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‘Kennel Cough’ in a patient following allogeneic hematopoietic stem cell transplant

Bone Marrow Transplantation volume 44, pages 381–382 (2009)Cite this article

Bordetella bronchiseptica is a Gram-negative coccobacillus that frequently causes infections in animals, including atrophic rhinitis in swine, snuffles in rabbits and kennel cough in dogs.1 The most common symptom of kennel cough is a dry ‘honking’ cough. B. bronchiseptica belongs to the same genus as the causative agent of whooping cough in humans, Bordetella pertussis, an organism that infects only humans. Most infections with B. bronchiseptica occur in immunocompromised individuals exposed to farm or companion animals, although infections have been reported in immunocompetent patients.1, 2, 3 The organism is usually susceptible in vitro to the aminoglycosides, antipseudomonal penicillins, quinolones, tetracycline, third-generation cephalosporins and trimethoprim–sulfamethoxazole. Effective treatment is often difficult because of the patient's underlying disease and the ability of the organism to invade and persist in epithelial cells. The two veterinary vaccines currently marketed are an avirulent live intranasal vaccine and a s.c. antigen extract vaccine. Although data suggest that the intranasal route may be effective within 72 h, there is less data on the efficacy of the s.c. vaccine.

We present a case of B. bronchiseptica infection in a patient with graft-versus-host disease (GVHD) after allogeneic hematopoietic SCT (allo-HSCT). A 29-year-old man with chemorefractory stage IIIB anaplastic large cell-lymphoma underwent a myeloablative conventional allo-HSCT from a 10/10 matched unrelated donor after conditioning with TBI, thiotepa and CY. He received tacrolimus, sirolimus and MTX for GVHD prophylaxis. His transplant course was notable for acute renal failure and the nephrotic syndrome with a maximum creatinine of 3.5 mg/dl, which resolved after the discontinuation of sirolimus. Grade III gut GVHD was diagnosed by sigmoidoscopy on day +90 and he was treated with steroids (max dose 2 mg/kg), in addition to the ongoing tacrolimus and mycophenolate mofetil (MMF). On approximately day +170 he developed a flare of his gut GVHD while completing a slow taper of his prednisone necessitating an increase in steroid doses. On day +202, he first reported a persistent productive cough. He also noted dyspnea with exertion, but no fevers. Azithromycin was prescribed without relief in symptoms. Subsequently, he reported that his four-month-old puppy had been diagnosed with kennel cough approximately 2–3 weeks before the start of his symptoms. The dog had received one dose of the s.c vaccine, Bronchicine™CAe, without subsequent booster. After presenting to the veterinarian with the classic honking cough and rhinorrhea, the dog was empirically treated with an antibiotic injection leading to a rapid improvement in her symptoms. A nasopharyngeal specimen from the patient was sent for culture, with a specific request to rule out B. bronchiseptica. The culture was positive for B. bronchiseptica, sensitive to the usual antibiotics. He was treated with levofloxacin with an improvement in his symptoms. On completion of the antibiotics, he had recurrent symptoms and his culture showed the persistence of B. bronchiseptica. He was treated with a second course of levofloxacin. His chest X-Ray did not show any evidence of pneumonia and his symptoms improved again. A third nasopharyngeal specimen, collected three weeks later, was also culture-positive for B. bronchiseptica. He was then treated with a course of ciprofloxacin and doxycycline, on the basis of antimicrobial susceptibility test results. While on this therapy, a repeat specimen was culture-positive for B. bronchiseptica, now with resistance to ciprofloxacin. As he continued to report a slight chronic cough, his treatment was changed to inhaled tobramycin, and after four weeks of treatment, his nasopharyngeal specimens remained culture positive. He was observed off therapy and, because his symptoms had resolved by this time, he did not receive further antibiotics. In total, he received 10 weeks of antibiotic therapy.

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Acknowledgements

This work was supported by the National Institutes of Health (NIH) Grant T32 AI055409 (JDG).

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Authors and Affiliations

  1. Department of Medicine, Allogeneic Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    J D Goldberg, R Ford & M-A Perales

  2. Department of Medicine, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    M Kamboj

  3. Department of Clinical Laboratories, Microbiology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    T E Kiehn & K Gilhuley

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  1. J D Goldberg
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  2. M Kamboj
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  3. R Ford
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Correspondence to M-A Perales.

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Goldberg, J., Kamboj, M., Ford, R. et al. ‘Kennel Cough’ in a patient following allogeneic hematopoietic stem cell transplant. Bone Marrow Transplant 44, 381–382 (2009). https://doi.org/10.1038/bmt.2009.22

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