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Bordetella bronchiseptica is recognised as a respiratory tract pathogen in many mammalian species, but has rarely been implicated in human infection. A case is reported of pneumonia caused by B bronchiseptica in a patient suffering from acquired immunodeficiency syndrome (AIDS). (Thorax 1994;49:719-720) Bordetella bronchiseptica is a common respiratory tract commensal of wild and domestic animals, occasionally responsible for outbreaks of fatal tracheobronchitis, pneumonia, and septicaemia. It adenopathy was present in lateral/cervical, supraclavicular, and inguinal nodes.The total peripheral leucocyte count was 28 x 109/l, with 70% polymorphonuclear neutrophils, 13% band forms, 10% lymphocytes, and 7% monocytes. The CD4 count was 73/mm3 (normal value >400/mm3). The haemoglobin and platelet count were 8-4 g/dl and 51 x 109/l respectively. Arterial blood gases obtained while the patient was breathing room air revealed pH 7-52, Pao2 6-5 kPa, Paco2 38 kPa. Chest radiography (figure) revealed diffuse bilateral pulmonary infiltrates with lingular consolidation.Plasma sodium and lactate dehydrogenase levels were 126 mEq/l and 653 IU/l, respectively. A Gram stain of sputum contained > 25 neutrophils and < 10 epithelial cells per low power field and abundant, pleomorphic Gram negative coccobacilli. Culture (Charcoal blood medium) grew B bronchiseptica, and smears for acid-fast bacilli, fungi, direct immunofluorescence for Pneumocystis carinii and fluorescent antibody test for Legionella were all negative. Three blood cultures and sputum culture in Lowenstein medium remained negative. Empirical antimicrobial therapy was commenced with intravenous cefotaxime and vancomycin and oral cotrimoxazole for four days without a response. Based on minimum inhibitory concentrations, the initial antibiotic regimen was changed to intravenous ciprofloxacin, 200 mg twice daily. Four days later the patient became afebrile, and cough and dyspnoea disappeared. After the eighth day ciprofloxacin was given orally for three more weeks. Arterial blood gases and the chest radiograph gradually improved. Sputum cultures taken on the day of discharge and one month later were negative.

Our study shows that clinical outcomes of HIV-infected patients with CAP are not predicted by CD4+ cell counts or HIV-RNA levels after adjusting for confounders. The management of CAP in patients with HIV infection should not be based on CD4+ cell counts or HIV-RNA levels of the HIV infection.

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