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Bordetella holmesii in asplenic patients: a new pathogen?
  1. R de Nobrega1,
  2. K Kotecha2
  1. 1Microbiology, Barts and The London NHS Trust, London, UK
  2. 2Paediatric Haematology, Barts and The London NHS Trust, London, UK

Abstract

Bordetella holmesii is a Gram-negative organism recently recognised as a human pathogen. It can colonise the upper respiratory tract causing respiratory illness and can cause invasive infection, particularly in asplenic patients.

The American Centre for Disease Control and Prevention reported a series of 26 patients with B. holmesii bacteraemia, of whom 85% were asplenic and 38% had sickle cell disease (SCD)1.

We present our experience of B. holmesii bacteraemia over the last five years.

Case 1 A 12-year old girl with SCD was admitted with arthralgia, chest pain and fever. She was diagnosed with painful crisis and respiratory tract infection and started on intravenous co-amoxiclav. She was discharged after 48 hours on oral antibiotics.

Bordetella holmesii was isolated from blood cultures. The patient remained well at home on oral antibiotics and had negative blood cultures one week after discharge.

Case 2 A 15-year old girl with SCD was admitted with fever and arthralgia. She was diagnosed with painful crisis with no focus of infection. She was started on intravenous ceftriaxone and discharged on oral co-amoxiclav after 48 hours, having remained apyrexial since admission.

Bordetella holmesii was isolated from blood cultures. The isolate tested sensitive to augmentin and the patient remained well post discharge.

Case 3 A 36-year old woman with SCD was admitted with coryzal symptoms, chest pain and fever. She was started on intravenous cefuroxime for a lower respiratory tract infection. She was apyrexial after 48 hrs and discharged on oral antibiotics.

Bordetella holmesii was isolated from blood cultures. Despite in-vitro cephalosporin resistance of the organism this patient remained well post discharge.

Bordetella holmesii has been identified three times in our laboratory. All three isolates are from sterile site samples in sickle cell patients, supporting the observation that the organism is pathogenic in this patient group. We believe this is the first series of such patients in the UK.

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