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ISSN: 2472-1220
Journal of Kidney
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Bordetella Bronchiseptica in a Kidney-pancreas Transplant Recipient after Dog Vaccination

Youssefi N* and Chobanian M

Dartmouth University, USA

*Corresponding Author:
Nick Youssefi DO
Dartmouth-Hitchcock
Lebanon, NH, USA
E-mail: nicholas.d.youssefi@ hitchcock.org

Received Date: February 01, 2016; Accepted Date: February 25, 2016; Published Date: February 29, 2016

Citation: Youssefi N, Chobanian M (2016) Bordetella Bronchiseptica in a Kidneypancreas Transplant Recipient after Dog Vaccination. J Kidney 2:120. doi:10.4172/2472-1220.1000120

Copyright: © 2016 Youssefi N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

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.

Keywords

Bordetella bronchiseptica; Immunosuppressed; Transplant

Introduction

Bordetella bronchiseptica is a gram negative coccobacillus that causes infections in animals including dogs, rabbits, guinea pigs, rats, mice, horses, chicken, and koala bears. It is the causative agent in kettle cough, which is a dry ‘honking’ cough. Most infections with Bordetella bronchiseptica affect immunocompromised patients exposed to farm or companion animals. Immunocompetent patients may produce only pertussis-like symptoms, whereas immunosuppressed patient illnesses can range from respiratory symptoms to severe pneumonia [1]. We report a case of Bordetella bronchiseptica in a kidney and pancreas transplant patient.

Case History

A 55-year-old gentleman with a history of living related kidney transplant, pancreas transplant, diabetes, hypertension, hyperlipidemia, smoking history who presents to the hospital with fever/chills. Patient had a living related kidney transplant 4 years ago. He had pancreas transplant 3 weeks prior to current hospitalization. Patient immunosuppressed on Prograf, Cellcept. Patient recently had PICC line in place due to dehydration requiring IV fluids as outpatient. He had adopted a dog recently after his wife went back to work. 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, vomiting. Physical exam revealed blood pressure 117/84 mm/Hg, heart rate 70 beats per minute, respiratory rate14, temperature 38.3 C, 98% on room air. Cardiac exam revealed holosystolic murmur loudest at apex, regular rate. Auscultation of lungs revealed clear lungs bilaterally. Her extremities revealed no edema. No leukocytosis, normal renal function. CXR revealed no infiltrate, no lymphadenopathy. Blood cultures from peripheral line and PICC cath tip revealed Bordetella bronchiseptica sensitive to quinolones and trimethoprim-sulfamethoxazole. Transthoracic echocardiogram revealed no vegetations. Patient started on piperacillin/tazobactam and later converted to Ciprofloxacin after sensitivity results 72 hours later. PICC line removed. His symptoms gradually resolved and patient was discharged home with antibiotics after 4 days of hospitalization. Patient completed a two week course of Ciprofloxacin.

Discussion

Household dogs and some cats are regularly vaccinated against Bordetella bronchiseptica. There are two types of vaccines available: a live-attenuated intranasal administered vaccine and an injectable inactivated vaccine. The live-attenuated vaccine can be transmitted for weeks after immunization. Bordetella bronchiseptica are very closely related to B. pertussis and parapertussis [2] B. bronchiseptica and B. pertussis both possess the gene for the pertussis toxin but the toxin is only expressed in B. pertussis. Typically, Bordetella bronchiseptica affect the cilia of respiratory epithelial cells resulting in stasis and thickening of the mucous. Adenylate cyclase toxin also affects the host immune response by disrupting chemotaxis, superoxide production, and killing [3]. Transmission occurs via respiratory droplets or by direct contact. Nosocomial transmission of B. bronchiseptica has also been reported. 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, third-generation cephalosporins, and trimethoprimsulfamethoxazole. Duration of therapy is based on immune status of patient, however ranges from 2-6 weeks. Effective therapy is often hard due to the ability of Bordetella bronchiseptica to invade and persist in epithelial cells [4] . Immunosuppressed patients should avoid contact with sick humans and avoid animal contact, especially with young animals who have received live vaccines [5]. Solid organ transplant recipients should avoid live vaccines due to the risk of active infection. In the case of the shingles vaccine, transplant patients should be isolated from family members receiving the vaccine who develop a rash. Whenever possible, the varicella-zoster vaccine should be given to household contacts of varicella-zoster virus -seronegative solid organ transplant candidates prior to transplantation in order to reduce the risk of transmission of the vaccine strain of the virus following transplantation.

In summary, we report a case of Bordetella bronchiseptica in a kidney and pancreas transplant patient. The patient developed Bordetella bronchiseptica bacteremia after exposure to a recently vaccinated dog and exposure to the dog licking the PICC line. It is important for physicians to be aware of the risks for Bordetella bronchiseptica in immunosuppressed patients who have contact with pets as they pose a health risk.

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Review summary

  1. Eugene Kristiansen
    Posted on Oct 21 2016 at 6:36 pm
    Infection is a very common secondary complication in immunosuppressed. The author reported some unusual infections by unusual organisms. Infections by B. Bronchiseptica although rare is not uncommon and has been reported in the past by Woolfrey et al. (Clin Microbiol Rev. 1991 Jul; 4(3): 243-255.) and many other case reports in immunocompromised patient : Pediatr Transplant. 2003 Oct;7(5):413-7. and many. Further reports highlighting the correlation of such cases with other live vaccines and infections in immunosuppressed patient is sought. For example shingles vaccine to the family member of kidney transplant recipients.
 

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