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126 Bordetellosis

• ± Mild to moderate fever, tachypnea and lower airway disease suspected. Can • Contraindicated with pneumonia or produc-
tive cough
increased lung sounds (pneumonia) in severe confirm infection, provide susceptibility, Bronchodilators:
VetBooks.ir Etiology and Pathophysiology • Serologic testing not helpful; many healthy • May be indicated in patients with
and test for secondary pathogens.
cases
animals have positive titers
pneumonia
• The organism colonizes the nasal and tracheal
respiratory epithelium and can establish • Polymerase chain reaction (PCR) techniques Nebulization therapy (p. 1134):
• Nebulization with sterile saline may help
may be applied to nasal or pharyngeal swabs,
persistent, often subclinical infections. transtracheal wash, or BAL fluid samples. hydrate airway secretions and facilitate
• Infection occurs by contact of the organism Often, PCR is part of a multi-pathogen panel clearance, but patient must have adequate
with the upper airway and adherence to the testing for several agents of CIRD. Some systemic hydration.
respiratory epithelium by direct binding to assays can differentiate Bordetella species. • Nebulization with antibiotic solutions
cilia, inducing ciliary stasis and reducing Quantitative PCR of BAL samples is reported (gentamicin, enrofloxacin, kanamycin, or
mucociliary escalator clearance of bacteria to be the most sensitive means of confirming polymyxin B) has been suggested for refrac-
and other particulate matter from the infection. tory cases to reduce Bordetella populations
airways. in the trachea and bronchi, but dose delivery
• Airway colonization induces an inflammatory TREATMENT to airways is unpredictable.
response and increased mucus production. Glucocorticoids (controversial):
• Bordetella spp produce multiple factors Treatment Overview • Antiinflammatory doses administered short
that allow them to persist chronically Treatment is largely supportive care ± antimi- term may reduce cough (e.g., prednisolone
and predispose the host to secondary crobial drugs. Cough suppressants can help 0.5 mg/kg PO q 12-24h for 3-5 days)
infections. break the cough cycle but are contraindicated • Does not shorten course of disease
in cases with pneumonia or productive cough. • May exacerbate disease in immuno-
DIAGNOSIS Unless intensive treatment required (i.e., compromised animals
pneumonia), outpatient treatment best to • Do not use in cases with severe/complicated
Diagnostic Overview reduce nosocomial risk. disease.
Bordetellosis often is a clinical diagnosis, and Adequate systemic hydration very important
because many infections are mild and self- Acute General Treatment to facilitate clearance of respiratory secretions.
limited, the urgency of establishing a definitive Antimicrobials:
diagnosis of bordetellosis is low. Treatment is • Antimicrobials are not always necessary. Behavior/Exercise
usually based only on clinical signs of upper Typical upper respiratory infection is self- Exercise may exacerbate coughing during acute
respiratory infection. limited, and antimicrobials have not been infection.
shown to shorten the course of illness or
Differential Diagnosis reduce period of shedding. Drug Interactions
Dogs: • Antimicrobials are indicated for dogs with Reduce dose of trimethoprim-sulfonamide,
• Other agents of infectious tracheobronchitis fever, lethargy, inappetence, or mucopurulent and avoid gentamicin in patients with renal
(p. 987) nasal discharge and for dogs with evidence disease. Tetracyclines may cause discolor-
• Chronic bronchitis of pneumonia. ation of dental enamel in young animals,
• Collapsing trachea • Bordetella spp show high level of antimi- although less likely with doxycycline than
• Traumatic tracheitis crobial resistance; should treat based on other types.
• Airway foreign body C&S
• Mechanical or chemical airway irritant • Pending C&S for outpatient treatment Possible Complications
• Other causes of pneumonia: infectious, ○ Doxycycline 5 mg/kg PO q 12h or • Pneumonia may develop secondary to
aspiration minocycline 5-12 mg/kg PO q 12h for Bordetella-induced impairment of respiratory
Cats: 7-10 days is the traditional antimicrobial defenses.
• Other upper respiratory infections/agents of choice (most Bordetella isolates are • Dental or bone staining (in very young
(p. 1006) susceptible) or animals) or gastrointestinal (GI) side effects
• Other causes of pneumonia ○ Amoxicillin-clavulanate 12.5-25 mg/kg may occur with doxycycline or minocycline;
PO q 12h; resistance common and inef- avoid in neonates or pregnant dogs, and
Initial Database fective for possible concurrent Mycoplasma follow every dose with an oral bolus of tap
• CBC: often unremarkable; neutrophilia with or water or morsel of food to reduce risk of
left shift or toxic neutrophils may be seen ○ Trimethoprim-sulfonamide 15-30 mg/kg drug-associated esophagitis and stricture.
with pneumonia PO q 12h; resistance common or Tetracyclines may cause fever in cats.
• Thoracic radiographs: indicated with signs ○ Pradofloxacin suspension 7.5 mg/kg PO • Sulfonamides may induce keratoconjuncti-
of systemic illness (e.g., fever, anorexia) q 24h (cats) vitis sicca, hypersensitivity reactions, crystal-
or respiratory distress. Usually unremark- • Pending C&S for animals with pneumonia luria, renal tubule obstruction, polyarthritis,
able; interstitial to alveolar infiltrates with ○ Enrofloxacin 5-20 mg/kg IM, IV q 24h hepatic inflammation, and GI signs.
pneumonia (dogs), 5 mg/kg q 24h (cats)
○ Gentamicin 9-14 mg/kg IV q 24h (dogs), Recommended Monitoring
Advanced or Confirmatory Testing 5-8 mg/kg (cats) • Mild to moderate: clinical response
• Bacterial culture and susceptibility Antitussives: • Pneumonia (p. 795)
(C&S): many healthy animals harbor B. • For suppression of dry, nonproductive cough
bronchiseptica. in milder cases (animal is otherwise well); PROGNOSIS & OUTCOME
○ Nasal or oropharyngeal swabs for bacterial titrate dose to reduce cough without causing
culture: should be plated on selective sedation. • Disease is usually self-limited; uncompli-
medium to decrease overgrowth by other ○ Butorphanol 0.5-1 mg/kg PO q 8-12h cated cases resolve within approximately
respiratory flora or 2 weeks.
○ Transtracheal wash or bronchoalveolar ○ Hydrocodone 0.22-0.5 mg/kg PO q 8- • Severe (potentially fatal) pneumonia may
lavage (BAL) (p. 1073) if pneumonia or 12h (dogs) occur in young or debilitated animals.

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