Methodology, efficacy and safety of fecal microbiota transplantation in treating inflammatory bowel disease (2020, review). Possible herpes zoster (shingles) transfer, and herpes also reported as adverse event in a placebo group FMT

[Michael Harrop]

https://www.sciencedirect.com/science/article/pii/S2590097820300252

Highlights​

• Fecal microbiota transplant is a new treatment for inflammatory bowel disease.
• Fecal microbiota transplant methods and related results vary among different centers.
• The progress of methods and strategy is moving fecal microbiota transplant forward.
• Washed microbiota preparation reduced adverse event without discounting efficacy.

Click to shrink...

Abstract​

Fecal microbiota transplantation (FMT), as an emerging therapy, can be used to treat microbiota related diseases. Progresses in donor screening, washed microbiota preparation, microbiota delivery routes, clinical administrative strategies, and long-term safety are moving FMT forward. Increasing clinical studies, especially those randomized controlled trials about ulcerative colitis and pilot real-word studies about serious inflammatory bowel disease (IBD), have been conducted. This review presents the latest findings about the efficacy, safety and methodology of FMT in treating IBD.

Click to shrink...

You can search the page for "herpes". It's in Section 5, Short-term and long-term safety of FMT in IBD.

It apparently occurred in multiple studies. It's listed under "placebo".

NSAE = Non-serious adverse events.

 

[indigo34]

Do they not ask donors if they have herpes???

Or could you get herpes from FMT if your donor doesn't have herpes?

Also maybe I'm reading this wrong but it seems like 2/4 instances of herpes were from placebo in Paramsothy et al.

 

[Michael Harrop]

Do they not ask donors if they have herpes???

Click to shrink...

It's not part of the standard screening criteria. https://humanmicrobiome.info/fmt/#screening

Or could you get herpes from FMT if your donor doesn't have herpes?

Click to shrink...

I don't see how.

Also maybe I'm reading this wrong but it seems like 2/4 instances of herpes were from placebo in Paramsothy et al.

Click to shrink...

I think you're right. Their table is very hard to read on small screens (mine currently). It does appear that all reports for herpes are under "placebo". I'll change the thread title.

 

[indigo34]

Wow, it really should be part of the screening criteria.

It appears four times in the study you linked so you were not incorrect. Two instances were from FMT (2 separate studies, Ding et al. and Wang et al.) but 2 instances were from placebo (Paramsothy et al.) The placebo in the study involved colonoscopy. I suppose poor sanitation of medical equipment between patients could hypothetically cause herpes from colonoscopy.

 

[Michael Harrop]

This one mentions herpes zoster (shingles):

The Safety of Fecal Microbiota Transplantation for Crohn’s Disease: Findings from A Long-Term Study (2018) https://link.springer.com/article/10.1007/s12325-018-0800-3

FMT Related AEs​

In total, 139, 106 and 32 patients were included for analysis with 12 months, 2 years and 5 years of follow-up, respectively. All FMTs were delivered through the mid-gut. A total of 33 patients underwent multiple FMTs for maintaining clinical response during a long-term period. The second FMT for CD was performed generally 3–6 months after the first FMT [7]. Six patients were performed the second FMT within 1–3 months after the first FMT in consideration of their serious condition. In total, 184 FMTs were performed for 139 patients. Of these, 13.6% (25/184) of AEs occurred within 1 week after FMT (Fig. 1). Only herpes zoster was observed within 1 week after FMT but it was cured within 1 month. According to CTCAE, the relevance to FMT was classified as probable or possible, and 84.0% (21/25) of AE were considered grade 1. All AEs occurred after FMT and 84% of them were self-improvement without medication treatment (Table 2).

During 1 month after FMT, 13.6% of mild AEs occurred, including increased frequency of defecation, fever, abdominal pain, flatulence, hematochezia, vomiturition, bloating and herpes zoster. No AE beyond 1 month was observed.

Click to shrink...

They screened for herpes simplex virus:

Donors were considered to be suitable according to our screening criteria [6]. Healthy donors were selected from patients’ relatives or friends or from our universal stool bank (China fmtBank), and carefully screened using the following exclusion criteria: history of drug use (e.g., antibiotic, laxative or diet pill use within the past 3 months; prior immunomodulator or chemotherapy use) and history of disease (e.g., infectious diseases, obesity, diabetes, IBD, irritable bowel syndrome, chronic diarrhea, constipation, colorectal polyps or malignant neoplasm, immunocompromised states, metabolic syndrome, allergy, history of major gastrointestinal operation or auto-immune diseases, as well as any other diseases or conditions related to the disturbance of intestinal microbiota). All donors accepted laboratory examinations, such as regular blood tests, C-reactive proteins, erythrocyte sedimentation rates, immunoglobulin subtypes, biochemical tests, hepatitis-associated indices, HIV, syphilis, Cytomegalovirus, Epstein–Barr virus, rubella virus, herpes simplex virus, toxoplasma, and stool testing (including stool culture, stool ova and parasites).

Click to shrink...

I don't see herpes mentioned in the other one.