Youssefi N and Chobanian M
Bordetella bronchiseptica is a gram negative coccobacillus that causes infections in animals including dogs,rabbits, and guinea pigs. It’s the causative agent in kennel cough, producing a dry‚ ‘honking’ cough. We report a case of Bordetella bronchiseptica in a kidney and pancreas transplant patient. A 55-year-old gentleman with a history of a living related kidney transplant, pancreas transplant, diabetes, hypertension, hyperlipidemia, and smoking history who presented to the hospital with fever/chills. He underwent pancreas transplantation 3 weeks prior to his current hospitalization. He was immunosuppressed on Prograf, Cellcept. Patient recently had a PICC line in place due to dehydration requiring IV fluids as an outpatient. He had adopted a puppy recently after his wife went back to work for companionship. The puppy had been given live vaccines around the time of transplant. Puppy noted to have been licking the PICC line. Patient denied cough, sore throat, nausea or vomiting. Physical exam revealed blood pressure 117/84 mm/Hg, heart rate 70 beats per minute, respiratory rate 14, temperature 38.3°C, 98% on room air. Auscultation of lungs revealed clear lungs bilaterally. No leukocytosis, normal renal function. CXR revealed no infiltrate, no lymphadenopathy. Blood cultures revealed Bordetella bronchiseptica sensitive to quinolones and trimethoprim-sulfamethoxazole. Patient started on piperacillin/tazobactam. His PICC line was removed. All symptoms gradually resolved with antibiotics over a two week course of Ciprofloxacin. Household dogs and some cats are routinely vaccinated against Bordetella bronchiseptica. Transmission occurs via respiratory droplets or by direct contact. Diagnosis is based on positive cultures or polymerase chain reaction from a patient with a history of exposure to infected animals. Treatment includes aminoglycosides, antipseudomonal penicillins, quinolones, tetracyclines, thirdgeneration cephalosporins, and trimethoprim-sulfamethoxazole. Duration of therapy is based on immune status of patient, however ranges from 2-6 weeks. Immunosuppressed patients should avoid contact with unvaccinated or newly vaccinated especially those with young animals who have received live vaccines.
