Erik S. Lesser / EPA for NBC News

Dr. Hunter Johnson, a pathology resident at the Emory University School of Medicine, has helped at least four patients with C. difficile infections by giving them a dose of his stool. Fecal transplants have been shown to have a 90 percent success rate of curing the potentially deadly infection.

An Emory University medical resident has taken the notion of donation to a whole new level, agreeing to provide stool samples for multiple patients who need life-saving procedures called fecal transplants.

Dr. Hunter Johnson has aided at least four people in the past year by providing doses of his healthy feces -- yes, poop -- to help cure devastating bowel infections caused by a nasty germ known as C. difficile.

“As you can imagine, it’s not the most glamorous thing,” says Johnson, 30, of Atlanta, who was recruited by his boss, Dr. Colleen Kraft. “It’s hard enough to get people to donate blood, but it’s much harder to get people to donate feces.”

Kraft, an infectious disease specialist and clinical microbiologist at Emory, turned to Johnson and other medical residents last summer, when a gravely ill lung transplant patient came down with a C. diff infection as well.

“Basically, we had been doing it using a family member or friend to donate and this patient didn’t have anyone who could help,” she said. That's where Johnson came in. 

The process worked, allowing the woman to recover from the bowel infection with the help of a stranger’s stool.

Fecal transplants are rapidly becoming a treatment of choice for recurrent C. diff infections, which strike more than 336,000 people each year and are linked to 14,000 deaths, according to the Centers for Disease Control and Treatment. 

In the procedures, stool from a healthy patient is transplanted into the colon of a C. diff sufferer to restore the balance of bacteria. C. diff infections typically occur following heavy antibiotic use, when the drugs kill healthy bacteria in the gut, allowing toxic germs to flourish.

Though they sound distasteful, fecal transplants have been racking up success rates as high as 90 percent or more. Sufferers say they recover swiftly after the transplants, returning to full health within a few days.

“I’m telling you, I can’t say enough good things about this thing,” said Tom Wilson, 76, who received one of Johnson’s stool donations in March.

Wilson, who was treated for a serious bowel condition called diverticulitis in 2006, developed a life-threatening case of C. diff last December and was severely ill for months. He tried a fecal transplant using a sample from a family member, but it wasn’t completely successful.

When he fell ill again, doctors sent the real estate developer from Alpharetta, Ga., to Emory for help. He said the notion of accepting stool from a stranger didn’t faze him at all.

“When you’re as sick as I have been, you’ll do anything to feel better,” said Wilson, who figures he’s nearly fully recovered.

Johnson said he gets a sense of satisfaction from helping -- and from knowing he’s advancing knowledge about a new kind of therapy.

He figures he’s a good donor because he’s young, fairly healthy, and is at low risk for infections. People with kids, for instance, wouldn’t be good choices because children bring home so many germs.

“They don’t want you to be eating anything too crazy, not a lot of travel, no history of gastrointestinal illness,” he said. “We can’t have taken any drugs in the recent past.

“Essentially, the best donor is someone who leads a pretty boring life," he added.

In addition, a good donor has to have predictable bowel habits and be able to perform, as it were, on demand. Johnson typically donates on the morning of a patient’s transplant. “They want it to be relatively fresh,” he said.

He provides the sample and then takes it to the lab, where it’s processed to be given to the patient. At Emory, they use a colonoscope to deliver the donation, though others use enemas or tubes that run through the nose and to the stomach.

Kraft has conducted the transplants on a case-by-case basis with hospital approval. She plans to apply for a investigational new drug application that would essentially define Johnson's stool as a useful medication. Meanwhile, she and others who perform fecal transplants are waiting for the federal Food and Drug Administration to weigh in on regulation of the promising new therapy.

Both Kraft and Johnson say they’re excited by the promise of fecal transplants to cure the misery of C. diff infections. “I became a physician to help people,” Johnson said. “To these patients, it’s a big deal.”

Still, he acknowledges that not everyone finds his altruism so intriguing.

“My wife is kind of tentatively grossed out by it,” he said. “It’s a little weird for her. But she realizes it’s a good thing.”

Related stories: 

• Fecal transplant from mom cures ailing toddler
• Sounds gross, works great: Fecal transplants cure nasty C. diff infections

By Gene Emery
Reuters

It may sound like the most unappealing treatment available, but a small new study has concluded that inserting fecal material from a healthy person into the gut of someone with severe diarrhea may cure their problem more effectively than antibiotics. 

The study, which appears in the New England Journal of Medicine, involved patients who had repeated bouts of diarrhea caused by a bacterium known as Clostridium difficile. So-called C. diff can take over the intestines after antibiotic treatment has killed off the beneficial bacteria found in the gut.

One transplant of fecal material from a volunteer - with its mix of healthy bacteria - resolved severe diarrhea in 13 out of 16 volunteers. Standard treatment with an antibiotic, in comparison, worked in four of 13 patients.

"This is the first hard evidence that has been provided for the treatment," senior author Dr. Josbert Keller of the University of Amsterdam told Reuters Health.

"Those of us who do it know how effective it is," said Dr. Colleen Kelly of Brown University's Alpert Medical School in Providence, Rhode Island, who was not connected with the study but uses fecal transplant in her practice.

About 3 million people in the U.S. are infected annually with C. diff, which spreads mainly through hospitals, nursing homes and doctors' offices.

The bacterium underlying the problem is called "difficile" for a reason. When it controls the gut, it can be difficult to eradicate. Antibiotics typically only work in 15 to 26 percent of patients with C. diff. - and after repeated rounds of treatment, the drugs become less effective.

"I've done 90 of these now in the last four and a half years. In patient after patient who has failed multiple courses of antibiotic, if you give them a dose of stool, they get better," she told Reuters Health.

Stool transplants have been proposed as one alternative (see Reuters story of November 30, 2012: http://reut.rs/QRaAIy).

Keller and his colleagues compared three treatments in a small trial.

Thirteen volunteers with C. diff received a standard antibiotic, vancomycin, four times a day for 14 days. After 10 weeks, four were free of bacteria-related diarrhea.

Another 13 patients had the same drug therapy after drinking a solution to clean out the bowel, a process known as bowel lavage that is similar to what people go through if they are getting a colonoscopy. That worked in three cases.

The remaining 16 volunteers had a brief treatment with vancomycin, combined with bowel lavage, followed by the infusion of 500 milliliters of diluted donor feces through a tube that went into the nose, down the throat, past the stomach and into the small intestine.

In the three cases where that treatment failed, the doctors re-treated patients with fecal material from a different donor. That worked in all but one case.

Among the volunteers in the non-transplant groups who had a relapse of C. diff, 18 were later given a fecal transplant. It cured 15 of them, although four of the 15 needed two treatments.

All of the donors - people who worked in the hospital who were not involved with patient care - were periodically screened for a variety of diseases.

When side effects were tallied in the transplant group, 94 percent of patients reported diarrhea, 31 percent had cramping and 19 percent had belching, but all of those symptoms disappeared within three hours. Nineteen percent ultimately reported constipation after treatment.

Feces transplants may sound extremely distasteful, but "the patients were desperate because they had had several episodes. There was nothing else they could do. There was no psychological hurdle for them," said Keller.

"I think the 'yuck' thing is overplayed," Kelly said. "There's a desperation when you're this sick this long."

Only eight of the 43 patients in the study were willing to try the treatment after their first relapse of C. diff, Keller and his colleagues reported.

"The efficacy of antibiotic therapy decreases with subsequent recurrences, and it seems reasonable to initiate treatment with donor-feces infusion after the second or third relapse," they wrote. 

Courtesy Tatum Williams

Tatum Williams, 28, didn't flinch when doctors told her the only cure for her son Jesse's terrible gut infection was a fecal transplant from mother to son. Today, the 2-year-old's C. difficile infection is gone.

As a young mom with a very sick toddler, Tatum Williams would have done anything -- no matter how odd -- to make her baby better.

So when doctors told her that 20-month-old Jesse’s last chance to cure a life-threatening gut infection was to transfer a stool sample -- yes, poop -- from mother to son, Williams didn’t blink.

“I was all for it,” recalled the 28-year-old mother of two from Baltimore.

After some research, she quickly agreed to what’s known as Fecal Microbiota Transplantation, or FMT, an unusual treatment used to battle serious, recurrent diarrhea and other symptoms caused by a nasty bug called Clostridium difficile, or C. diff.

“We had been dealing with his C. diff for nine months,” said Williams. “He was losing weight because of everything he would lose in his diaper.”

Jesse may have been the youngest child ever to undergo the treatment that transfers feces from a healthy donor to help repopulate the beneficial bacteria in an infected colon. But as far as Williams was concerned, there was no choice.

“It couldn’t get any worse,” she said.

Dr. Sudhir K. Dutta, the head of the gastroenterology department at Sinai Hospital in Baltimore, agreed. The curly-haired toddler was suffering all of the signs of the dangerous, contagious infection that has become increasingly common, sickening more than 300,000 patients a year in U.S. hospitals and causing some 14,000 deaths, according to federal health officials.

Jesse, who was born at 27 weeks’ gestation, has grappled with several problems since birth, including respiratory distress and feeding troubles, all made worse by the C. diff infection.

The child already had received powerful antibiotics, even an intravenous immunoglobulin -- blood products -- injection to battle the infection, to no avail. 

“They really had no other option,” said Dutta, who performed the transplant in March. His assistant is Dr. Ritu Walia, also of Sinai Hospital. The pair presented their report on Jesse's case at the American College of Gastroenterology's annual scientific meeting in Las Vegas. Dutta has gained attention for his fecal transplant work, including a clip that aired on Comedy Central's The Colbert Report. 

C. diff infection occurs when the spore-forming bug invades the intestine, often after heavy use of certain types of antibiotics kill off other healthy bacteria in the gut. It's an infection often acquired in hospitals, though patients in nursing homes and other care centers get C. diff, too. It's not clear how Jesse acquired his infection, though he has been hospitalized often during his short life.

Fecal transplants increasingly have been used in adults with success rates as high as 90 percent or more, according to recent reviews. A new study released last week by researchers at Henry Ford Hospital found that 43 of 49 patients with C. diff infections recovered swiftly after fecal transplants and had no problems up to three months later.

Still, performing the procedure on a toddler was different. The stool is typically transferred through a tube that runs from the nose to the stomach, or through a colonoscopy.

“The concerns were basically perforation of the bowel in such a young child,” explained Dutta. “So fragile, so delicate.”

Pediatricians at Johns Hopkins Hospital were reluctant to perform the transplant themselves, so they referred Jesse to Dutta, who had to get special certification to work on a child.

Once the procedure was approved, a donor had to be found, preferably someone from the same household. Tests showed Jesse’s mom was a good match.

Despite the early worries, the procedure went smoothly, Dutta said. Even better, Jesse started to improve almost immediately.

“Within two days, I saw changes,” his mother said. “It was unbelievable.”

Since the fecal transplant, however, he hasn’t been admitted to the hospital and seems to be healing better, his mother said.

“Now, he’s a typical 2-year-old,” she said. “He loves playing with cars, Mickey Mouse.”

Williams credits the doctors at Johns Hopkins and Sinai for arranging the unusual procedure that helped her family, which includes Jesse’s dad, Chad Snyders, and his brother, Kaiden, 9.

But, she added, her youngest son’s health is nothing less than a blessing.

“I want all Jesse’s success to go to the glory of God,” she said.

Related stories: 

• Sounds gross, works great: Fecal transplants cure nasty C. diff infections
• No butts about it: Fecal transplants work for some
• Heartburn drugs linked to serious infections

Courtesy Shoop family

Pat Shoop, center, received a fecal transplant to treat a life-threatening Clostridium difficile infection. The 75-year-old Minneapolis teacher was transplanted with stool from her husband, Bob, left, in a procedure that a new review shows is effective in 92 percent of cases. The couple's children are Doug Shoop, far left, and Teri Quamme, far right.

After 52 years of marriage, Pat Shoop thought she'd shared every intimacy possible with her husband, Bob.

But that was before she became so ill with a Clostridium difficile infection last year that doctors suggested that a spousal stool transplant -- yes, a dose of Bob’s feces -- might be the only way to save her life.

“I'd heard of intercourse, but I'd never heard of 'pooper-course,'" Shoop, 75, of Minnetonka, Minn., jokes now. At the time, though, there was nothing funny about it.

“I was so sick, I didn’t care," she recalled. "It feels like the worst case of flu you could possibly, possibly have.”

Shoop, a longtime schoolteacher, was suffering from recurrent C. diff infection, a potentially life-threatening bacterial illness that causes severe diarrhea, abdominal pain, nausea and vomiting. It comes back again and again, resisting most treatments, except, as it turns out, an infusion of stool from a healthy donor.

A new review of more than two dozen scientific reports involving 317 patients, some dating back 50 years, finds that fecal bacteriotherapy, commonly known as fecal transplant, cured the problem in 92 percent of the cases. Nearly all got better after just one treatment. That's a better record than other treatments, including probiotics, toxin-binding molecules and an experimental vaccine.

The review offers the most comprehensive evidence so far in favor of the repugnant-sounding practice in which stool from a healthy donor is emulsified, usually mixed with water or saline, and transferred via a nasal tube or enema to the gut of a seriously ill C. diff patient.

“It’s considered a treatment of last resort,” said Amee R. Manges, an epidemiologist at McGill University in Montreal, Canada, who led the review published in the most recent issue of the journal Clinical Infectious Diseases.

Once transplanted, the healthy fecal bacteria help restore balance to the patient’s bowels. C. diff infections typically develop after the intestinal flora is disturbed, usually by overuse of certain antibiotics. For most of the last decade, fecal transplants have been regarded as something of a fringe treatment by outsiders, but as a viable treatment by doctors who see desperate C. diff patients every day.

"It validates what we've thought all along," said Dr. Tim Rubin, a gastroenterologist with Essentia Health in Duluth, Minn., whose team performed its 119th fecal transplant last week. "We quote people a success rate of about 90 percent."

Shoop, who was diagnosed in May 2010, believes she contracted the infection either while in a nursing home for a broken arm or in a hospital for breast cancer treatment. Rates of C. diff acquired in health care settings have skyrocketed in recent years, climbing more than 200 percent in people older than 65 between 1996 and 2009, according to the Centers for Disease Control and Prevention. Between 20 percent and 50 percent of those patients may wind up with hard-to-treat recurrent infections, Rubin said.

For Shoop, getting an appointment with Dr. Rubin was a godsend. She and her husband stayed at a nearby hotel, where Bob, 77, was under pressure to produce a usable stool sample within 15 minutes of her scheduled appointment.

“We gave him chocolate, we gave him wine, we gave him steak,” she said.

Bob complied and the pair rushed to the clinic, where Dr. Rubin snaked a tube through Shoop’s nose and into her stomach.

“It was 20 minutes,” she said. “He told me, ‘You’re not going to taste it, you’re not going to smell it.’” And she didn’t.

That was on a Thursday. By Sunday afternoon, Shoop was better. Nearly a year later, she says she still feels fine. Her health is so much improved, in fact, that Shoop has become an ambassador of sorts for fecal transplant, sharing her story with anyone who raises the specter of C. diff.  

“I tell them I know of a procedure that works,” said Shoop, who believes she would have died without it.

“Now, I’m disgustingly normal."

Related stories:

Nasty gut bug spikes in U.S. hospitals

Hospital garb harbors nasty infections

From petri dish to people? Lab infections spread illness, death