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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 152-154

Bordetella bronchiseptica infection in an intensive care unit patient


Department of Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission21-Jan-2020
Date of Acceptance21-Jan-2020
Date of Web Publication16-Mar-2020

Correspondence Address:
Dr. Manodeep Sen
Dr. Manodeep Sen, Department of Microbiology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, Uttar Pradesh.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_13_20

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  Abstract 

Bordetella bronchiseptica is a pleomorphic gram-negative coccobacilli typically causing respiratory tract infections in dogs. Its infection in humans is very uncommon. B. bronchiseptica was cultured from the pus swab taken from an ulcer on the chest at the site of chemo-port in a 15-year-old girl in intensive care unit having postviral encephalopathy with cerebral palsy. It is a unique case because we could not find any prior published case report of B. bronchiseptica associated with wound infection in humans. B. bronchiseptica can be a cause of wound infection in humans. In severely immunocompromised patients, this rare organism can become an opportunistic pathogen to cause severe wound infections and medical microbiologists should keep themselves updated in diagnosing such isolates and clinicians should be mindful of their diverse clinical manifestations and limited treatment options.

Keywords: Bordetella bronchiseptica, immunocompromised, wound infection


How to cite this article:
Islahi S, Sen M, Das A, Gupta A, Trivedi S, Agarwal J. Bordetella bronchiseptica infection in an intensive care unit patient. MGM J Med Sci 2019;6:152-4

How to cite this URL:
Islahi S, Sen M, Das A, Gupta A, Trivedi S, Agarwal J. Bordetella bronchiseptica infection in an intensive care unit patient. MGM J Med Sci [serial online] 2019 [cited 2020 Apr 6];6:152-4. Available from: http://www.mgmjms.com/text.asp?2019/6/3/152/280754




  Introduction Top


Bordetella bronchiseptica is a pleomorphic gram-negative coccobacilli that typically causes respiratory tract infections in dogs. B. bronchiseptica infection is an unusual entity in humans, and as of 2014, less than 60 cases of human with bloodstream, respiratory tract, and surgical wound infections are documented in the literature.[1] It is a unique case because we could not find any prior published case reports of B. bronchiseptica associated with wound infection in humans.


  Case report Top


A 15-year-old girl had been admitted in intensive care unit (ICU) for 18 months. She had been on a ventilator. The girl had developed chicken pox some 2 years back. Following this, she had postviral encephalopathy with cerebral palsy. Since then she is admitted and has also developed bacteremia because of Acinetobacter baumannii and fungemia because of Candida tropicalis. Recently she developed an ulcer on her chest just above her right breast at the site of chemo-port. A swab sample was sent from this ulcer for culture and sensitivity. The culture was done on blood agar and MacConkey agar. On blood agar, small grayish-white and shiny hemolytic colonies (1–2mm in diameter after 24h of incubation) were seen [Figure 1]. On MacConkey agar, nonlactose fermenting, pale colonies were seen [Figure 2]. On gram stain, gram-negative coccobacilli were observed. Primary tests used in the identification were indole-negative, methyl red–negative, urease produced (almost instantaneous), oxidase-positive (strong), glucose-non-fermenter, oxidative-fermentative (alkaline in an oxidative tube), motile on motility media, and hanging drop test. The isolated organism was identified as B. bronchiseptica by Vitek 2 compact system. The isolate showed resistance to all the antibiotics except meropenem and trimethoprim–sulfamethoxazole. The patient was put on IV meropenem to which she responded positively [Figure 3] and [Figure 4]. No history of exposure to dogs or cats was noted.
Figure 1: Colonies of Bordetella bronchiseptica on blood agar

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Figure 2: Colonies of Bordetella bronchiseptica on MacConkey agar

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Figure 3: Ulcer after few days of antibiotic treatment

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Figure 4: Ulcer healed after few weeks of treatment

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  Discussion Top


B. bronchiseptica, a gram-negative rod-shaped coccobacillus, is primarily a zoonotic organism that is infrequently pathogenic in humans. B. bronchiseptica in human disease is a rare occurrence and a challenging microbiological diagnosis.[2]

B. bronchiseptica has been associated with surgical wound infections, bloodstream infections, pneumonia, and pertussis-like illness.[3] Very few cases have documented severe sepsis and respiratory failure associated with acute B. bronchiseptica infection. Typically, this organism manifests in immunocompromised or immunoincompetent patients with at least one predisposing condition, such as severe chronic obstructive pulmonary disease, previous lung transplantation, AIDS, acute lymphocytic leukemia, Crohn’s disease, lung cancer, and cystic fibrosis.[1],[4] Although this patient was not immunocompromised, it is likely that infection with B. bronchiseptica was potentiated by improper hand hygiene.

There is no clear guidance regarding the duration of therapy in B. bronchiseptica infection, and antimicrobial administration should be guided by sensitivities as evidence of resistant strains of B. bronchiseptica exists in the literature. B. bronchiseptica is generally sensitive to antipseudomonal penicillins, carbapenems, fluoroquinolones, and aminoglycosides, but not to erythromycin, in contrast to other Bordetella species. Antimicrobial duration is determined on a case-by-case basis, but treatment with one that has good intracellular penetration is essential because of the organism’s ability to invade epithelial cells and phagocytes.[5]

In this case, piperacillin/tazobactam and meropenem were found sensitive and meropenem was chosen based on sensitivities, with duration guided by clinical response to which she responded positively.


  Conclusion Top


Rare cases of B. bronchiseptica causing respiratory tract infections in humans are known. B. bronchiseptica rarely causes wound/skin infection in humans. In severely immunocompromised patients, this rare organism can become an opportunistic pathogen to cause severe wound infections and medical microbiologists should keep themselves updated in diagnosing such isolates. In conclusion, the transmission of B. bronchiseptica remains unclear. There have been a number of cases in the literature traditionally associated with canines and swine that are unable to clarify a clear point of animal interaction in the history of the patient. B. bronchiseptica possibly persists as the human respiratory tract’s normal commensal flora, causing opportunistic infections when its host becomes immunocompromised. This case illustrates its incomplete understanding as a human pathogen. Clinicians should be conscious of its diverse clinical manifestations and limited treatment options.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Yacoub AT, Katayama M, Tran J, Zadikany R, Kandula M, Greene J.Bordetella bronchiseptica in the immunosuppressed population - a case series and review. Mediterr J Hematol Infect Dis2014;6:e2014031.  Back to cited text no. 1
    
2.
Clements J, McGrath C, McAllister C.Bordetella bronchiseptica pneumonia: beware of the dog!BMJ Case Rep2018;2018: pii:bcr-2018-224588.  Back to cited text no. 2
    
3.
Stefanelli P, Mastranantonio P, Hausman SZ, Giuliano M, Burns DL.Molecular characterization of two Bordetella bronchiseptica strains isolated from children with coughs. J Clin Microbiol1997;35:1550-1555.  Back to cited text no. 3
    
4.
García San Miguel L, Quereda C, Martínez M, Martin-Davila P, Cobo J, Guerrero A.Bordetella bronchiseptica cavitary pneumonia in a patient with AIDS. Eur J Clin Microbiol Infect Dis1998;17:675-676.  Back to cited text no. 4
    
5.
Papasian CJ, Downs NJ, Talley RL, Romberger DJ, Hodges GR.Bordetella bronchiseptica bronchitis. J Clin Microbiol1987;25:575-577.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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