JOHNS HOPKINS
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Department of Pathology
600 N. Wolfe Street / Baltimore MD 21287-7093
(410) 955-5077 / FAX (410) 614-8087
Division of Medical Microbiology
THE JOHNS HOPKINS MICROBIOLOGY NEWSLETTER Vol. 26, No. 20
Tuesday, October 23, 2007
A. Provided by Emily Luckman, Division of Outbreak Investigation, Maryland Department
of Health and Mental Hygiene.
B. The Johns Hopkins Hospital, Department of Pathology, Information provided by,
Danielle Wehle, M.D., M.S.
Case presentation: A 32-year-old gentleman with a history of sickle cell disease, hepatitis C and
renal insufficiency presented with headaches, unexplained fever and sensorineural hearing loss of
unknown etiology. Magnetic resonance imaging demonstrated a sphenoid sinus mucocele which
was thought to have contributed to his symptoms. In the work-up of his unexplained fevers and
hearing loss blood cultures were performed which grew Bordetella holmesii. The patient did not
receive treatment for this organism as of 10/8/2007.
Microbiology: Bordetella holmesii, formerly designated as a CDC nonoxidizer group 2 (NO-2),
was identified as a member of the genus Bordetella in 1995. Bordetella holmesii is a small,
coccoid gram negative rod which is asaccharolytic, non-motile and oxidase negative. In addition
to differing from Bordetella pertussis by virtue of being oxidase negative, B.holmseii also differs
in that it produces a brown diffusible pigment in solid phase media. This brown pigment also
differentiates it from Acinetobacter species.
Clinical Features, Epidemiology & Transmission: The natural habitat of Bordetella holmesii
is not known. It is a rare cause of bacteremia and is associated with respiratory tract infection and
endocarditis. From isolates submitted for further identification to the Centers for Disease Control
and Prevention from 1983 through 2000, 30 patients with B. holmesii bacteremia were identified.
Of 26 patients for whom data was available, 22 (85%) were anatomically or functionally asplenic.
In 25 (96%) of the 26 patients, B. holmesii was the only organism isolated from blood samples,
and 14 patients (54%) had B. holmesii recovered from 2 or more blood cultures. The clinical
course of the infection was generally characterized by a nonspecific febrile illness. Twenty-one
patients (81%) were treated with various antimicrobial agents and 20 (77%) were admitted to the
hospital. There were no deaths. These findings suggest that B. holmesii may be a true pathogen
associated with bacteremia primarily among asplenic patients.
Other predisposing conditions for invasive B. holmesii disease include renal transplantation,
sickle cell disease, HIV infection, long-term steroid therapy, Hodgkin's lymphoma, and chronic
obstructive pulmonary disease.
Treatment: Since B. holmesii is a rare infection there is little information available on treatment.
However in-vitro-susceptibility data from one study suggests that carbapenems and
fluoroquinolones may be clinically useful for treating B. holmesii infections. In a recently
published analysis of 26 strains of B. holmesii, MICs of β-lactam agents including third-generation
cephalosporins were high with MIC ranges of 8 to >16mg/l for penicillin, 1–8mg/l for ampicillin
and 4 to >8mg/l for cefotaxime suggesting these agents are not optimal for treatment.
References:
Koneman EW. Color Atlas and Textbook of Diagnostic Microbiology, 6th edition. 2006.
Dörbecker C, Licht C, Körber F, Plum G, Haefs C, Bernd Hoppe B, Seifert H. Community-acquired
pneumonia due to Bordetella holmesii in a patient with frequently relapsing nephrotic syndrome.
Journal of Infection 54 (4), April 2007,203-205.
Shepard CW, et al. Bordetella holmesii Bacteremia: A Newly Recognized Clinical Entity among
Asplenic Patients. Clinical Infectious Diseases, 2004;38:799-804.