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A3617 - 'Kennel Cough' in a Patient Following Orthotropic Heart Transplant
Author Block: M. Naddour1, M. Kalani2, E. Bihler2; 1Allegheny Health Network, Pittsburgh, PA, United States, 2Allegheny General Hospital, Pittsburgh, PA, United States.
Introduction: Bordetella bronchiseptica is a zoonotic infection that commonly causes respiratory tract infections in dogs. Although very rare, human infections with B. bronchiseptica have been documented in immunocompromised individuals including HIV and stem cell transplant patients. We presented a case of an infection in a heart transplant patient which to our knowledge has not been described Case: 61-year-old male with past medical history of heart transplant in 2015 on cellcept, and COPD presented with progressive dyspnea, cough and hypoxia. CT chest showed bibasilar ground-glass opacities. Bronchoalveolar lavage grew Brodetella bronchispetica. After obtaining further social history, it was found that the patient's daughter has a dog who coughs continuously and the patient had been in contact with. Patient was started on doxycycline for two weeks, and had significant improvement in his symptoms and complete resolution of his hypoxemic respiratory failure Discussion: Bordetella bronchiseptica is a gram-negative coccobacillus and is known to cause respiratory infections in many wild and domestic animals such as dogs, pigs and rabbits. In dogs, the bacteria causes inflammatory infiltration in the submucosa of the respiratory tract, and causes mechanical blockade of respiratory cilia resulting in failure to clear mucus secretions. B. bronchiseptica is a rare cause of clinically significant respiratory infections in humans. In the English literature, less than 70 cases have been reported. Majority of the patients had underlying lung disease such as cystic fibrosis or were immunocomprimised, commonly with HIV/AIDS. Our patient was immunocomprimised due to heart transplant, which is an uncommon predisposition. Common histories include direct contact with respiratory secretions from domestic animals such as cats or dogs. Patients typically present with classic symptoms of pneumonia, and infrequently with sinusitis or bronchitis. Diagnosis is established by obtaining cultures from sputum or bronchoalveolar lavage. B. bronchiseptica is usually susceptible to aminoglycosides, extended-spectrum penicillins, tetracyclines, quinolones and TMP-SMX, however appropriate duration has not been established. In the literature. Our patient was treated with doxycycline, which is commonly used for gram-positive bacteria infections, for 2 weeks, and had resolution of symptoms. Conclusion: Physicians should be aware of Bordetella bronchiseptica as a possible cause of pneumonia in organ transplant patients. These patients should be educated regarding animal contact. Further, doxycycline should be considered for treatment for this gram-negative bacterial infection.