It’s easy to write a series of posts about oddball infections. I often wonder whether it’s worth highlighting some of these rare disease reports since it’s possible for them to be taken out of context and unnecessarily freak people out. Yet, they often have a couple of useful messages.
A paper in an upcoming edition of Transplant Infectious Diseases (Powers et al 2017) describes Bordetella bronchiseptica infection in a kidney transplant recipient. This bacterium is typically dog-associated, although it can be found in a variety of species. The risk to people is very limited (as evidenced by how common it is in dogs and how rare reports are in people), but infections can occur.
In this case, a person who had a kidney transplant 15 years earlier was being maintained on drugs to suppress his immune response, putting him at increased of infection of any sort. He developed some non-specific signs such as fever and chills, which progressed to signs of respiratory disease, abdominal pain and diarrhea. Blood cultures were taken when he was hospitalized and he was started on antibiotics. Bordetella bronchiseptica was isolated from the blood cultures, and he was then switched to an appropriate drug. Fortunately, he recovered.
A dog source was considered, as is reasonable, and he owned 3 dogs. An interesting aspect of his history was that he had had skin biopsies taken recently, and the dogs had licked the biopsy sites. The combination of inoculation of saliva (a source of this bacterium) into skin wounds and his compromised immune system probably accounts for this rare infection. The dogs weren’t tested and there’s no mention of whether they had been sick or had high-risk contacts for acquiring Bordetella themselves.
In the grand scheme of things, this rare infection isn’t particularly important (unless you’re the person with the infection). But the accompanying message is important. As the authors concluded:
- Health care providers should ask about animal exposure when taking the history of an SOT patient with a suspected infection. It also serves as a reminder to educate patients on immunosuppressive therapy to maintain good hygiene with pets, especially around open wounds.
It’s a pretty basic message (and one that’s repeated here a lot), but it’s important to keep saying it.