The 900th Hospital of the Chinese People's Liberation Army Joint Logistics Support Force——Wang Rong

The patient, male, started to have diarrhea after eating wild boar meat, with watery stools, no fever, and loose stools.10remaining times/Day.2022year4month20He visited a local hospital on the same day, and his stool routine and electrolytes were normal. Colonoscopy showed multiple polyps in the colon (removed). He was treated with antidiarrheal and other symptomatic treatments, but did not improve.2022year5month23day, due to repeated diarrhea1I visited No. 900 Hospital more than a month ago, and multiple routine stool examinations were normal. Daily stool culture examinations, tumor markers, electrolytes, and thyroid function tests were all normal. I was given probiotics, antidiarrheal and other symptomatic treatments, but the condition did not improve. After admission5High fever occurs in the day, and the body temperature is the highest39℃, diarrhea worsens, stool becomes close20times/Day, accompanied by tenesmus and bowel sounds. It is easy to defecate during bowel borborygm without abdominal pain. Symptoms improved slightly after fasting and worsened after eating, due to the recent consumption of liquid diet.1Months, weight loss is approx.2.5kg。2022year5month29On the same day, the first fecal culture result suggested a Bacillus cereus infection, and multiple blood cultures were negative (Bacillus cereus is a recognized foodborne pathogen that is widely distributed in the environment and can cause diarrhea and vomiting. Cereus spores are a highly specialized, metabolically dormant cell type that tolerates extreme environmental conditions such as high temperature, freezing, and drying well. High-temperature sterilization of spore-forming strains requires120℃60Minutes to kill. The detection of Bacillus cereus increases significantly during high temperatures in summer. The main reason is eating spoiled leftovers. After food is contaminated, there are8-16hour incubation period).2022year5month30day, treated with vancomycin3day, the body temperature drops to38℃, diarrhea reduced to15times/On the same day, she was switched to moxifloxacin, her body temperature returned to normal, and her diarrhea reduced to10times/Day. Colonoscopy showed no obvious abnormalities, excluding pseudomembranous colitis. Gastroscopy showed atrophic gastritis, and gastrointestinal barium meal angiography showed accelerated intestinal motility. Continue treatment with moxifloxacin for a total of6days, the frequency of bowel movements remains the same9-10times/On the same day, the patient still had watery stools, accompanied by tenesmus and bowel sounds, and the patient gradually developed anxiety symptoms. Adding intestinal motility regulators, anti-anxiety drugs, and replacing various probiotics did not improve the condition.

Genetic testing of gut microbiota showed that the patient's gut microbiota was in a third-level imbalance. Most beneficial bacteria were low in abundance or absent, while neutral and pathogenic bacteria were high in abundance. Most of the bacteria that could easily cause diarrhea were too high in abundance. Considering that conventional treatment was ineffective, microbiota transplantation was performed.

Transplantation plan: Oral liquid live bacteria enteric-coated capsules,40grains/times, once every other day, three times in total.

Transplantation efficacy: after transplantation1weeks, the frequency of bowel movements gradually decreased to3times/On the same day, the stool was more formed than before, with no obvious symptoms of tenesmus, and bowel borborygmire improved. The patient's mood improved significantly and he was discharged from the hospital. After discharge1months, stool2-3times/Day, a little out of shape, diet restored, weight gain1.5kg, no other discomfort. The bacterial flora test was reviewed and the abundance of beneficial bacteria increased, while the abundance of most neutral bacteria and pathogenic bacteria decreased.

Chronic diarrhea is a common symptom of the digestive system and a common reason for outpatient consultation in gastroenterology departments. When it occurs, it affects the patient's physical strength, mental state, nutrient absorption, and daily work, greatly reducing the patient's quality of life and causing a large social burden. Chronic diarrhea lasts longer than4weeks, or intermission period in2~4Recurrent diarrhea within weeks. Chronic diarrhea can be caused by a variety of diseases, among which bacterial infection can cause chronic diarrhea symptoms by releasing toxins or causing gut microbiota imbalance. Microbiota transplantation can effectively treat chronic diarrhea caused by bacterial infections and severe gut microbiota imbalance.