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Assessment of Dientamoeba fragilis interhuman transmission by fecal microbiota transplantation
Alicia Moreno-Sabater1, Rachel Sintes2, Sandrine Truong3
1Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Immunologie et Maladies infectieuses, CIMI-PARIS, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France; Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France; French Group for Fecal Microbiota Transplantation (GFTF), Paris, France.
Abstract:
Fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) requires careful selection of stool donors to avoid transmitting pathogens. Dientamoeba fragilis detection remains an exclusion criterion based on its uncertain pathogenicity. The aim of this study was to assess D. fragilis interhuman transmission by FMT and its impact on the clinical success of rCDI. A retrospective study was conducted in rCDI patients from the COSMIC cohort undergoing FMT to investigate the potential transfer of D. fragilis from donor to recipient. The impact of FMT involving D. fragilis was also evaluated in regard to the clinical outcomes of rCDI and adverse effects. This protist was found to be present in 15 of 86 healthy donors screened (18.7%) who voluntarily took part in an FMT program. Examination of D. fragilis presence in stool samples from 17 patients both before and after FMT with D. fragilis-positive donations revealed no evidence of interhuman transmission through this process. Analysis of clinical outcomes and adverse events in 124 rCDI patients who underwent FMT (with 45 receiving D. fragilis-positive donations) showed no significant differences in success rates between patients receiving positive or negative D. fragilis transplants (95.5% and 93.6%, respectively). No significant variances were observed in other side effects analyzed. These findings underscore the safety of using fecal transplant from D. fragilis-positive donors in the FMT process. D. fragilis should be removed from the donor screening, which will represent a major improvement in the donor selection process from financial and practical standpoints.
Insights
Fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) is safe even with donors positive for Dientamoeba fragilis. This study found no transmission or impact on rCDI treatment success, suggesting D. fragilis screening is unnecessary.
Area of Science:
- Microbiology
- Gastroenterology
- Infectious Diseases
Background:
- Recurrent Clostridioides difficile infection (rCDI) treatment often involves fecal microbiota transplantation (FMT).
- Donor screening for FMT excludes individuals with Dientamoeba fragilis due to uncertain pathogenicity and potential transmission risks.
- The clinical significance of D. fragilis in FMT remains unclear.
Purpose of the Study:
- To evaluate the interhuman transmission of Dientamoeba fragilis via FMT.
- To assess the impact of D. fragilis-positive FMT on the clinical success of rCDI treatment.
- To determine the safety and efficacy of using D. fragilis-positive donors in FMT.
Main Methods:
- Retrospective analysis of the COSMIC cohort of rCDI patients undergoing FMT.
- Investigation of D. fragilis presence in donor and recipient stool samples before and after FMT.
- Comparison of clinical outcomes and adverse events in rCDI patients receiving FMT from D. fragilis-positive versus D. fragilis-negative donors.
Main Results:
- Dientamoeba fragilis was detected in 18.7% of screened healthy donors.
- No evidence of D. fragilis interhuman transmission was observed in patients receiving FMT from positive donors.
- FMT success rates (95.5% vs. 93.6%) and adverse events did not significantly differ between patients receiving D. fragilis-positive or negative donations.
Conclusions:
- Fecal microbiota transplantation from Dientamoeba fragilis-positive donors is safe and does not impede rCDI treatment success.
- Dientamoeba fragilis transmission does not occur through FMT.
- The study recommends removing D. fragilis from donor screening criteria to improve the FMT donor selection process.
