Plus-Hex CLINICAL
( Suchodolski , 2016 ). The gut microbiome can be affected by diet and the environment , but also by medication . The human microbiome is affected by the administration of ciprofloxacin , with the microbiome reducing in diversity and never returning to its original state , even when the ciprofloxacin is stopped ( Dethlefsen et al ., 2008 ). Dogs are affected in similar ways , with a reduction in bacterial richness and diversity of 40 % in dogs after the administration of tylosin ( Suchodolski et al ., 2009 ).
Figure 1 . Persistent third eyelid protrusion due to ongoing diarrhoea .
with hypoallergenic food caused worsening of the diarrhoea , and novel proteins only worked for a short period of time ( 3 – 4 weeks ), after which the diarrhoea developed again .
Blood analysis and B12 , folate and trypsin-like immunoreactivity ( TLI ) were in conclusive . Hypermotility was noted on the ultrasound , and gastrointestinal biopsies were inconclusive . Logan also had persistent third eyelid protrusion ( Figure 1 ), polydipsia , polyphagia and severe weight loss concurrent to his diarrhoea ( 2.9 kg ), resulting in a body condition score ( BCS ) of 2 / 9 .
A provisional diagnosis of exocrine pancreatic insufficiency ( EPI ) was made , and Logan was started on vitamin B12 ( 0.5 mg Protexin Cobalaplex SID ), probiotics ( 1 pinch of Vivomixx 450 billion SID ), pancreatic enzymes ( VetPlus Lypex 0.6 g SID ) and a low-carbohydrate diet ( Purina Pro Plan Feline Diabetes Management ).
This treatment plan increased Logan ’ s weight to 5 kg ( BCS of 4 / 9 ) but the diarrhoea persisted throughout . In the summer of 2020 , he experienced an acute ( within 1 week ) weight loss of 900 g , 15 % of his overall bodyweight , as well as further diarrhoea , polydipsia ( 8 ml / kg / 24 hours ) and polyphagia . Repeat biochemistry , haematology , B12 , folate and TLI were within normal limits . With the addition of a negative faecal analysis and culture , a decision was made to perform a faecal microbiota transplantation ( FMT ).
FMT : the evidence
The gut microbiome itself is the ecosystem within the gastrointestinal system and is important in balancing digestive health in all mammals . Dysbiosis ( microbial imbalances ) can cause a decrease in production of short-chain fatty acids , leading to the development of chronic inflammatory conditions within the gut
FMT involves the administration of a faecal matter solution into the intestinal tract of a recipient to change the microbial composition and improve health ( Gupta et al ., 2016 ). FMT has been used in human medicine since 1958 ( Eiseman et al ., 1958 ), and can be delivered through a range of routes , including oral capsules , nasoduodenal , nasogastric or colonoscopic administration and via enema . Within feline medicine , FMT had been observed to be successful in practice but studies on the success rates were not widely available . There is an example of a successful case in Israel , where it was performed on a 10-year-old female cat with ulcerative colitis ( Furmanski & Mor , 2017 ). FMT was performed through rectal enema and resulted in an immediate improvement in the texture , colour and odour of the faeces , for the first time in 12 months . The FMT was repeated after a few days due to a relapse of diarrhoea . Afterwards , the patient only required a hypoallergenic diet to maintain healthy faeces .
FMT : the procedure
The following procedural guidelines were put together by Elise Robertson , MRCVS , the veterinary surgeon responsible for Logan ’ s care . They are based on recommendations from discussions with other veterinary surgeons and on the viscosity required for the sample to be placed endoscopically .
FAECES DONOR
The donor selected was the second cat in the household , a 1-year-old domestic short-hair with no vomiting or diarrhoea within the last 6 months . This donor was selected as they had been exposed to the same environment as the recipient . A faecal analysis was performed on a sample beforehand to rule out parasites , Giardia , Salmonella and Tritrichomonas foetus . Fresh faeces were collected the morning of the procedure and stored at room temperature before being prepared for transplantation .
The RVN was crucial in helping the owner source a donor cat and running the tests to ensure the sample would be suitable . Both cats were owned within the same household , so gaining informed consent , collecting samples and reporting test results to the owner was streamlined .
VOL 37 • May 2022
19