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- As yet, with cure rates around 85%, recurrent Clostridium difficile infection is the only definite indication for faecal microbiota transplantation.- Faecal microbiota transplantation induces clinical remission and endoscopic improvements in 24-30% of patients with ulcerative colitis, compared to 5% (water) to 20% (autologous faeces) in placebo-treated patients. Current research focuses on the identification of 'super donors', and subgroups of patients in which faecal microbiota transplantation is effective.- In patients with metabolic syndrome, faecal microbiota transplantation may increase insulin sensitivity. Weight, body mass index, and energy metabolism are not affected by faecal microbiota transplantation in humans.- In addition to the aforementioned indications, faecal microbiota transplantation is an emerging treatment modality for patients with Crohn's disease, irritable bowel syndrome, graft-versus-host-disease, and carriage of multidrug-resistant micro-organisms. Randomized controlled trials, comparing faecal microbiota transplantation with placebo treatment, are required to determine the effectiveness of faecal microbiota transplantation in these patient groups.

A 72-year-old man with a history of prostate cancer was seen with pain in the right leg and the left arm. He suffered from a clostridial myonecrosis. Physical examination showed typical findings of purple discoloration of the skin and hemorrhagic bullae. The patient eventually died because of septic shock.

Background: Clostridium difficile infection usually manifests as pseudomembranous colitis. Infection of the small intestine is rare. C. difficile enteritis has a high mortality rate due to secondary enteric necrosis and perforation., Case Description: We describe an 87-year-old woman with abdominal pain, who died from necrotizing enteritis due to a C. difficile infection. This is the first described case of small bowel involvement in the absence of known risk factors for C. difficile enteritis, i.e. bowel surgery and recent use of antibiotics. The described patient was using immunosuppressants, which in this case could have been a risk factor for small bowel colonization with C. difficile., Conclusion: In clinical practice it is important to be prepared for C. difficile infection, as early treatment of this infection will strongly improve the prognosis. Identification of patients at an increased risk of C. difficile infection is of great value in this respect.

A 59-year-old man was admitted to the hospital to be operated on for carcinoma of the pancreas. During the operation, it turned out that resection ofthe tumour was not possible. Therefore, a double bypass was created for palliation: hepaticojejunostomy and duodenojejunostomy. The postoperative course was complicated by a fulminant sepsis accompanied by massive intravascular haemolysis. This is a rare and often fatal complication of a Clostridium perfringens sepsis. The patient was given antibiotics and multiple blood transfusions, but his haemoglobin remained low and despite the administration of large amounts of fluid, high doses ofinotropic agents and corticosteroids, it was not possible to achieve an adequate circulation. The patient died within 40 hours after admission to Intensive Care. Severe intravascular haemolysis with spherocytes in the blood smear must be interpreted as an important indication of a C. perfringens-sepsis.