Serial Microbiota Analysis after Fecal Microbiota Transplantation in a Child with down Syndrome

Fecal microbiota transplantation (FMT) is a very effective treatment for recurrent Clostridium difficile infection (CDI) in adults. However, there is a paucity of data on FMT in children and associated microbiome changes in this specific group. We describe a child with Down syndrome and intracranial malignancy, who received FMT for recurrent CDI. Detailed microbiota analysis prior to and following FMT, and preand post-recurrence, linked to microbial communities in the donor feces showed that the patient developed a unique microbiota profile after FMT which was very stable over time despite CDI recurrence and subsequent fidaxomicin therapy. Bacteroidetes were stably acquired form donor feces, while Firmicutes, Actinobacteria, Fusobacteria, Verrucomicrobia and Proteobacteria were unique to the patient. The diversity of microbiota of our patient increased from a Shannon diversity index of 2.08 pre-FMT to 3.12 post-FMT. Our findings underscore that patients with Down syndrome, with an alternate immune system, may well tolerate and benefit from FMT even in a severe immunocompromised state.