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Bordetella Bronchiseptica Infection in an Immunosuppressed Patient FREE TO VIEW

Satish C. Chada, MBBS; Jennifer A. LaRosa, MD; Michael V. Cutaia, MD; Ravindra M. Mehta, MD
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SUNY Downstate, Brooklyn, NY


Chest. 2003;124(4_MeetingAbstracts):256S. doi:10.1378/chest.124.4_MeetingAbstracts.256S
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INTRODUCTION:  Infection with Bordetella bronchiseptica, a pleomorphic gram-negative coccobacillus is rare in humans. About 35 cases have been reported, predominantly in hiv or immunosuppressed patients with exposure to dogs. We report a case of this infection in an immunosuppressed individual with exposure to cats.

CASE PRESENTATION:  55-year black male presented with 5 days of fever, chills and productive cough. Past medical history included diabetes, end stage renal disease and renal transplant (1994) on predisnone and cylcosporine, and treatment for tuberculosis (1971). Other relevant details included a significant smoking history and two pet cats. Physical exam was unremarkable. Chest xray showed a new right upper lobe infiltrate. Due to the acute presentation, he was treated for community acquired pneumonia with ampicillin/sulbactam and azithromycin.He returned 2 months later with persistent cough and blood-tinged sputum. Chest imaging showed a persistent right upper lobe infiltrate, with partial scarring. Three sputum samples were negative for acid-fast bacilli. Bronchoscopy was unremarkable, but bal cultures of the affected segment were positive for Bordetella bronchiseptica, which was sensitive to quinolones/aminogycosides, and resistant to ampicillin/cephalosporins. He recieved ciprofloxacin for 4 weeks, with complete resolution of symptoms and infiltrate/scarring on chest imagingDISCUSSION: Most cases of Bordetella bronchisepticainfection are associated with respiratory infections in hiv and immunosuppressed individuals, though it may also occur in the immunocompetent host. The organism is isolated from sputum cultures, nasal swab, or BAL fluid. Treatment is based on results of susceptibility testing, Bactrim or aminoglycosides are empirical options. Contact with animals is important. In our patient, the infection was likely acquired from a cat, and of note Bordetella bronchisepticaculture-positive cats may be clinically normal. The exact duration of treatment is not clear. This case also emphasizes the importance of bal in immunocompromised patients in isolating unusual organisms, especially in the setting of failure of empirical therapy.

CONCLUSION:  Bordetella bronchiseptica infection is a treatable cause of infiltrates in immunosuppressed patients, especially with a history of animal contact.

DISCLOSURE:  S.C. Chada, None.

Monday, October 27, 2003

4:15 PM - 5:45 PM




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