cow had healthy rumen microbiomes, and these were transplanted into other cows to help their GI tract in a procedure called transfaunation.
While fecal transplants are performed a little differently in small animals and humans, the concept is the same. The gastrointestinal tract is made up of a large number of organisms that aim to keep their host healthy. These microorganisms are called the intestinal microbiota. This microbiota helps to act as a defense against enteropathogens, helps with the immune system, aids in digestion and provides nutritional support to the enterocytes. When the microbiota gets damaged secondary to disease, bacterial overgrowth or antibiotic use, the delicate balance of helpful microorganisms is lost. This is called dysbiosis.
Fecal microbiota transplants have been used most commonly in human medicine in the treatment and management of Clostridium difficile infections and have very high success rates. Dysbiosis has been found in cases of acute diarrhea, chronic diarrhea, gastrointestinal mobility disorders, exocrine pancreatic insufficiency, antibiotic use and gastrointestinal protectants that lower gastric acid production. Limited studies have been performed in small animals, and the role that fecal microbiota transplants can play in treatment of diseases. One disease that transplants have shown to help is canine parvovirus.
In a recent study, puppies with parvovirus that received transplants in addition to standard therapy compared to a control population that received standard therapy, had a shortened hospitalization time and an improvement in mortality. This is exciting information, as parvovirus can be a financially and emotionally draining process for families and any treatment that could expedite recovery and survivability as well as potentially decrease cost is welcome news. In the control population, mortality was noted to be 36.4% (12/33) and hospitalization was a median of 6 days. In the group that received fecal transplants, mortality was 21.2% (7/33) and hospitalization was a median of three days. Fecal microbiota transplants should be considered early on in the treatment of canine parvovirus patients, ideally within the first 6-12 hours of hospitalization if possible. The transplants were repeated every 48 hours for a total of five applications.
To incorporate fecal microbiota transplants into practice for parvovirus puppies or other patients who may be suffering from dysbiosis, a protocol should be created for each hospital to achieve the best results.
Criteria for fecal microbiota donors:
Protocols may need to be adjusted based on patients and hospital, but the protocol used in a recent study with slight modifications is described below. A fresh fecal sample is divided into 10-gram aliquots, and samples that are not going to be immediately used can be packaged/labeled and frozen for up to three months.
Dose: 2 grams/kg or 10 grams per puppy.
The fecal sample is mixed with 0.9% NaCl in a fecal-designated blender (any blender can be used, but it needs to be clearly labeled for fecal transplants only and no other use). The amount of saline that needs to be added can vary based on the moisture content of the feces, but somewhere between 10 mL total dose up to 10 mL/kg as a maximum dose. Once mixed, the sample should be strained to remove large pieces of fiber/plant material. The strained sample is aspirated into a catheter tip syringe and given as a retention enema by placing the patient in lateral recumbency for 15 minutes with anus held closed and then switched to alternate lateral recumbency for the remaining 15 minutes.
Clinical signs noted in some patients after transplant can include abdominal discomfort, nausea, transient fever, and bloating. Diarrhea is common afterwards as these patients often had diarrhea before the transplant and will continue to have diarrhea during their recovery.
Fecal microbiota transplants should be considered in future parvovirus puppies to help speed up their recovery and improve overall mortality with this disease.