SESSION TITLE: Chest Infections I Student/Resident Case Report Posters
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Bordetella bronchiseptica is a pleomorphic gram-negative coccobacillus that commonly causes respiratory tract infections in dogs. Bordetella bronchiseptica infections in humans is a very rare entity and less than 40 cases of infections involving bloodstream, respiratory tract, surgical wound infections have been described in literature1. In this case we describe a patient with CD 4 count of 5 cells/µl presenting with 3 week history of productive cough, night sweats and known home pet (cat) exposure presenting with this uncommon infection.
CASE PRESENTATION: 51 year old man with a history of HIV/AIDS (CD4 count of 5 cells/µl, last viral load 500,000 a month prior to presentation), diffuse large B cell lymphoma status post chemotherapy in 2011, listeria meningitis, hypertension, poly substance abuse (nasal cocaine and heroin) presented with 2-3 weeks of productive cough, muscle aches, joint pain, fatigue, shortness of breath, wheezing, fevers and night sweats. The cough was productive of brownish sputum and was associated with chest pain. He also reported alternating diarrhea and constipation. Patient had several episodes of hypoxemia requiring supplemental oxygen via facemask during his stay. On exam he had no crackles or wheezing but had decreased breath sounds throughout all lung fields. Chest radiograph revealed a persistent right mid and lower lung reticular opacity, compatible with pneumonia. Patient went under bronchoscopy for further evaluation of the opacity. Bronchoscopy was negative for any endobronchial lesions, mucous plugs and any other etiology. Cultures from the bronchoalveolar lavage grew Bordetella bronchiseptica. He was discharged home on levofloxacin for a 7 day course with resolution of symptoms.
DISCUSSION: Pneumonia is a common disease seen in immunocompromised patients with organisms ranging from aerobic to anaerobic types. Bordetella bronchiseptica as the cause of pneumonia in immunocompromised patients is very rare and less than 10 cases have been reported. It commonly causes respiratory tract infections in dogs but multiple animals have been identified to be carriers with different susceptibilities ranging from guinea to rats, rabbits, horses, cats, chickens and mice.2
CONCLUSIONS: In severely immunosuppressed patients with atypical pneumonia like presentation, pet exposure should be part of the inquiry and infections related to pet ownership/exposure should be considered in the list of differential diagnoses.
Reference #1: Dworkin MS, Sullivan PS, Buskin SE, Harrington RD, Olliffe J, MacArthur RD, Lopez CE. Bordetella bronchiseptica infection in human immunodeficiency virus-infected patients. Clin Infect Dis. 1999 May;28(5):1095-9
Reference #2: Woolfrey BF, Moody JA. Human infections associated with Bordetella infected patients, especially those with severe immunosuppres- bronchiseptica. Clin Microbiol Rev 1991;4:243-55
DISCLOSURE: Keith Guevarra: Other: ACCP The following authors have nothing to disclose: John Kileci, Yuriy Takhalov
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