Bordetella bronchisepticapneumonia in a kidney-pancreas transplant patient after exposure to recently vaccinated dogs

Abstract

Bordetella bronchiseptica is an uncommon cause of respiratory infection in humans generally occurring in immunocompromised individuals exposed to infected animals. A 61-year-old female underwent a kidney-pancreas transplant 7 years before presentation. Postoperative immunosuppression was achieved with sirolimus and mycophenolate mofetil. The patient was doing well until she developed a small bowel obstruction secondary to adhesions. She underwent surgical adhesiolysis without complications. Two weeks postoperatively the patient developed pneumonia. She failed to respond to repeated courses of antibiotics, and thus, diagnostic bronchoscopy with bronchoalveolar lavage (BAL) was performed. BAL cultures grew B. bronchiseptica. Further investigation revealed that the patient's dogs had recently received a live-attenuated B. bronchiseptica intranasal vaccination. The patient recovered after 21 days of therapy with doxycycline based upon in vitro susceptibility testing. B. bronchiseptica is an uncommon but recognized human pathogen. It most commonly affects immunocompromised individuals. Here, we report a culture-proven case of B. bronchiseptica pneumonia in an immunocompromised host residing in a household with her dogs who had recently received live-attenuated, intranasal B. bronchiseptica vaccinations. As polymerase chain reaction testing was not performed comparing the isolated strain to the vaccination strain, the association is presumptive. This report expands the spectrum of immunocompromised hosts to include renal-pancreas transplant patients who have developed infection from B. bronchiseptica, while illustrating the risks associated with animal contacts and attenuated vaccines in the immunosuppressed population.

Bordetella Bronchiseptica in the Immunosuppressed Population – A Case Series and Review.

“…Common patient histories include recent contact with ill cats and dogs, healthy dogs,24 and contact with newly vaccinated dogs 27. Therefore, a history of contact with animals is very important in immunocompromised individuals and such patients should be counseled on how to minimize zoonotic infections.…”

Immunocompromised patients and their pets: Still best friends?

“…These vaccines may cause human infections following exposure to the preparations or their persistence in and shedding by immunized animals (Berkelman, 2003). To the best of the author's knowledge, only one case of an IC person being infected from her pet immunized with a live B. bronchiseptica vaccine has been reported (Gisel et al, 2009).…”

Bordetellosis

“…39,40 However, as yet, there has been no molecular proof that the B. bronchiseptica strains isolated from affected human patients match vaccine strains. 39,40 However, as yet, there has been no molecular proof that the B. bronchiseptica strains isolated from affected human patients match vaccine strains.…”