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Bordetella bronchiseptica : caso clínico de uma zoonose em doente imunodeprimido
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Bordetella bronchiseptica é um cocobacilo Gram negativo, responsável por diversas infecções em animais, mas que raramente causa doença em humanos. As infecções por este agente têm sido documentadas sobretudo em indivíduos imunocomprometidos ou com patologia estrutural pulmonar, embora haja também casos descritos em indivíduos saudáveis.
Neste trabalho apresentamos um caso clínico de um doente com infecção por VIH, com uma pneumonia por Bordetella bronchiseptica, tratada inicialmente com piperacilina / tazobactam e gentamicina. O quadro complicou-se com lesão renal aguda, cuja etiologia se poderá dever à nefrotoxicidade da gentamicina. Posteriormente a antibioterapia foi alterada para piperacilina / tazobactam e ciprofloxacina, de acordo com a sensibilidade do agente infeccioso isolado, com resolução clínica do quadro.
Como o quadro de lesão renal aguda foi acompanhado de hiperuricemia, hipercaliemia, hiperfosfatemia e hipocalcemia, foi estudada a hipótese de o doente ter uma síndrome de lise tumoral, hipótese que não se veio a verificar.
Bordetella bronchiseptica is a Gram negative coccobacillus, responsible for several infections in animals, but that rarely causes disease in humans. Infections with this agent have been documented mainly in immunocompromised individuals or those with pulmonary structural disease, although there are also cases described in healthy individuals. In this work we present a clinical case of an HIV-infected patient with Bordetella bronchiseptica pneumonia, initially treated with piperacillin / tazobactam and gentamicin. The case was complicated by acute renal injury, the etiology of which may be due to the nephrotoxicity of gentamicin. Subsequently antibiotic therapy was changed to piperacillin / tazobactam and ciprofloxacin, according to the sensitivity of the infectious agent isolated, with clinical resolution of the case. As the acute renal lesion was accompanied by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia, the hypothesis that the patient had a tumor lysis syndrome was investigated, but this hypothesis was not confirmed.
Bordetella bronchiseptica is a Gram negative coccobacillus, responsible for several infections in animals, but that rarely causes disease in humans. Infections with this agent have been documented mainly in immunocompromised individuals or those with pulmonary structural disease, although there are also cases described in healthy individuals. In this work we present a clinical case of an HIV-infected patient with Bordetella bronchiseptica pneumonia, initially treated with piperacillin / tazobactam and gentamicin. The case was complicated by acute renal injury, the etiology of which may be due to the nephrotoxicity of gentamicin. Subsequently antibiotic therapy was changed to piperacillin / tazobactam and ciprofloxacin, according to the sensitivity of the infectious agent isolated, with clinical resolution of the case. As the acute renal lesion was accompanied by hyperuricemia, hyperkalemia, hyperphosphatemia and hypocalcemia, the hypothesis that the patient had a tumor lysis syndrome was investigated, but this hypothesis was not confirmed.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Bordetella bronchiseptica Pneumonia VIH Doenças transmissíveis