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Chen J, Wang J, Deng Z, Li Y, Zhou J. Compare Clinical Characteristics of Psittacosis Pneumonia in 35 Patients and of Non Psittacosis Bacterial Pneumonia in 46 Patients. Infect Drug Resist 2024; 17:2913-2921. [PMID: 39011343 PMCID: PMC11249111 DOI: 10.2147/idr.s453900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 07/02/2024] [Indexed: 07/17/2024] Open
Abstract
Background We aimed to describe the difference between Chlamydia psittaci pneumonia group and non C. psittaci bacterial pneumonia group in community acquired pneumonia in this single-center clinical study. Methods We collected the data of 35 patients with C. psittaci pneumonia cases and 46 patients with non C. psittaci bacterial pneumonia cases diagnosed with metagenomic next-generation sequencing assays from February 2019 to December 2021 in Huaihua First People's Hospital in China. Results In the C. psittaci pneumonia group, 35 patients (100%) had a chance of exposure to poultry or birds, and their body temperature was greater than or equal to 39.0°C. The other common symptoms were a slow pulse (68.6%), cough (65.7%), expectoration (54.3%), chills (51.4%) and a shortness of breath (37.1%). Laboratory tests showed that >90% of the cases had markedly elevated infection indicators, and 97.1% of the cases had markedly declined calcium. The most common imaging finding was patchy shadows (94.3%), pleural effusion (68.6%), bilateral in 54.3% (n = 19) and unilateral in 45.7% (n = 16) participants, and 51.4% (n = 18) of cases met the criteria for severe pneumonia. In the non C. psittaci bacterial pneumonia group, 18 patients (39.1%) had a chance of exposure to poultry or birds, and 11 patients (23.9%) body temperature was greater than or equal to 39.0°C. Laboratory tests showed that >67% of cases had a mildly elevated infection indicators, and mildly declined serum albumin. Conclusion The following characteristics are more likely to help distinguish C. psittaci pneumonia from non C. psittaci bacterial pneumonia. Including had a chance of exposure to poultry or birds, high fever, exhibit chills, expectoration, relatively slow pulse, and progress into severe pneumonia. Percentage of neutrophils, C-reactive protein, procalcitonin, lactate dehydrogenase, and myoglobin levels are higher. Blood calcium and corrected calcium are lower. Chest CT showed pleural effusion, pericardial effusion, and mediastinal lymphadenopathy.
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Affiliation(s)
- Jiamei Chen
- Department of Infectious Diseases, Hunan Medical College General Hospital, Huaihua, Hunan Province, People’s Republic of China
| | - Jin Wang
- Department of Infectious Diseases, Hunan Medical College General Hospital, Huaihua, Hunan Province, People’s Republic of China
| | - Ziwei Deng
- Department of Clinical Pharmacy Group, Hunan Medical College General Hospital, Huaihua, Hunan Province, People’s Republic of China
| | - Yongzhong Li
- Department of Infectious Diseases, Hunan Medical College General Hospital, Huaihua, Hunan Province, People’s Republic of China
| | - Jianliang Zhou
- Department of Intensive Care Medicine, Hunan Medical College General Hospital, Huaihua, Hunan Province, People’s Republic of China
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Riccio MB, García JP, Chiapparrone ML, Cantón J, Cacciato C, Origlia JA, Cadario ME, Diab SS, Uzal FA. Outbreak of Chlamydia psittaci Infection in a Commercial Psittacine Breeding Aviary in Argentina. Animals (Basel) 2024; 14:1959. [PMID: 38998071 PMCID: PMC11240451 DOI: 10.3390/ani14131959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Chlamydiosis, caused by Chlamydia psittaci is a bacterial infection found in at least 465 species of birds worldwide. It is highly contagious among birds and can spread to humans. In birds, the disease can manifest itself in acute, subacute, and chronic forms with signs including anorexia, diarrhea, lethargy, weight loss, or, occasionally, mucopurulent or serous oculonasal discharge. This article describes an outbreak of chlamydiosis that occurred in a commercial psittacine breeding aviary in 2021 in Buenos Aires province, Argentina. In total, 16 juvenile blue-fronted parrots, more than 60 blue-fronted parrot chicks, and 2 adult macaws died during the outbreak. In all cases, clinical signs were weight loss, diarrhea, yellowish green excrement, and respiratory distress. The necropsy of four juvenile blue-fronted parrots, two blue-fronted parrot chicks, and two adult macaws revealed cachexia, hepatomegaly, splenomegaly, splenic petechial hemorrhages, ascites, pulmonary edema, and hydropericardium. Histologically, multifocal lymphoplasmacytic and heterophilic airsaculitis, multifocal lymphoplasmacytic and necrotizing hepatitis with intracytoplasmic elementary bodies, multifocal necro-heterophilic hepatitis, multifocal lymphoplasmacytic nephritis, and diffuse heterophilic pneumonia were found. A presumptive diagnosis was established based on gross and microscopic lesions, and it was confirmed using immunohistochemistry and polymerase chain reactions. The sequencing and phylogenetic analysis of the ompA gene revealed genotype A and B of Chlamydia psittaci.
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Affiliation(s)
- María Belén Riccio
- Servicio de Diagnóstico Veterinario FCV Tandil, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil B7000GHG, Argentina;
| | - Jorge Pablo García
- Servicio de Diagnóstico Veterinario FCV Tandil, Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil B7000GHG, Argentina;
| | - María Laura Chiapparrone
- Laboratorio de Microbiología Clínica y Experimental, Centro de Investigación Veterinaria de Tandil (CIVETAN) (UNCPBA-CICPBA-CONICET), Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil B7000GHG, Argentina; (M.L.C.); (J.C.); (C.C.)
| | - Juliana Cantón
- Laboratorio de Microbiología Clínica y Experimental, Centro de Investigación Veterinaria de Tandil (CIVETAN) (UNCPBA-CICPBA-CONICET), Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil B7000GHG, Argentina; (M.L.C.); (J.C.); (C.C.)
| | - Claudio Cacciato
- Laboratorio de Microbiología Clínica y Experimental, Centro de Investigación Veterinaria de Tandil (CIVETAN) (UNCPBA-CICPBA-CONICET), Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil B7000GHG, Argentina; (M.L.C.); (J.C.); (C.C.)
| | - Javier Anibal Origlia
- Cátedra de Patología de Aves y Pilíferos, Facultad de Ciencias Veterinarias, Universidad Nacional de La Plata, La Plata B1900BVB, Argentina;
| | - María Estela Cadario
- INEI-ANLIS «Dr. Carlos G. Malbrán», Ciudad Autónoma de Buenos Aires, Buenos Aires B1282AFF, Argentina;
| | - Santiago Sain Diab
- Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA;
| | - Francisco Alejandro Uzal
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, University of California Davis, San Bernardino, CA 92408, USA;
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De Meyst A, Alexiou Z, Lernout T, Morré SA, Vanrompay D. Challenges in Chlamydial Serology: Insights from a Belgian and a Dutch Population Cohort. Microorganisms 2024; 12:658. [PMID: 38674603 PMCID: PMC11052210 DOI: 10.3390/microorganisms12040658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
Serology routinely serves as a diagnostic tool to confirm Chlamydia infections in humans. Particularly in delayed settings, such as post-outbreak scenarios where the acute phase of infection has subsided, serology is invaluable. Multiple studies, nonetheless, indicate deficiencies in specificity and sensitivity of current chlamydial antibody detection assays. Incorporation of multiple antigens per target is known to improve the accuracy of chlamydial serological assays. We, therefore, used the recomLine test (Mikrogen diagnostics) on serological samples of two cohorts, as it is the only commercially available test allowing detection of antibodies against three human pathogenic Chlamydia species (C. trachomatis, C. pneumoniae and C. psittaci) using multiple antigens per target. The first cohort (n = 156; samples collected between 2008 and 2022 during a C. trachomatis screening initiative) comprised women from the Netherlands (NL) with past exposure to C. trachomatis, while the second cohort (n = 44; samples collected in 2018 in a health examination survey) consisted of Belgian citizens (BE) with occupational or recreational exposure to chickens, representing a risk population for C. psittaci. The test indicated a statistically equivalent C. pneumoniae seroprevalence in both cohorts (39.10% in NL and 34.09% in BE; p = 0.337). As expected C. trachomatis seroprevalence was significantly higher (p < 0.001) in the Dutch cohort (48.72%), as compared to the Belgian cohort (4.55%). Lastly, C. psittaci seroprevalence did not significantly differ between the two groups (2.27% in BE and 1.92% in NL; p = 0.633), even though a higher prevalence was expected for the Belgian cohort. This prompts us to question whether the Belgian cohort truly constituted a C. psittaci risk population or whether the recomLine test is susceptible to cross-reaction of species-specific antibodies, thereby increasing C. psittaci prevalence in the Dutch cohort. We advocate for the development of affordable, highly sensitive antibody detection assays that can effectively distinguish between chlamydial species, addressing the increasing demand for enhanced serological testing methodologies.
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Affiliation(s)
- Anne De Meyst
- Laboratory of Immunology and Animal Biotechnology, Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium;
| | - Zoïe Alexiou
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands;
- Institute for Public Health Genomics (IPHG), GROW Research Institute for Oncology and Reproduction, Maastricht University, 6211 LK Maastricht, The Netherlands;
| | - Tinne Lernout
- Epidemiology of Infectious Diseases, Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium;
| | - Servaas A. Morré
- Institute for Public Health Genomics (IPHG), GROW Research Institute for Oncology and Reproduction, Maastricht University, 6211 LK Maastricht, The Netherlands;
- Dutch Chlamydia trachomatis Reference Laboratory, Deptartment Medical Microbiology, Faculty of Health, Medicine & Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Molecular and Cellular Engineering, Jacob Institute of Biotechnology and Bioengineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad 211007, Uttar Pradesh, India
| | - Daisy Vanrompay
- Laboratory of Immunology and Animal Biotechnology, Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium;
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Zhang A, Liang J, Lao X, Xia X, Liang J. Pneumonia Caused by Chlamydia psittaci and SARS-CoV-2 Coinfection Diagnosed Using Metagenomic Next-Generation Sequencing: A Case Report. Int Med Case Rep J 2024; 17:187-194. [PMID: 38529114 PMCID: PMC10962458 DOI: 10.2147/imcrj.s458131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/18/2024] [Indexed: 03/27/2024] Open
Abstract
We report a case of pneumonia caused by coinfection with Chlamydia psittaci and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron XBB.1 variant, confirmed using metagenomic next-generation sequencing (mNGS) and quantitative polymerase chain reaction (qPCR). C. psittaci and SARS-CoV-2 were detected in bronchoalveolar lavage fluid using mNGS. Additionally, mNGS detected C. psittaci in blood and nasopharyngeal specimens and was more sensitive than qPCR. The patient recovered after treatment with moxifloxacin. This report highlights the use of coinfections of C. psittaci and SARS-CoV-2, as mNGS has already been recognized to be a diagnostic tool for identifying coinfections.
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Affiliation(s)
- Anbing Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, Guangdong Province, People’s Republic of China
| | - Jinguang Liang
- Department of Respiratory and Critical Care Medicine, Zhongshan Huangpu People’s Hospital, Zhongshan, Guangdong Province, People’s Republic of China
| | - Xiaoli Lao
- Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, Guangdong Province, People’s Republic of China
- Graduate School, Guangdong Medical University, Zhanjiang, Guangdong Province, People’s Republic of China
| | - Xiuqiong Xia
- Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, Guangdong Province, People’s Republic of China
| | - Jianping Liang
- Department of Respiratory and Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, Guangdong Province, People’s Republic of China
- Graduate School, Guangdong Medical University, Zhanjiang, Guangdong Province, People’s Republic of China
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Wang J, Jia P, Zhang D, Zhao Y, Sui X, Jin Z, Song W. Diagnosis of a Familial Psittacosis Outbreak with Clinical Analysis and Metagenomic Next-Generation Sequencing Under COVID-19: A Case Series. Infect Drug Resist 2024; 17:1099-1105. [PMID: 38590553 PMCID: PMC10999973 DOI: 10.2147/idr.s440400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose To explore the clinical characteristics, diagnosis, and treatment of family outbreak of psittacosis and to improve the success rate of treatment. Patients and Methods The clinical characteristics, diagnosis, treatment, and outcome of family outbreak of psittacosis, which consists three patients, diagnosed by clinical analysis and metagenomic next-generation sequencing (mNGS) in our hospital were analyzed retrospectively. Results We report on three instances of clustered atypical pneumonia, which were caused by Chlamydia psittaci during the COVID-19 pandemic. All patients exhibited symptoms of fever and cough, while one patient also experienced gastrointestinal symptoms such as nausea, vomiting, and diarrhea. Laboratory tests indicated no significant increase in leukocytes and neutrophils, but a mild increase in C-reactive protein was observed in all three patients. Chest computed tomography (CT) scans revealed a consolidation shadow in a unilateral lung lobe in all three patients. Both patients were treated with empirical moxifloxacin, yielding unsatisfactory outcomes. mNGS was conducted on sputum samples from one adult patient, revealing the presence of Chlamydia psittaci. Additional doxycycline was prescribed immediately, and then the patients' temperatures were stabilized, and the lesion in chest CT was absorbed. The pediatric patient exhibited less severe symptoms compared to the adult patients and exhibited a favorable response to azithromycin administration. Conclusion This study reports a cluster of a family outbreak of atypical pneumonia caused by C. psittaci in China. The occurrence of a family outbreak during the COVID-19 pandemic may be attributed to familial aggregation resulting from the epidemic. The three cases reported in this study did not experience severe complications, which can be attributed to the prompt medical intervention and swift diagnosis. This finding implies the need to enhance patients' awareness and vigilance towards their health. Additionally, mNGS emerges as a valuable technique for accurately identifying pathogens causing pulmonary infections.
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Affiliation(s)
- Jiaru Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Peiyao Jia
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Dong Zhang
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
| | - Ying Zhao
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, People’s Republic of China
| | - Xin Sui
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Wei Song
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
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Favier P, Wiemeyer GM, Arias MB, Lara CS, Vilar G, Crivelli AJ, Ludvik HK, Ardiles MI, Teijeiro ML, Madariaga MJ, Rolón MJ, Cadario ME. Chlamydia psittaci Screening of Animal Workers from Argentina Exposed to Carrier Birds. ECOHEALTH 2024; 21:38-45. [PMID: 38637441 DOI: 10.1007/s10393-024-01683-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 12/29/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
Different syndromes are involved in human psittacosis (flu-like syndrome, atypical pneumonia up to lacrimal gland lymphoma). Diagnostic methods include serology, culture, and PCR. The rate of Chlamydia psittaci (Cp) positive tests among exposed workers is still unknown. Our study aimed to assess the rate of positive tests among workers who have contact with carrier birds in natural reserves from Buenos Aires, Argentina. Secondary aims were to analyze risk factors linked to these outcomes and the occurrence of signs that suggest psittacosis. Nasopharyngeal swabs and serum pairs were collected from employees who had interacted with confirmed carrier birds. Those with detectable DNA of Cp and/or anti-Chlamydia spp. antibody baseline titer ≥ 160 mUI/ml, or at least quadruplicating, were considered positive. Activities performed with or near birds, personal protective equipment use, and previous chronic conditions were assessed. Possible Cp-related pathologies were evaluated during follow-up. A total of 63 exposed workers (71.4% men) with a median age of 35.7 years (IQR 26-39) were evaluated to detect 28.6% positives. Respiratory chronic conditions were the unique factor associated with positive tests (OR 5.2 [1.5-18.5] p < .05). Surprisingly, about a third of the workers resulted positive and all responded to medical treatment, none developing an acute atypical pneumonia syndrome associated with classical presentation of psittacosis. Active testing for early diagnosis and proper treatment in zoological workers exposed to carrier or potentially carrier birds is strongly suggested as part of zoonotic diseases preventive measures.
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Affiliation(s)
- Patricio Favier
- Infectious Diseases Division, Hospital General de Agudos Dr. Juan A. Fernández, Avenida Cerviño 3365, MO C1425AGP, City of Buenos Aires, Argentina
| | - Guillermo M Wiemeyer
- Animal Welfare Department, Ecoparque de la Ciudad de Buenos Aires, República de la India 3000, MO C12425FGC, City of Buenos Aires, Argentina.
- CONICET, Facultad de Ciencias Veterinarias, Universidad Nacional de La Pampa, Calle 5 esq. 116, MO L6360, General Pico, La Pampa, Argentina.
| | - Maite B Arias
- Service of Clinical Bacteriology, Instituto Nacional de Enfermedades Infecciosas-Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Avenida Vélez Sarsfield 563, MO C1282AFF, City of Buenos Aires, Argentina
| | - Claudia S Lara
- Service of Clinical Bacteriology, Instituto Nacional de Enfermedades Infecciosas-Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Avenida Vélez Sarsfield 563, MO C1282AFF, City of Buenos Aires, Argentina
| | - Gabriela Vilar
- Service of Clinical Bacteriology, Instituto Nacional de Enfermedades Infecciosas-Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Avenida Vélez Sarsfield 563, MO C1282AFF, City of Buenos Aires, Argentina
| | - Ana J Crivelli
- Infectious Diseases Division, Hospital General de Agudos Dr. Juan A. Fernández, Avenida Cerviño 3365, MO C1425AGP, City of Buenos Aires, Argentina
| | - Herman K Ludvik
- Infectious Diseases Division, Hospital General de Agudos Dr. Juan A. Fernández, Avenida Cerviño 3365, MO C1425AGP, City of Buenos Aires, Argentina
| | - María I Ardiles
- Prevention and Control of Zoonoses Department, Instituto de Zoonosis Luis Pasteur, Avenida Díaz Vélez 4821, MO C1405DCD, City of Buenos Aires, Argentina
| | - María L Teijeiro
- Department of Biological Products Diagnosis, Serology and Molecular Biology Section, Instituto de Zoonosis Luis Pasteur, Avenida Díaz Vélez 4821, MO C1405DCD, City of Buenos Aires, Argentina
| | - María J Madariaga
- Department of Biological Products Diagnosis, Serology and Molecular Biology Section, Instituto de Zoonosis Luis Pasteur, Avenida Díaz Vélez 4821, MO C1405DCD, City of Buenos Aires, Argentina
| | - María J Rolón
- Infectious Diseases Division, Hospital General de Agudos Dr. Juan A. Fernández, Avenida Cerviño 3365, MO C1425AGP, City of Buenos Aires, Argentina
| | - María E Cadario
- Service of Clinical Bacteriology, Instituto Nacional de Enfermedades Infecciosas-Administración Nacional de Laboratorios e Institutos de Salud Dr. Carlos G. Malbrán, Avenida Vélez Sarsfield 563, MO C1282AFF, City of Buenos Aires, Argentina
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Wang J, Dong S, Fang M, Fan Z, Xu Y. Omadacycline for the Treatment of Severe Chlamydia psittaci Pneumonia Complicated with Guillain-Barre Syndrome. Infect Drug Resist 2024; 17:81-87. [PMID: 38223561 PMCID: PMC10787558 DOI: 10.2147/idr.s437100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/29/2023] [Indexed: 01/16/2024] Open
Abstract
Background Chlamydia psittaci (C. psittaci) is a pathogen that is seldom implicated in community-acquired pneumonia and is rarely linked to severe pneumonia. Reports of severe C. psittaci pneumonia accompanied by Guillain-Barre syndrome (GBS) are scarce. Tetracyclines are the preferred therapeutic approach for psittacosis. Omadacycline, a novel tetracycline, demonstrates strong antibacterial efficacy against typical bacteria and atypical pathogens, including C. psittaci. However, its application in the treatment of psittacosis pneumonia remains constrained. Case Presentation A 77-year-old female patient was admitted to the hospital presenting with symptoms of fever, low back pain, and headache. The diagnosis of C. psittaci was established through the utilization of metagenomic next-generation sequencing (mNGS). Initial administration of moxifloxacin, meropenem, piperacillin-tazobactam, and doxycycline proved to be ineffective. Subsequent omadacycline leaded to the successful resolution of fever and dyspnea. However, after the endotracheal tube was removed, the patient experienced a rapid decline in symmetrical limb strength, leading to a diagnosis of GBS based on clinical manifestations, cerebrospinal fluid analysis, and electromyography. Following a 5-day course of immunoglobulin therapy and nutritional nerve treatment, the patient's condition ameliorated, culminating in an uncomplicated discharge. Conclusion This case provides evidence supporting the potential use of omadacycline as a therapeutic option for the treatment of severe C. psittaci pneumonia. The utilization of mNGS technology is of paramount importance in the prompt identification of uncommon pathogens, including C. psittaci. Nevertheless, the occurrence of GBS should be taken into consideration when C. psittaci pneumonia is accompanied by symmetrical limb weakness. These findings have important implications for the diagnosis, treatment, and management of patients with C. psittaci pneumonia.
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Affiliation(s)
- Juan Wang
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
| | - Shuangyong Dong
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
| | - Mengjuan Fang
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
| | - Zhiyan Fan
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
| | - Yuansheng Xu
- Department of Emergency, Affiliated Hangzhou First People`s Hospital, School of Medicine, Westlake University, Hangzhou, People’s Republic of China
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8
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Wang DX, Xiao LX, Deng XY, Deng W. Omadacycline for the treatment of severe pneumonia caused by Chlamydia psittaci complicated with acute respiratory distress syndrome during the COVID-19 pandemic. Front Med (Lausanne) 2024; 10:1207534. [PMID: 38264056 PMCID: PMC10805100 DOI: 10.3389/fmed.2023.1207534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Chlamydia psittaci infection in humans is a rare cause that mainly present as community-acquired pneumonia. Severe Chlamydia psittaci pneumonia can lead to acute respiratory distress syndrome (ARDS), septic shock, or multiple organ dysfunction with a mortality rate of 15%-20% before accurate diagnosis and targeted treatment. Metagenomic next-generation sequencing (mNGS) has an advantage in achieving early diagnosis. In the study, omadacycline implementation was described to provide a better understanding of effectiveness in severe psittacosis pneumonia with ARDS. Methods Sixteen patients with severe psittacosis pneumonia with ARDS were selected between September 2021 and October 2022. They were diagnosed using mNGS and treated with omadacycline. Retrospective analysis of clinical manifestations, laboratory data, disease progression, diagnostic tool, treatment, and prognosis was summarized. Results Common symptoms included fever, dyspnea, and cough. All patients developed ARDS, accompanied by septic shock (43.7%) and pulmonary embolism (43.7%). Laboratory data showed normal leucocytes, increased creatine kinase isoenzyme, and decreased albumin with liver dysfunction in most patients. All patients had increased neutrophils, C-reactive protein, procalcitonin, and D-dimer with decreased lymphocytes. Airspace consolidation, ground glass opacity, and pleural effusion were found on chest CT. mNGS results were obtained in 24-48 h to identify the diagnosis of Chlamydia psittacosis. All patients received mechanical ventilation with omadacycline treatment. Fourteen patients experienced complete recovery, while the other two patients died from multidrug-resistant bacterial infection and renal failure. Conclusion mNGS has a significant value in the diagnosis of Chlamydia psittaci infection. Timely treatment of omadacycline can improve prognosis and provide a promising new option for the treatment of severe Chlamydia psittaci pneumonia with ARDS.
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Affiliation(s)
- Dao-Xin Wang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Research Center for Respiratory and Critical Care Medicine, Chongqing, China
| | - Ling-Xi Xiao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Research Center for Respiratory and Critical Care Medicine, Chongqing, China
| | - Xin-Yu Deng
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Research Center for Respiratory and Critical Care Medicine, Chongqing, China
| | - Wang Deng
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Research Center for Respiratory and Critical Care Medicine, Chongqing, China
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9
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Zheng X, Wu C, Jiang B, Qin G, Zeng M. Clinical analysis of severe Chlamydia psittaci pneumonia: Case series study. Open Life Sci 2023; 18:20220698. [PMID: 37772263 PMCID: PMC10523279 DOI: 10.1515/biol-2022-0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/25/2023] [Accepted: 07/30/2023] [Indexed: 09/30/2023] Open
Abstract
The clinical characteristics and diagnosis of ten cases with severe Chlamydia psittaci pneumonia were analyzed. Ten patients had high fever, cough, or diarrhea, and all had a history of contact with birds or poultry. The white blood cell count of the patients was normal or slightly increased. The percentage of neutrophils (N%) and C reactive protein of the patients were significantly increased. Chest computer tomography showed patchy consolidation of both lungs, with one-sided lung lobes prominent, and bronchial inflation signs. All the patients were admitted to the intensive care unit due to respiratory failure. Nine patients needed ventilator-assisted ventilation therapy, and one patient needed high-flow oxygen therapy. All patients had sepsis, and five patients developed septic shock. The patients were diagnosed with severe C. psittaci pneumonia by clinical manifestations and contact history. After timely adjustment of tetracycline-based treatment, eight patients recovered and were discharged, and two patients died of septic shock and respiratory failure. Patients with poultry contact should be cautious toward C. psittaci pneumonia. A better method for the detection of C. psittaci is metagenomic next-generation sequencing. Its examination can shorten the diagnosis time. In a later stage, large-sample research is needed to guide clinical diagnosis and treatment.
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Affiliation(s)
- Xi Zheng
- Department of Respiratory and Critical Care Medicine, Yongchuan Hospital Affiliated to Chongqing Medical University, 439 Xuanhua Road, Yongchuan District, Chongqing, 402160, China
| | - Chonghao Wu
- Department of Respiratory and Critical Care Medicine, Yongchuan Hospital Affiliated to Chongqing Medical University, 439 Xuanhua Road, Yongchuan District, Chongqing, 402160, China
| | - Bing Jiang
- Department of Respiratory and Critical Care Medicine, Yongchuan Hospital Affiliated to Chongqing Medical University, 439 Xuanhua Road, Yongchuan District, Chongqing, 402160, China
| | - Guangmei Qin
- Department of Respiratory and Critical Care Medicine, Yongchuan Hospital Affiliated to Chongqing Medical University, 439 Xuanhua Road, Yongchuan District, Chongqing, 402160, China
| | - Ming Zeng
- Department of Respiratory and Critical Care Medicine, Yongchuan Hospital Affiliated to Chongqing Medical University, 439 Xuanhua Road, Yongchuan District, Chongqing, 402160, China
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Huang W, Wang F, Cai Q, Xu H, Hong D, Wu H, Zhou L, Hu L, Lu Y. Epidemiological and clinical characteristics of psittacosis among cases with complicated or atypical pulmonary infection using metagenomic next-generation sequencing: a multi-center observational study in China. Ann Clin Microbiol Antimicrob 2023; 22:80. [PMID: 37679777 PMCID: PMC10486088 DOI: 10.1186/s12941-023-00631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Chlamydia psittaci (C. psittaci) causes parrot fever in humans. Development of metagenomic next-generation sequencing (mNGS) enables the identification of C. psittaci. METHODS This study aimed to determine the epidemiological and clinical characteristics of parrot fever cases in China. A multi-center observational study was conducted in 44 tertiary and secondary hospitals across 14 provinces and municipalities between April 2019 and October 2021. RESULTS A total of 4545 patients with complicated or atypical pulmonary infection were included in the study, among which the prevalence of C. psittaci was determined to be 2.1% using mNGS. The prevalence of C. psittaci was further determined across demographic groups and types of specimens. It was significantly higher in patients with senior age (2.6% in those > 50 years), winter-spring (3.6%; particularly in December, January, and February), and southwestern (3.4%) and central and southern China (2.7%) (each P < 0.001). Moreover, the prevalence was the highest in bronchoalveolar lavage fluid (BALF) (2.9%), compared with sputum (1.1%) and peripheral blood specimens (0.9%). Additionally, co-infection of principal microorganisms was compared. Certain microorganisms were more likely to co-infect in parrot fever cases, such as Candida albicans in BALF (26.7%) and peripheral blood (6.3%), compared with non-parrot fever cases (19.7% and 1.3%); however, they did not significantly differ (each P > 0.05). CONCLUSION Parrot fever remains low in patients with complicated or atypical pulmonary infection. It is likely to occur in winter-spring and southwestern region in China. BALF may be the optimal specimen in the application of mNGS. Co-infection of multiple microorganisms should be further considered.
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Affiliation(s)
- Weifeng Huang
- Department of Intensive Care Medicine, The Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fengge Wang
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Qingqing Cai
- Genoxor Medical Science and Technology Inc, Shanghai, China
| | - Huiliang Xu
- Department of Respiratory, Nanxiang Hospital of Jiading district, Shanghai, China
| | - Dengwei Hong
- Genoxor Medical Science and Technology Inc, Shanghai, China
| | - Han Wu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, Fudan University School of Public Health, Shanghai, China
| | - Lu Zhou
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, Fudan University School of Public Health, Shanghai, China
| | - Linjie Hu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, Fudan University School of Public Health, Shanghai, China
| | - Yihan Lu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, Fudan University School of Public Health, Shanghai, China
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Zhang Y, Jiang X, Ye W, Sun J. Clinical features and outcome of eight patients with Chlamydia psittaci pneumonia diagnosed by targeted next generation sequencing. THE CLINICAL RESPIRATORY JOURNAL 2023; 17:915-930. [PMID: 37552996 PMCID: PMC10500319 DOI: 10.1111/crj.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/29/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION The clinical symptoms of Chlamydia psittaci pneumonia are still poorly understood. This study was designed to summarize the clinical features and outcome of eight C. psittaci pneumonia patients diagnosed by targeted next generation sequencing (tNGS). METHODS We included eight C. psittaci pneumonia patients admitted to our hospital from January 2021 to July 2022. The tNGS was performed to the samples collected from bronchoalveolar lavage fluid of each patient. Their clinical data were analysed, including baseline features, clinical symptoms, chest radiographic findings and laboratory examinations. RESULTS The tNGS sequence number for C. psittaci was in a range of 10 to 1722. The radiographic characteristics were mainly featured by patchy consolidation shadows, ground-glass density shadows, air bronchogram and slight pleural effusion. Within 1-3 days after hospitalization, most patients showed increased neutrophil ratio, C-reactive protein and erythrocyte sedimentation rate, and decreased lymphocyte count, total protein, albumin and prealbumin. Some patients showed increased glutamic-pyruvic transaminase, glutamic-oxaloacetic transaminase and lactate dehydrogenase levels. Three critically ill patients showed increased creatine kinase, creatine kinase isoenzyme and high-sensitivity troponin T (hs-TnT) levels. CONCLUSIONS A poultry or bird contact history, typical flu-like symptoms, patchy consolidation, ground-glass density shadow and air bronchogram may contribute to the diagnosis and treatment of C. psittaci pneumonia. Increase in creatine kinase, creatine kinase isoenzyme and hs-TnT may indicate a severe condition. Moxifloxacin and minocycline were effective in the management of C. psittaci pneumonia.
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Affiliation(s)
- Yanping Zhang
- Department of Respiratory MedicineShandong Provincial Third HospitalJinanP.R. China
| | - Xiangsen Jiang
- Imaging CenterShandong Provincial Third HospitalJinanP.R. China
| | - Wei Ye
- Department of Respiratory MedicineShandong Provincial Third HospitalJinanP.R. China
| | - Jinlin Sun
- Department of Respiratory MedicineShandong Provincial Third HospitalJinanP.R. China
- Department of Respiratory MedicineHui Ya Hospital of The First Affiliated Hospital, Sun Yat‐Sen UniversityHuizhouP.R. China
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Marchese S, Marchese G, Paviglianiti G, Lapi M, Ottoveggio G, Pipitone G, Corsello G. A pediatric case of Chlamydia psittaci caused severe Acute Respiratory Distress Syndrome (ARDS) in Italy. Ital J Pediatr 2023; 49:107. [PMID: 37649055 PMCID: PMC10468848 DOI: 10.1186/s13052-023-01497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 07/11/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND This case of psittacosis in children, is the first described in literature, in Italy. This respiratory infection can be transmitted to humans from the inhalation of respiratory secretions, feces and plumage aerosol of infected birds (and other animals). Usually it can have an asymptomatic or paucisymptomatic course, and the onset is often flu-like, but in this case the child risked his life for a severe respiratory failure. This report is unique because in children psittacosis is rare, and always misdiagnosed, or could cause a delayed diagnosis because of lack of awareness among the paediatricians and physicians. Furthermore, psittacosis enters a differential diagnosis with SARS-COV2 infection because both diseases may determine dyspnea and atypical pneumonia, up to acute respiratory failure. CASE PRESENTATION This clinical case talks about a three-and-a-half-year-old male child affected by psittacosis (or ornithosis), with severe dyspnea and systemic symptoms who required oro-tracheal intubation for acute respiratory failure. The child had slept in a room at home, with some recently bought parrots affected by psittacosis. Initially the child was treated with empiric antibiotic therapy (i.v.ceftriaxone and teicoplanin), but after having isolated the DNA of the germ "Chlamydia psittaci" in both serological and through bronchoalveolar lavage (BAL), he was treated with targeted antibiotic therapy: tetracyclines (doxicillin). CONCLUSIONS Psittacosis is an extremely contagious disease, caused by an intracellular germ, called "Chlamydia psittaci", a Gram-negative bacterium, transmitted to humans in particular by infected birds, responsible for atypical pneumonia, with acute and chronic respiratory symptoms, sometimes with multi-organ failure and disseminated intravascular coagulation. Even if it is a rare respiratory disease among children, a good doctor must think about psittacosis as cause of respiratory symptoms (and not only flu or SARS-COV2), above all through a correct medical history, in order to provide a targeted antibiotic therapy. An interesting case of psittacosis in a child is being reported here, which has been treated successfully with doxycillin.
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Affiliation(s)
- Serena Marchese
- Emergency and Admission Medicine and Surgery, Childrens'Hospital, ISMEP-Arnas Civico-Benfratelli- Di Cristina, Palermo, Italy.
| | | | | | - Maria Lapi
- Anesthesia and Pediatric Resuscitation with Trauma Center, ISMEP-Arnas Civico-Benfratelli- Di Cristina, Palermo, Italy
| | - Gaetano Ottoveggio
- Anesthesia and Pediatric Resuscitation with Trauma Center, ISMEP-Arnas Civico-Benfratelli- Di Cristina, Palermo, Italy
| | - Giuseppe Pipitone
- Systemic and immune-suppressed associated infection Disease Unit, INMI Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Giovanni Corsello
- Unit of General Pediatrics, Childrens'Hospital, ISMEP-Arnas Civico-Benfratelli- Di Cristina, University of Palermo, Palermo, Italy
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13
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Cao J, Xie X, Lei Y, Li S, Song X, Lei Y, An Q, Zhang B. Epidemiological and clinical characteristics of a family cluster of psittacosis: A case report. IDCases 2023; 33:e01845. [PMID: 37492645 PMCID: PMC10365937 DOI: 10.1016/j.idcr.2023.e01845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/27/2023] Open
Abstract
Psittacosis accounts for 1-2 % of community-acquired pneumonia. In recent years, reports of psittacosis are increasing. Most reported cases of psittacosis are sporadic. Here, we report a familial cluster of five patients infected with Chlamydophila in a northwest Chinese region and share our diagnosis and treatment experience. The epidemiological characteristics, clinical features, laboratory examinations of family cluster psittacosis were collected and analyzed. We closely followed up all the family members and analyzed their clinical outcome. Five cases of family clustered pneumonia were mainly characterized by fever, cough and fatigue. mNGS rapidly identified the infecting agent as Chlamydophila in case 1 followed by RT-PCR analysis. A newly purchased pet parrot, which had diarrhea, was probably the primary source of infection. The main change of inflammation index in five patients was the decrease of lymphocyte counts. Chest CT showed peripheral or subpleural involvement of patchy high-density shadows with bronchial ventilation signs and blurred edges, mostly unilateral lesions. Five cases were completely cured with moxifloxacin and azithromycin. Our findings suggest that a familial cluster of Chlamydophila infection maybe caused by contact with sick pet parrot or human to human transmission in one close family. For this community-acquired pneumonia, epidemiological characteristics and use of mNGS is very important for improving accuracy in the early diagnosis.
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Affiliation(s)
- Jing Cao
- Department of Pulmonary Medicine, Air Force No. 986 Hospital, Air Force Medical University, Xi'an, China
| | - Xiaoyan Xie
- Department of Pulmonary Medicine, Air Force No. 986 Hospital, Air Force Medical University, Xi'an, China
| | - Yan Lei
- Department of Pulmonary Medicine, Air Force No. 986 Hospital, Air Force Medical University, Xi'an, China
| | - Shuangshuang Li
- Department of Pulmonary Medicine, Air Force No. 986 Hospital, Air Force Medical University, Xi'an, China
| | - Xuan Song
- Department of Pulmonary Medicine, Air Force No. 986 Hospital, Air Force Medical University, Xi'an, China
| | - Yingfeng Lei
- Department of Medical Microbiology and Parasitology, Air Force Medical University, Xi'an, China
| | - Qunxing An
- Department of Transfusion Medicine, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Binghua Zhang
- Department of Pulmonary Medicine, Air Force No. 986 Hospital, Air Force Medical University, Xi'an, China
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Wang S, Tang J, Tan Y, Song Z, Qin L. Prevalence of atypical pathogens in patients with severe pneumonia: a systematic review and meta-analysis. BMJ Open 2023; 13:e066721. [PMID: 37041056 PMCID: PMC10106036 DOI: 10.1136/bmjopen-2022-066721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES We aimed to summarise the prevalence of atypical pathogens in patients with severe pneumonia to understand the prevalence of severe pneumonia caused by atypical pathogens, improve clinical decision-making and guide antibiotic use. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, Web of Science and Cochrane Library were searched through November 2022. ELIGIBILITY CRITERIA English language studies enrolled consecutive cases of patients diagnosed with severe pneumonia, with complete aetiological analysis. DATA EXTRACTION AND SYNTHESIS We conducted literature retrieval on PubMed, Embase, Web of Science and The Cochrane Library to estimate the prevalence of Chlamydia, Mycoplasma and Legionella in patients with severe pneumonia. After double arcsine transformation of the data, a random-effects model was used for meta-analyses to calculate the pooled prevalence of each pathogen. Meta-regression analysis was also used to explore whether the region, different diagnostic method, study population, pneumonia categories or sample size were potential sources of heterogeneity. RESULTS We included 75 eligible studies with 18 379 cases of severe pneumonia. The overall prevalence of atypical pneumonia is 8.1% (95% CI 6.3% to 10.1%) In patients with severe pneumonia, the pooled estimated prevalence of Chlamydia, Mycoplasma and Legionella was 1.8% (95% CI 1.0% to 2.9%), 2.8% (95% CI 1.7% to 4.3%) and 4.0% (95% CI 2.8% to 5.3%), respectively. We noted significant heterogeneity in all pooled assessments. Meta-regression showed that the pneumonia category potentially influenced the prevalence rate of Chlamydia. The mean age and the diagnostic method of pathogens were likely moderators for the prevalence of Mycoplasma and Legionella, and contribute to the heterogeneity of their prevalence. CONCLUSIONS In severe pneumonia, atypical pathogens are notable causes, especially Legionella. The diagnostic method, regional difference, sample size and other factors contribute to the heterogeneity of prevalence. The estimated prevalence and relative heterogeneity factors can help with microbiological screening, clinical treatment and future research planning. PROSPERO REGISTRATION NUMBER CRD42022373950.
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Affiliation(s)
- Sidan Wang
- The Second Department of Gastrointestinal Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jiaoqi Tang
- Emergency Department, Zhuzhou Central Hospital, Zhuzhou, Hunan, China
| | - Yurong Tan
- Department of Medical Microbiology, School of Basic Medical Sciences, Central South University, Changsha, Hunan, China
| | - Zhi Song
- The Second Department of Gastrointestinal Surgery, Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ling Qin
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
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15
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He L, Yang H, Liu S, Liang W, Zhou Z, Long J, Wu J. Physiological analysis of severe chlamydia psittaci pneumonia and clinical diagnosis after doxycycline-based treatment. Front Physiol 2023; 14:1132724. [PMID: 36846335 PMCID: PMC9947341 DOI: 10.3389/fphys.2023.1132724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Objective: To describe the clinical spectrum of severe Chlamydia psittaci pneumonia in order to understand the disease better. Methods: Retrospective analysis was made on 31 patients with severe Chlamydia psittaci pneumonia diagnosed in ICU by next-generation sequencing of metagenome Metagenomic next-generation sequencing(mNGS) from January 2019-November 2022, including clinical characteristics, laboratory examination results, imaging characteristics, treatment, and prognosis. Results: We included 31 patients with severe Chlamydia psittaci pneumonia, 15 of whom had a history of virus exposure. There were 12 cases with multiple bacterial infections, and the common symptoms included fever (31/31,100%), dyspnea (31/31, 100%), cough (22/31, 71.0%), and myalgia (20/31, 64.5%). Laboratory data showed that white blood cells were average or slightly increased, but the levels of C-reactive protein and neutrophils were high. CT findings of the lung were consolidation (19/31, 61.3%) and pleural effusion (11/31, 35.5%). Only one lobe was involved in 11 patients (35.5%). Before diagnosis, 22 patients (71.0%) did not have atypical pathogens in their antimicrobial regimen. After diagnosis, 19 patients (61.3%) received single drug treatment, of which doxycycline or moxifloxacin were the most commonly used drugs. Among 31 patients, three died, nine improved, and nineteen were cured. Conclusion: The clinical manifestations of severe Chlamydia psittaci pneumonia are non-specific. The application of mNGS can improve the diagnostic accuracy of Chlamydia psittaci pneumonia, reduce the unnecessary use of antibiotics, and shorten the course of the disease. Doxycycline-based treatment is effective for severe chlamydia psittaci pneumonia, but it is necessary to understand the secondary bacterial infection and other complications in the course of the disease.
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Affiliation(s)
- Lujuan He
- The Affiliated Changsha Central Hospital, Department of Respiratory and Critical Care Medicine, Hengyang Medical School, University of South China, Changsha, China
| | - Hongzhong Yang
- The Affiliated Changsha Central Hospital, Department of Respiratory and Critical Care Medicine, Hengyang Medical School, University of South China, Changsha, China
| | - Shenggang Liu
- The Affiliated Changsha Central Hospital, Department of Respiratory and Critical Care Medicine, Hengyang Medical School, University of South China, Changsha, China
| | - Weijun Liang
- The Affiliated Changsha Central Hospital, Department of Respiratory and Critical Care Medicine, Hengyang Medical School, University of South China, Changsha, China
| | - Zezhi Zhou
- The Affiliated Changsha Central Hospital, Department of Respiratory and Critical Care Medicine, Hengyang Medical School, University of South China, Changsha, China
| | - Jing Long
- The Affiliated Changsha Central Hospital, Department of Respiratory and Critical Care Medicine, Hengyang Medical School, University of South China, Changsha, China
| | - Jinyang Wu
- The Affiliated Changsha Central Hospital, Department of Internal Neurology, Hengyang Medical School, University of South China, Changsha, China,*Correspondence: Jinyang Wu,
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Cui Z, Meng L. Psittacosis Pneumonia: Diagnosis, Treatment and Interhuman Transmission. Int J Gen Med 2023; 16:1-6. [PMID: 36628298 PMCID: PMC9826634 DOI: 10.2147/ijgm.s396074] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Psittacosis pneumonia is a zoonosis caused by Chlamydia psittacosis infection, mainly resulting from contact with aerosols of birds or poultry's urine, feces, and excrement. The clinical manifestations range from general symptoms of infection to severe acute respiratory syndrome and systemic diseases, currently diagnosed using metagenomic next-generation sequencing (mNGS) to improve diagnostic accuracy. To date, most reports have only discussed human exposure to poultry disease. However, the latest studies have shown that human-to-human transmission of Chlamydia psittaci occurs not only between infected patients and their close contacts but also between secondary contacts. After looking back on relevant literature at home and abroad in the past ten years, this paper reviews the diagnosis, diagnosis and treatment, and progress in epidemiological research of Psittacosis pneumonia.
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Affiliation(s)
- ZiQi Cui
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, People’s Republic of China
| | - Ling Meng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, People’s Republic of China,Correspondence: Ling Meng, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, No. 366 Taishan Street, Taian, 271000, People’s Republic of China, Tel +86-18505386929, Email
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He Y, Wang S, Deng J, Pu Q, Chen H, Huang L. Chlamydia psittaci Pneumonia Complicated with Lower Extremity Atherosclerotic Occlusive Disease. Infect Drug Resist 2023; 16:2141-2145. [PMID: 37077253 PMCID: PMC10106326 DOI: 10.2147/idr.s393256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/29/2023] [Indexed: 04/21/2023] Open
Abstract
Chlamydia is a zoonotic pathogen that mainly infects poultry and pet birds. This Gram-negative obligate intracellular parasite also causes human psittacosis, the severity of which varies from mild flu-like symptoms to life-threatening severe pneumonia, including sepsis, acute respiratory distress syndrome, and multiple organ failure. Inhalation of aerosols from contaminated bird excreta through the respiratory tract is the main route of transmission to humans. Here, we present a case of Chlamydia psittaci pneumonia accompanied by lower extremity atherosclerotic occlusive disease. A 48-year-old man was admitted to the emergency department with a four-day history of cough and dyspnea. A detailed history revealed his contact with domestic pigeons. The results of metagenomic next-generation sequencing of bronchoalveolar lavage fluid suggested C. psittaci infection. Antibacterial agents were switched to targeted doxycycline, but in the next week, skin examination revealed acrocyanosis of both lower extremities, and the remarkable palpable purpura progressively worsened. Re-examination of the lower extremity vascular ultrasound suggested left dorsalis pedis artery occlusion and right peroneal vein thrombosis, which resulted in the amputation of both legs. This case is the first report of C. psittaci pneumonia combined with arterioocclusive sclerosis of both lower extremities.
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Affiliation(s)
- YongHong He
- Department of Respiratory Medicine and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, 646000, People’s Republic of China
| | - SongPing Wang
- Department of Respiratory Medicine and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, 646000, People’s Republic of China
- Correspondence: SongPing Wang, Department of Respiratory Medicine and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, 646000, People’s Republic of China, Email
| | - Jun Deng
- Department of Respiratory Medicine and Critical Care Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou City, Sichuan Province, 646000, People’s Republic of China
| | - Qian Pu
- Department of Intensive Care Medicine, Chengdu Second People’s Hospital, ChengDu City, Sichuan Province, 610000, People’s Republic of China
| | - Hong Chen
- Department of Respiratory Medicine, Chengdu Second People’s Hospital, ChengDu City, Sichuan Province, 610000, People’s Republic of China
| | - Lan Huang
- Department of Respiratory Medicine, Chengdu Second People’s Hospital, ChengDu City, Sichuan Province, 610000, People’s Republic of China
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Three Cases of Atypical Pneumonia with Chlamydia psittaci: The Role of Laboratory Vigilance in the Diagnosis of Psittacosis. Pathogens 2022; 12:pathogens12010065. [PMID: 36678414 PMCID: PMC9861199 DOI: 10.3390/pathogens12010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
Chlamydia psittaci is an established zoonotic agent causing respiratory disease in humans. An infection often remains asymptomatic but can also result in flu-like illness, pneumonia or even multi-organ failure. This paper describes three patients, hospitalised at AZ Sint-Lucas Hospital, with atypical pneumonia who were diagnosed with C. psittaci after an in-depth anamnesis and laboratory investigation in the midst of the COVID pandemic. All three infections were confirmed with PCR and serology, whereas viable bacteria were only present for one patient. Genotyping revealed the presence of genotype B for patient 1 and 2 whereas ompA genotyping was unsuccessful for patient 3. This case report demonstrates the importance of a thorough patient history as close contact with birds is one of the main risk factors to contract the pathogen. Once exposure to birds has been confirmed, a diagnosis by a combination of PCR and serology is essential in order to initiate a treatment with the proper antibiotics. As psittacosis is still an underestimated and underdiagnosed disease, communication between laboratory, clinicians and bird fanciers is encouraged.
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Yao W, Chen X, Wu Z, Wang L, Shi G, Yang Z, Zhang Y, Wu B. A cluster of Psittacosis cases in Lishui, Zhejiang Province, China, in 2021. Front Cell Infect Microbiol 2022; 12:1044984. [PMID: 36590592 PMCID: PMC9798449 DOI: 10.3389/fcimb.2022.1044984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Psittacosis, caused by Chlamydia psittaci, is widespread throughout the world. In humans, C. psittaci infection may lead to severe conditions and complications, including sepsis and multiple organ failure. We report a cluster of cases caused by C. psittaci in Zhejiang Province, 2021, which led to one death and three cases of hospitalization. Methods The cases were confirmed by nest-PCR, RT-PCR, and mNGS. Results The four cases were related and the sequences obtained from the samples were closely correlated with those from Taiwan. Discussion This study is the first to report on the case of death from psittacosis in Zhejiang Province, and our results help to assess the disease and recommend effective measures to prevent further spread of C. psittaci.
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Affiliation(s)
- Wenwu Yao
- Key laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiuying Chen
- Department of Microbiology, Lishui Center for Disease Control and Prevention, Lishui, China
| | - Zhuoying Wu
- Key laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Lingbo Wang
- Key laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Guoxiang Shi
- Key laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhangnv Yang
- Key laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,*Correspondence: Zhangnv Yang, ; Yanjun Zhang, ; Beibei Wu,
| | - Yanjun Zhang
- Key laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,*Correspondence: Zhangnv Yang, ; Yanjun Zhang, ; Beibei Wu,
| | - Beibei Wu
- Key laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China,*Correspondence: Zhangnv Yang, ; Yanjun Zhang, ; Beibei Wu,
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20
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Liang Y, Dong T, Li M, Zhang P, Wei X, Chen H, Wang Y, Gao X. Clinical diagnosis and etiology of patients with Chlamydia psittaci pneumonia based on metagenomic next-generation sequencing. Front Cell Infect Microbiol 2022; 12:1006117. [PMID: 36310873 PMCID: PMC9606567 DOI: 10.3389/fcimb.2022.1006117] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022] Open
Abstract
The incidence of severe Chlamydia psittaci (C. psittaci) pneumonia and coinfections is increasing. Early detection of this condition is needed to prevent negative outcomes, along with detailed descriptions of its associated clinical characteristics. Our study contributes by undertaking etiological analysis of patients with C. psittaci pneumonia based on metagenomic next-generation sequencing (mNGS). A retrospective analysis of 30 patients with C. psittaci pneumonia was undertaken and confirmed by mNGS or polymerase chain reaction (PCR). Clinical manifestations of the severe and non-severe C. psittaci pneumonia groups were compared for clinical reference. Etiological analyses were also performed to comprehensively understand pathogeny and coinfection with other respiratory pathogens in C. psittaci patients. The absolute value of lymphocytes (LYM) in the severe group was lower than in the non-severe group. At the same time, neutrophil-to-lymphocyte ratio (NLR), procalcitonin (PCT), alanine aminotransferase (ALT), D-II polymer, brain natriuretic peptide (BNP), myoglobin (MYO), and cardiac troponin I (cTnI) were significantly higher (P < 0.05) in the severe group. mNGS has a broader pathogen spectrum and can more sensitively detect C. psittaci and other low-abundance pathogens with a higher positive detection rate (100%, 13/13 vs. 46%, 6/13, P <0.05) than conventional culture methods. mNGS detected the following dominant species associated with C. psittaci in patients: bacteria (53.2%, 39% gram-positive, 61% gram-negative), fungi (12.9%), and viruses (33.9%). A total of 73.3% (11/15) of patients had suspected coinfections, with a coinfection rate of 91.7% (11/12) in the severe group. No coinfection or death occurred in the non-severe group. Prognosis in the severe group was poor, with a mortality rate of 27.3% (3/11) for patients with coinfection. Eight of 11 patients with coinfections (72.7%) recovered. In conclusion, the clinical symptoms of severe C. psittaci pneumonia manifested as abnormal inflammatory indicators, impaired liver function, myocardial injury, coagulation, and relatively low immune responses. The higher proportion of patients with coinfections in our study supports the use of mNGS for comprehensive early detection of respiratory infections in patients with C. psittaci pneumonia. Simultaneous early identification of coinfections would further improve the clinical treatment of these patients.
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Affiliation(s)
- Yueming Liang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Respiratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
| | - Tingyan Dong
- Integrated Diagnostic Centre for Infectious Diseases, Guangzhou Huayin Medical Laboratory Center, Guangzhou, China
- The School of Medicine, Nanjing University, Nanjing, China
| | - Minjing Li
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Foshan, Foshan, China
| | - Peifang Zhang
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Foshan, Foshan, China
| | - Xiaoqun Wei
- Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Foshan, Foshan, China
| | - Haitao Chen
- Integrated Diagnostic Centre for Infectious Diseases, Guangzhou Huayin Medical Laboratory Center, Guangzhou, China
| | - Yongsi Wang
- Integrated Diagnostic Centre for Infectious Diseases, Guangzhou Huayin Medical Laboratory Center, Guangzhou, China
| | - Xinglin Gao
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Geriatric Respiratory Medicine, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, China
- *Correspondence: Xinglin Gao,
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21
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De Meyst A, Aaziz R, Pex J, Braeckman L, Livingstone M, Longbottom D, Laroucau K, Vanrompay D. Prevalence of New and Established Avian Chlamydial Species in Humans and Their Psittacine Pet Birds in Belgium. Microorganisms 2022; 10:microorganisms10091758. [PMID: 36144360 PMCID: PMC9500992 DOI: 10.3390/microorganisms10091758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
The presence and zoonotic transfer of four different avian Chlamydia spp. was assessed in an epidemiological study in a psittacine bird population and its owners. Fecal swabs from 84 pet birds and pharyngeal swabs from 22 bird owners were collected from 21 locations in Flanders. Samples were examined using established and novel PCR platforms combined with culture on PCR-positive samples. Chlamydiaceae DNA was detected in 33 of 84 (39.3%) birds. The predominant part of the avian infections could be attributed to C. psittaci (22 of 84; 26.2%), followed by C. avium (11 of 84; 13.1%). C. gallinacea and C. abortus were not detected in birds or humans. C. psittaci was the only species detected in pet bird owners (4 of 22; 18.2%), stressing its zoonotic importance. This study showed that C. psittaci and the more recently discovered novel avian species C. avium are undoubtedly present in the Flemish psittacine bird population. Our results justify additional research in a larger psittacine bird population and its owners, focusing on C. psittaci and C. avium. In the meantime, increased awareness among pet bird owners and the implementation of preventive measures in the pet bird industry is advised to limit the circulation of established and novel emerging avian chlamydial species.
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Affiliation(s)
- Anne De Meyst
- Laboratory of Immunology and Animal Biotechnology, Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium
- Correspondence: ; Tel.: +32-09-264-5972
| | - Rachid Aaziz
- Bacterial Zoonoses Unit, Animal Health Laboratory, Anses, University Paris-Est, 94706 Maisons-Alfort, France
| | - Joachim Pex
- Laboratory of Immunology and Animal Biotechnology, Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium
| | - Lutgart Braeckman
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Morag Livingstone
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Edinburgh EH26 0PZ, UK
| | - David Longbottom
- Moredun Research Institute, Pentlands Science Park, Bush Loan, Edinburgh EH26 0PZ, UK
| | - Karine Laroucau
- Bacterial Zoonoses Unit, Animal Health Laboratory, Anses, University Paris-Est, 94706 Maisons-Alfort, France
| | - Daisy Vanrompay
- Laboratory of Immunology and Animal Biotechnology, Department of Animal Sciences and Aquatic Ecology, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium
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22
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Spreading of Pasteurella multocida Infection in a Pet Rabbit Breeding and Possible Implications on Healed Bunnies. Vet Sci 2022; 9:vetsci9060301. [PMID: 35737353 PMCID: PMC9229391 DOI: 10.3390/vetsci9060301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
The number of pets such as dogs, cats, rabbits, and parrots has increased in European families. Social benefits to owners such as decreasing feelings of loneliness and anxiety are provided by pets which are also used in Animal-assisted Therapy (AAT). Nevertheless, human-animal interactions are also associated with health problems including allergies, asthma, and zoonosis. Rabbits may carry potential pathogens for humans. One of the most common bacteria that colonizes the oro-pharynx and the upper respiratory tract of rabbits is Pasteurella (P.) multocida. Transmission of the infection to humans results from scratches, licks, and bites but it also can occur from the inhalation of air particles containing the microorganism. Immunocompromised people or persons with pulmonary disorders are particularly susceptible to the infection. Infected rabbits may carry P. multocida with or without clinical signs. In this paper, the sensitivity to antibiotics and the invasiveness ability of P. multocida identified in a farm of pet rabbits affected by severe pasteurellosis were investigated. The strain was P. multocida belonging to capsular type A which is the type most often detected in humans. The identified strain was susceptible to the tested antibiotics, but it appeared equipped with several virulence genes which are responsible for fimbriae production, adhesion processes to host cells, enzyme production, and are involved in iron acquisition processes. These findings are of particular interest because rabbits recovered from pasteurellosis very often become carriers of the bacteria. Therefore, we suggest considering P. multocida screening in the routine medical checks of rabbits, especially if they are meant to be companion animals for children and elder people, given that the transmission of the pathogen cannot be excluded.
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23
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Zhang A, Xia X, Yuan X, Lv Y, Liu Y, Niu H, Zhang D, Liang J. Clinical characteristics of 14 cases of severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing: A case series. Medicine (Baltimore) 2022; 101:e29238. [PMID: 35713429 PMCID: PMC9276423 DOI: 10.1097/md.0000000000029238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION The objective of this study was to explore the clinical, laboratory, and imaging features of severe Chlamydia psittaci pneumonia in order to improve early diagnosis and treatment success rates. METHODS We conducted a retrospective record review of 14 cases of severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing technology in our hospital. We extracted and analyzed data on the clinical symptoms and signs, contact history, laboratory investigations, chest computed tomography, treatment, and clinical outcomes. RESULTS Of the 14 patients, 12 (86%) were male and two (14%) were female, with a mean age of 57 years (SD: 7 years). Eleven patients (79%) had a history of poultry contact. The main clinical manifestations were fever (n = 14, 100%), flu-like symptoms (n = 10, 71%), cough, sputum (n = 9, 64%), and dyspnea (n = 5, 36%). Blood tests revealed marked elevation of neutrophil percentage, C-reactive protein, procalcitonin, brain natriuretic peptide, and creatine kinase levels; slight elevation of aspartate aminotransferase, creatinine, urea, fibrinogen, and D-dimer levels; and decreased albumin, sodium, and calcium levels. Chest computed tomography showed bilateral lesions (n = 7, 50%), middle-lower lobe lesions (n = 10, 71%), lesions in multiple lobes (n = 9, 64%), consolidation shadows (n = 11, 79%), and pleural effusions (n = 11, 79%). The median time from disease onset to hospital admission was 4.5 days (interquartile range: 1-17 days); the mean length of hospital stay was 20.9 ± 8.5 days, and the mean time from admission to diagnosis was 5.1 ± 2.6 days. After diagnosis, patients were either treated with doxycycline alone or doxycycline combined with quinolones. All 14 patients developed respiratory failure and received invasive mechanical ventilation; two (14%) received veno-venous extracorporeal membrane oxygenation, four (29%) received continuous renal replacement therapy, and three (21%) died. DISCUSSION AND CONCLUSION A poultry contact history and typical flu-like symptoms are early indicators of Chlamydia psittaci pneumonia. Substantial elevations in procalcitonin, creatine kinase, and brain natriuretic peptide indicate severe disease. Metagenomic next-generation sequencing is useful for diagnosis. Early empirical antibiotic therapy with quinolones can reduce the mortality in critically ill patients.
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Affiliation(s)
- Anbing Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan People's Hospital, Zhongshan, People's Republic of China
| | - Xiuqiong Xia
- Department of Respiratory and Critical Care Medicine, Zhongshan People's Hospital, Zhongshan, People's Republic of China
| | - Xiaoling Yuan
- Department of Respiratory and Critical Care Medicine, Zhongshan People's Hospital, Zhongshan, People's Republic of China
| | - Yanhua Lv
- Department of Respiratory and Critical Care Medicine, Zhongshan People's Hospital, Zhongshan, People's Republic of China
| | - Yuxia Liu
- Department of Intensive Care Unit, Zhongshan People's Hospital, Zhongshan, People's Republic of China
| | - Haiming Niu
- Department of Intensive Care Unit, Zhongshan People's Hospital, Zhongshan, People's Republic of China
| | - Dandan Zhang
- Department of Respiratory and Critical Care Medicine, Zhongshan People's Hospital, Zhongshan, People's Republic of China
| | - Jianping Liang
- Department of Respiratory and Critical Care Medicine, Zhongshan People's Hospital, Zhongshan, People's Republic of China
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24
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Duan Z, Gao Y, Liu B, Sun B, Li S, Wang C, Liu D, Wang K, Zhang Y, Lou Z, Xie L, Xie F. The Application Value of Metagenomic and Whole-Genome Capture Next-Generation Sequencing in the Diagnosis and Epidemiological Analysis of Psittacosis. Front Cell Infect Microbiol 2022; 12:872899. [PMID: 35734579 PMCID: PMC9207344 DOI: 10.3389/fcimb.2022.872899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/10/2022] [Indexed: 01/16/2023] Open
Abstract
BackgroundTo evaluate the value of metagenomic next-generation sequencing (mNGS) for the early diagnosis of psittacosis, and to investigate its epidemiology by whole-genome capture.MethodsTwenty-one bronchoalveolar lavage fluid (BALF) and blood samples of 16 psittacosis patients from multiple centers during August 2019 to September 2021 were analyzed retrospectively. mNGS with normal datasets (10 M 75-bp single-end reads after sequencing) and larger datasets (30 M 150-bp paired-end reads after sequencing) as well as quantitative real-time polymerase chain reaction (qPCR) were used to detect the pathogen. Also, whole-genome capture of Chlamydophila psittaci was applied to draw the phylogenetic tree.ResultsmNGS successfully detected the pathogen in all 16 cases (100%), while qPCR was positive only in 5 out of 10 cases (50%), indicating a significantly higher sensitivity of mNGS than qPCR (p < 0.01). BALF-mNGS performed better than blood-mNGS (16/16 versus 3/5, p < 0.05). In addition, larger datasets (the read counts have tripled, and the base number was 12-fold larger compared to clinical mNGS with a normal dataset) of mNGS showed significantly increased contents of human DNA (p < 0.05) and decreased reads per million of the pathogen, suggesting no improvement. Whole-genome capture results of five samples (>60% coverage and >1 depth) were used to construct the phylogenetic tree.ConclusionSignificant advantages of mNGS with normal datasets were demonstrated in early diagnosing psittacosis. It is the first study to use whole-genome capture to analyze C. psittaci epidemiological information.
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Affiliation(s)
- Zhimei Duan
- College of Pulmonary and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yanqiu Gao
- Respiratory Intensive Care Unit, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Bin Liu
- Characteristic Medical Center, the Chinese People’s Armed Police Forces, Tianjin, China
| | - Baohua Sun
- Department of the Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Shuangfeng Li
- Respiratory Intensive Care Unit, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Chenlei Wang
- Department of the Respiratory and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Dongli Liu
- Department of the Respiratory and Critical Care Medicine, Yan’an University Affiliated Hospital, Yan’an, China
| | - Kaifei Wang
- College of Pulmonary and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Ye Zhang
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China
| | - Zheng Lou
- Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing, China
- *Correspondence: Fei Xie, ; Lixin Xie, ; Zheng Lou,
| | - Lixin Xie
- College of Pulmonary and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Fei Xie, ; Lixin Xie, ; Zheng Lou,
| | - Fei Xie
- College of Pulmonary and Critical Care Medicine, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
- *Correspondence: Fei Xie, ; Lixin Xie, ; Zheng Lou,
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25
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Yang F, Li J, Qi B, Zou L, Shi Z, Lei Y, Li J, Luo X, Zeng F, Lu S, Huang X, Liu R, Lan Y. Clinical Symptoms and Outcomes of Severe Pneumonia Caused by Chlamydia psittaci in Southwest China. Front Cell Infect Microbiol 2022; 11:727594. [PMID: 35071027 PMCID: PMC8770948 DOI: 10.3389/fcimb.2021.727594] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 12/13/2021] [Indexed: 11/23/2022] Open
Abstract
Here, we aimed to retrospectively analyze the clinical characteristics of 27 patients with severe pneumonia caused by Chlamydia psittaci between January 2019 and April 2021 in southwest China. To this end, we collected data on the exposure history, clinical symptoms, laboratory examination, imaging characteristics, evolution, etiology, treatment, and outcomes to suggest a better diagnosis and prevention system. Our results showed that a metagenomic next-generation sequencing test could provide early diagnosis. All patients were sensitive to quinolones and tetracyclines, and the recovery rate was relatively high. Overall, all patients were in critical condition with moderate to severe acute respiratory distress syndrome and shock. In conclusion, early diagnosis of pneumonia caused by C. psittaci depends on effective molecular testing, and most patients recover after treatment.
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Affiliation(s)
- Fuxun Yang
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiajia Li
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Qi
- Department of Intensive Care Unit, 903 Hospital, Mianyang, China
| | - Longfei Zou
- Department of ICU, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zongming Shi
- Department of ICU, Neijiang People's Hospital Southwest Medical University, Sichuan, China
| | - Yu Lei
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jun Li
- Department of ICU, Shifang City People's Hospital Affiliated to North Sichuan Medical College, Shifang, China
| | - Xiaoxiu Luo
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Fan Zeng
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Sen Lu
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaobo Huang
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Rongan Liu
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yunping Lan
- Department of ICU, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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26
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Qu J, Zhang J, Chen Y, Huang Y, Xie Y, Zhou M, Li Y, Shi D, Xu J, Wang Q, He B, Shen N, Cao B, She D, Shi Y, Su X, Zhou H, Fan H, Ye F, Zhang Q, Tian X, Lai G. Etiology of Severe Community Acquired Pneumonia in Adults Identified by Combined Detection Methods: A Multi-center Prospective Study in China. Emerg Microbes Infect 2022; 11:556-566. [PMID: 35081880 PMCID: PMC8843176 DOI: 10.1080/22221751.2022.2035194] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Severe Community Acquired Pneumonia (SCAP) challenges public health globally. Considerable improvements in molecular pathogen testing emerged in the last few years. Our prospective study combinedly used traditional culture, antigen tests, PCR and mNGS in SCAP pathogen identification with clinical outcomes. From June 2018 to December 2019, we conducted a multi-centre prospective study in 17 hospitals of SCAP patients within 48 hours of emergency room stay or hospitalization in China. All clinical data were uploaded into an online database. Blood, urine and respiratory specimens were collected for routine culture, antigen detection, PCR and mNGS as designed appropriately. Aetiology confirmation was made by the local attending physician group and scientific committee according to microbiological results, clinical features, and response to the treatment. Two hundred seventy-five patients were included for final analysis. Combined detection methods made identification rate up to 74.2% (222/299), while 14.4% (43/299) when only using routine cultures and 40.8% (122/299) when not using mNGS. Influenza virus (23.2%, 46/198), S. pneumoniae (19.6%, 39/198), Enterobacteriaceae (14.6%, 29/198), Legionella pneumophila (12.6%, 25/198), Mycoplasma pneumoniae (11.1%, 22/198) were the top five common pathogens. The in-hospital mortality of patients with pathogen identified and unidentified was 21.7% (43/198) and 25.9% (20/77), respectively. In conclusion, early combined detection increased the pathogen identification rate and possibly benefitted survival. Influenza virus, S. pneumoniae, Enterobacteriaceae was the leading cause of SCAP in China, and there was a clear seasonal distribution pattern of influenza viruses. Physicians should be aware of the emergence of uncommon pathogens, including Chlamydia Psittaci and Leptospira.
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Affiliation(s)
- Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai.,Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai
| | - Yu Chen
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang
| | - Yi Huang
- Department of Pulmonary and Critical Care Medicine, Changhai Hospital, Shanghai
| | - Yusang Xie
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai.,Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University
| | - Min Zhou
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai.,Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University
| | - Yuping Li
- Department of Pulmonary and Critical Care Medicine, The first affiliated Hospital Wenzhou Medical College, Zhejiang
| | - Dongwei Shi
- Department of Emergency Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai
| | - Jinfu Xu
- Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai
| | - Qiuyue Wang
- Department of Pulmonary and Critical Care Medicine, The first hospital of China Medical University, Shenyang
| | - Bei He
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing
| | - Ning Shen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing
| | - Danyang She
- Department of Pulmonary and Critical Care Medicine, The General Hospital of the People's Liberation Army, Beijing
| | - Yi Shi
- Department of Pulmonary and Critical Care Medicine, Jinling Hospital, Nanjing
| | - Xin Su
- Department of Pulmonary and Critical Care Medicine, Jinling Hospital, Nanjing
| | - Hua Zhou
- Department of Pulmonary and Critical Care Medicine, The first affiliated Hospital Zhejiang University, Hangzhou
| | - Hong Fan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan
| | - Feng Ye
- Department of Pulmonary and Critical Care Medicine, The First Affiliate Hospital of Guangzhou Medical University, Guangzhou
| | - Qiao Zhang
- Department of Pulmonary and Critical Care Medicine, Xinqiao Hospital of Army Medical University, Chongqing
| | - Xinlun Tian
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing
| | - Guoxiang Lai
- Department of Pulmonary and Critical Care Medicine, Fuzhou General Hospital, Fuzhou
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27
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SASSA-O’BRIEN Y, OHYA K, YASUDA-KOGA S, CHAHOTA R, SUGANUMA S, INOUE-MURAYAMA M, FUKUSHI H, KAYANG B, OWUSU EH, TAKASHIMA Y. Chlamydial species among wild birds and livestock in the foothills of Mt. Afadjato, Ghana. J Vet Med Sci 2022; 84:817-823. [PMID: 35491091 PMCID: PMC9246696 DOI: 10.1292/jvms.21-0600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The members of family Chlamydiaceae have a broad host range and cause
many kinds of diseases in humans and animals. Several cases of
Chlamydiaceae being detected in atypical hosts have been reported
recently. Consequently, cross-species monitoring of Chlamydia in wildlife
and livestock is pertinent for public health, animal hygiene and wildlife conservation. In
this study, we conducted molecular surveillance of Chlamydia in wild
birds and livestock around a small village in the foothills of Mt. Afadjato, Ghana where
direct contact between wildlife and livestock occurs. Among 29 captured wild birds and 63
livestock, 5 sheep, 30 goats and 28 chickens, the positive ratios of
Chlamydia were 24.1%, 40.0%, 43.3% and 26.9%, respectively.
Chlamydia pecorum was detected in wild birds, goats, sheep and
chickens. On the basis of the variable domain 2 region of ompA, several
samples from different hosts showed identical sequences and were phylogenetically located
to the same clusters. In addition, using ompA, C.
psittaci, C. abortus and C. gallinacea were
also detected in this small habitat. Further genetic and pathogenic analyses of the
chlamydial distribution in this area, which represents the interface of wild and domestic
animal interactions, may improve our knowledge of their transmission among different
hosts.
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Affiliation(s)
- Yukiko SASSA-O’BRIEN
- Laboratory of Veterinary Infectious Disease, Faculty of Agriculture, Tokyo University of Agriculture and Technology
| | - Kenji OHYA
- Faculty of Applied Biological Sciences, Gifu University
| | | | - Rajesh CHAHOTA
- Department of Veterinary Microbiology, DGCN College of Veterinary and Animal Sciences
| | | | | | | | | | | | - Yasuhiro TAKASHIMA
- Department of Applied Veterinary Science, United Graduate School of Veterinary Sciences, Gifu University
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28
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Zhao W, He L, Xie XZ, Liao X, Tong DJ, Wu SJ, Liu J. Clustering cases of Chlamydia psittaci pneumonia mimicking COVID-19 pneumonia. World J Clin Cases 2021; 9:11237-11247. [PMID: 35071554 PMCID: PMC8717496 DOI: 10.12998/wjcc.v9.i36.11237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/11/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The onset symptoms of people infected by Chlamydia psittaci can mimic the coronavirus disease 2019 (COVID-19). However, the differences in laboratory tests and imaging features between psittacosis and COVID-19 remain unknown.
AIM To better understand the two diseases and then make an early diagnosis and treatment.
METHODS Six patients from two institutions confirmed as psittacosis by high-throughput genetic testing and 31 patients confirmed as COVID-19 were retrospectively included. The epidemiology, clinical characteristics, laboratory tests and computed tomography (CT) imaging features were collected and compared between the two groups. The follow-up CT imaging findings of patients with psittacosis were also investigated.
RESULTS The white blood cell count (WBC), neutrophil count and calcium were more likely to be decreased in patients with COVID-19 but were increased in patients with psittacosis (all P = 0.000). Lymphocyte count and platelet count were higher in patients with psittacosis than in those with COVID-19 (P = 0.044, P = 0.035, respectively). Lesions in patients with psittacosis were more likely to be unilateral (P = 0.001), involve fewer lung lobes (P = 0.006) and have pleural effusions (P = 0.002). Vascular enlargement was more common in patients with COVID-19 (P = 0.003). Consolidation in lung CT images was absorbed in all 6 patients.
CONCLUSION Psittacosis has the potential for human-to-human transmission. Patients with psittacosis present increased WBC count and neutrophil count and have specific CT imaging findings, including unilateral distribution, less involvement of lung lobes and pleural effusions, which might help us to differentiate it from COVID-19.
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Affiliation(s)
- Wei Zhao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha 410011, Hunan Province, China
| | - Lei He
- Department of Radiology, The First People’s Hospital of Yueyang, Yueyang 410005, Hunan Province, China
| | - Xing-Zhi Xie
- Department of Radiology, Hunan Chest Hospital, Changsha 410013, Hunan Province, China
| | - Xuan Liao
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - De-Jun Tong
- Hospital Infection Control Center, The Second Xiangya Hospital, Changsha 410011, Hunan Province, China
| | - Shang-Jie Wu
- Pulmonary and Critical Care Medicine, The Second Xiangya Hospital, Changsha 410011, Hunan Province, China
| | - Jun Liu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha 410011, Hunan Province, China
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Xiao Q, Shen W, Zou Y, Dong S, Tan Y, Zhang X, Yao L, Li Q, Pei W, Wang T. Sixteen cases of severe pneumonia caused by Chlamydia psittaci in South China investigated via metagenomic next-generation sequencing. J Med Microbiol 2021; 70. [PMID: 34817316 DOI: 10.1099/jmm.0.001456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction. Chlamydia psittaci is an important cause of community-acquired pneumonia (CAP). The spectrum of CAP due to Chlamydia psittaci ranges from mild, self-limited to acute respiratory failure and the early identification of this disease can be challenging. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid has the potential to improve the pathogen identification in severe CAP.Hypothesis/Gap Statement. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid has the potential to rapidly identify pathogens in severe CAP. The early identification and appropriate use of antibiotics can improve the prognosis of severe CAP caused by Chlamydia psittaci.Aim. The aim of the study is to describe the clinical spectrum of severe psittacosis pneumonia to provide a better understanding of this disease and to demonstrate that mNGS is an effective method for pathogen detection.Methodology. Retrospective case analysis from November 2019 to November 2020 was performed. Sixteen cases of severe psittacosis pneumonia were diagnosed through mNGS. Clinical features, laboratory findings, imaging features, treatment and outcome were summarized.Results. Frequent symptoms included fever (16/16, 100%), dyspnoea (16/16, 100%), cough (12/16, 75%), sputum (11/16, 69%) and headache (9/16, 56%). The median leukocytosis was within the normal range, while C-reactive proteins, CK, LDH, AST, D-Dimer were significantly elevated. The feature of computed tomography included ground-glass opacity with consolidation and multiple lobar distributions. The total number of sequences of Chlamydia psittaci identified from bronchoalveolar lavage by mNGS varied from 58 to 57115. Five patients underwent noninvasive mechanical ventilation, four patients underwent high flow humidified oxygen therapy and one patient underwent invasive mechanical ventilation. Two patients had septic shock needing vasoactive medications. All of the sixteen patients experienced full recoveries.Conclusion. The symptoms of severe CAP caused by Chlamydia psittaci were not typical while laboratory results may have some clues. The mNGS technology can early detect of psittacosis, reduce unnecessary use of antibiotics and short the course of the disease.
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Affiliation(s)
- Qiang Xiao
- Department of Respiratory Medicine, The First People's Hospital of Changde City, Hunan, PR China
| | - Wei Shen
- Department of Outpatient, The First People's Hospital of Changde City, Hunan, PR China
| | - Yeqiang Zou
- Department of Respiratory Medicine, The First People's Hospital of Changde City, Hunan, PR China
| | - Susu Dong
- Department of Respiratory Medicine, The First People's Hospital of Changde City, Hunan, PR China
| | - Yafen Tan
- Department of Respiratory Medicine, The First People's Hospital of Changde City, Hunan, PR China
| | - Xuan Zhang
- Department of Respiratory Medicine, The First People's Hospital of Changde City, Hunan, PR China
| | - Lu Yao
- Department of Respiratory Medicine, The First People's Hospital of Changde City, Hunan, PR China
| | - Qiuping Li
- Department of Respiratory Medicine, The First People's Hospital of Changde City, Hunan, PR China
| | - Wenjun Pei
- Department of Respiratory Medicine, The First People's Hospital of Changde City, Hunan, PR China
| | - Tianli Wang
- Department of Respiratory Medicine, The First People's Hospital of Changde City, Hunan, PR China
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Wang L, Shi Z, Chen W, Du X, Zhan L. Extracorporeal Membrane Oxygenation in Severe Acute Respiratory Distress Syndrome Caused by Chlamydia psittaci: A Case Report and Review of the Literature. Front Med (Lausanne) 2021; 8:731047. [PMID: 34722571 PMCID: PMC8554049 DOI: 10.3389/fmed.2021.731047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/14/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Infection of Chlamydia psittaci (C. psittaci) could lead to serious clinical manifestations in humans, including severe pneumonia with rapid progression, adult respiratory distress syndrome (ARDS), sepsis, multiple organ dysfunction syndromes (MODS), and probably death. Implementation of extracorporeal membrane oxygenation (ECMO) in the patient with severe ARDS gives a promising new method for recovery. Case Presentation: We report our successful use of venovenous (VV) ECMO in a 48-year-old man who manifested with severe respiratory distress syndrome, acute kidney injury, and septic shock caused by a diagnosis of pneumonia. After the combination of therapy including anti-infection, mechanical ventilation, and continuous renal replacement therapy (CRRT), acute inflammatory syndrome developed. However, his respiratory status rapidly deteriorated. Then, venoarterial (VA)-ECMO support was placed on the patient as suddenly slowing of the heart rate. Harlequin (North-South) syndrome occurred after ECMO initiation. A series of the process could not relieve hypoxia in the upper body. At last, transition to VV-ECMO improved hypoxia. The duration of VV-ECMO was 7 days and the mechanical ventilation was weaned on the next day. On the day of ECMO weaning, nanopore targeted sequencing (NTS) of bronchoalveolar lavage fluid (BALF) reported the presence of C. psittaci. After 19 days of critical systemic rehabilitation and combination therapy, the patient fully recovered from C. psittaci. Conclusion: This is the first reported case of the patient receiving ECMO for C. psittaci pneumonia. ECMO puts the lungs on temporary rest, promotes the recovery of pulmonary function, and also wins time for finding the pathogens, which is crucial in the treatment of rare pathogens.
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Affiliation(s)
- Lu Wang
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhaokun Shi
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wei Chen
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xianjin Du
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Liying Zhan
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
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Wu HH, Feng LF, Fang SY. Application of metagenomic next-generation sequencing in the diagnosis of severe pneumonia caused by Chlamydia psittaci. BMC Pulm Med 2021; 21:300. [PMID: 34556069 PMCID: PMC8461849 DOI: 10.1186/s12890-021-01673-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Psittacosis is a zoonotic infectious disease caused by the transmission of the bacterium Chlamydia psittaci (C. psittaci) from birds to humans. Infections in humans mainly present as community-acquired pneumonia (CAP). However, most cases are treated without diagnostic testing, and the importance of Chlamydia psittaci infection as a cause of CAP is therefore unclear. Diagnostic tools, including culture, serologic test, and PCR-based methods, are available but prone to false negative results. Metagenomic next-generation sequencing (mNGS) has been increasingly used in the diagnosis of infectious diseases, particularly when conventional diagnostic approaches have limitation. Detection of nucleic acid sequence of C. psittaci in respiratory tract samples by metagenomic next-generation sequencing (mNGS) is effective for early diagnosis of severe C. psittaci pneumonia. Timely treatment based on tetracycline can reduce unnecessary use of antibiotics and improve prognosis of patients with severe C. psittaci pneumonia. Methods Clinical data of thirteen patients with severe C. psittaci pneumonia diagnosed by mNGS were collected. Clinical manifestations, treatment and prognosis of patients were summarized. Results The typical symptoms of pneumonia caused by C. psittaci include fever, headache, myalgia, cough, and dyspnea. In the current study, all patients met the criteria for severe C. psittaci pneumonia and received mechanical ventilation, including noninvasive mechanical ventilation (five/thirteen) and invasive mechanical ventilation (eight/thirteen). The findings showed that patients with C. psittaci pneumonia presented with normal or slightly increased leucocytes and procalcitonin, and high C-reactive protein levels. Computed tomography manifestations included consolidation of lung parenchyma, with air bronchogram and pleural effusion in some patients. mNGS analysis results were obtained within 48–72 h. Eleven patients fully recovered after targeted treatment, however, two patients died from secondary multidrug-resistant Pseudomonas aeruginosa infection. Conclusions The findings of the current study show that mNGS is effective in diagnosis of C. psittaci pneumonia, and has significant diagnosis value in patients with severe infection. Patients responds well to the timely use of appropriate antibiotics.
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Affiliation(s)
- Huan-Huan Wu
- Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang, 322100, Zhejiang Province, China.
| | - Lan-Fang Feng
- Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang, 322100, Zhejiang Province, China
| | - Shuang-Yan Fang
- Department of Respiratory Medicine, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang, 322100, Zhejiang Province, China
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32
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Chaber AL, Jelocnik M, Woolford L. Undiagnosed Cases of Human Pneumonia Following Exposure to Chlamydia psittaci from an Infected Rosella Parrot. Pathogens 2021; 10:pathogens10080968. [PMID: 34451432 PMCID: PMC8399200 DOI: 10.3390/pathogens10080968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/21/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
This report describes two cases of occupational exposure to Chlamydia psittaci following dissection of an infected Rosella (Platycercus elegans). The C. psittaci infections (with one of them resulting in diagnosed pneumonia and hospitalisation) were undiagnosed during routine medical investigations but later established due to epidemiological and clinical evidence, and molecular testing of the archived Rosella’ specimens. This case report stresses the importance of correct application and interpretation of diagnostic tests and the need to raise awareness about this zoonotic pathogen among medical practitioners and people exposed to potential animal carriers. Our findings suggest other infected individuals might be misdiagnosed and that C. psittaci (psittacosis) is likely to be underreported in Australia. This case highlights the need to operationalise the One Health concept. We call for improved communication between human and animal health service providers to allow accurate and rapid diagnosis of this zoonotic disease and raised awareness among medical practitioners. Further targeted surveys of wild birds (and other animals) should be conducted to improve assessment of risks to the general population and people working with or exposed to wild birds.
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Affiliation(s)
- Anne-Lise Chaber
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy, SA 5371, Australia;
- Correspondence:
| | - Martina Jelocnik
- Genecology Research Centre, University of the Sunshine Coast, Sippy Downs, QLD 4557, Australia;
| | - Lucy Woolford
- School of Animal and Veterinary Science, University of Adelaide, Roseworthy, SA 5371, Australia;
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Ravichandran K, Anbazhagan S, Karthik K, Angappan M, Dhayananth B. A comprehensive review on avian chlamydiosis: a neglected zoonotic disease. Trop Anim Health Prod 2021; 53:414. [PMID: 34312716 PMCID: PMC8313243 DOI: 10.1007/s11250-021-02859-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 07/09/2021] [Indexed: 01/12/2023]
Abstract
Avian chlamydiosis is one of the important neglected diseases with critical zoonotic potential. Chlamydia psittaci, the causative agent, affects most categories of birds, livestock, companion animals, and humans. It has many obscured characters and epidemiological dimensions, which makes it unique among other bacterial agents. Recent reports on transmission from equine to humans alarmed the public health authorities, and it necessitates the importance of routine screening of this infectious disease. High prevalence of spill-over infection in equines was associated with reproductive losses. Newer avian chlamydial species are being reported in the recent years. It is a potential biological warfare agent and the disease is an occupational hazard mainly to custom officers handling exotic birds. Prevalence of the disease in wild birds, pet birds, and poultry causes economic losses to the poultry industry and the pet bird trade. Interestingly, there are speculations on the ‘legal’ and ‘illegal’ bird trade that may be the global source of some of the most virulent strains of this pathogen. The mortality rate generally ranges from 5 to 40% in untreated cases, but it can sometimes be higher in co-infection. The intracellular lifestyle of this pathogen makes the diagnosis more complicated and there is also lack of accurate diagnostics. Resistance to antibiotics is reported only in some pathogens of the Chlamydiaceae family, but routine screening may assess the actual situation in all pathogens. Due to the diverse nature of the pathogen, the organism necessitates the One Health partnerships to have complete understanding. The present review focuses on the zoonotic aspects of avian chlamydiosis with its new insights into the pathogenesis, transmission, treatment, prevention, and control strategies. The review also briefs on the basic understandings and complex epidemiology of avian chlamydiosis, highlighting the need for research on emerging one health perspectives.
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Affiliation(s)
- Karthikeyan Ravichandran
- Division of Public Health and Epidemiology, ICAR-Indian Veterinary Research Institute, Izatnagar, India.
| | - Subbaiyan Anbazhagan
- Division of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
| | - Kumaragurubaran Karthik
- Central University Laboratory, Tamil Nadu Veterinary and Animal Sciences University, Chennai, India
| | - Madesh Angappan
- Division of Public Health and Epidemiology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
| | - Balusamy Dhayananth
- Division of Public Health and Epidemiology, ICAR-Indian Veterinary Research Institute, Izatnagar, India
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Shi Y, Chen J, Shi X, Hu J, Li H, Li X, Wang Y, Wu B. A case of chlamydia psittaci caused severe pneumonia and meningitis diagnosed by metagenome next-generation sequencing and clinical analysis: a case report and literature review. BMC Infect Dis 2021; 21:621. [PMID: 34193063 PMCID: PMC8243071 DOI: 10.1186/s12879-021-06205-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/18/2021] [Indexed: 12/19/2022] Open
Abstract
Background Psittacosis, which is also known as parrot fever, is Chlamydia psittaci (C. psittaci) caused infectious disease. The clinical manifestations vary from asymptomatic infection to severe atypical pneumonia or even fatal meningitis. Early recognition of psittacosis is difficult because of its nonspecific clinical manifestations. Culture and gene probe techniques for C. psittaci are not available for routine clinical use, which makes the diagnosis difficult too. Although psittacosis has increasingly been recognized and reported in recent years, cure of severe pneumonia complicated with meningitis, with etiologic diagnosis aided by the use of metagenomic next-generation sequencing (mNGS), is still uncommon. So, it is necessary to report and review such potentially fatal case. Case presentation This report describes a 54-year-old woman with C. psittaci caused severe atypical pneumonia and meningitis. She presented with symptoms of fever, dry cough and dyspnea, accompanied by prominent headache. Her condition deteriorated rapidly to respiratory failure and lethargy under the treatment of empirical antibacterial agents, and was treated with invasive mechanical ventilation soon. She denied contact with birds, poultry or horses, but unbiased mNGS of both the bronchoalveolar lavage fluid (BALF) and the cerebrospinal fluid (CSF) identified sequence reads corresponding to C. psittaci infection, and there was no sequence read corresponding to other probable pathogens. Combined use of targeted antimicrobial agents of tetracyclines, macrolides and fluoroquinolones was carried out, and the patient’s condition improved and she was discharged home 28 days later. Her status returned close to premorbid condition on day 60 of follow-up. Conclusions When clinicians come across a patient with atypical pneumonia accompanied by symptoms of meningitis, psittacosis should be taken into consideration. mNGS is a promising detection method in such condition and is recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06205-5.
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Affiliation(s)
- Yunfeng Shi
- Medical Intensive Care Unit, Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.,Institute of Respiratory Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Junxian Chen
- Medical Intensive Care Unit, Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.,Institute of Respiratory Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Xiaohan Shi
- Medical Intensive Care Unit, Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China. .,Institute of Respiratory Diseases, Sun Yat-Sen University, Guangzhou, China.
| | - Jiajia Hu
- Medical Intensive Care Unit, Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.,Institute of Respiratory Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Hongtao Li
- Medical Intensive Care Unit, Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.,Institute of Respiratory Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Xiaojie Li
- Department of Laboratory Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China
| | - Yanhong Wang
- Medical Intensive Care Unit, Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China.,Institute of Respiratory Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Benquan Wu
- Medical Intensive Care Unit, Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, China. .,Institute of Respiratory Diseases, Sun Yat-Sen University, Guangzhou, China.
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Occurrence of Chlamydiaceae in Raptors and Crows in Switzerland. Pathogens 2020; 9:pathogens9090724. [PMID: 32887370 PMCID: PMC7558692 DOI: 10.3390/pathogens9090724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/21/2020] [Accepted: 08/29/2020] [Indexed: 12/26/2022] Open
Abstract
Bacteria of the family Chlamydiaceae are globally disseminated and able to infect many bird species. So far, 11 species of Chlamydia have been detected in wild birds, and several studies found chlamydial strains classified as genetically intermediate between Chlamydia (C.) psittaci and C.abortus. Recently, a group of these intermediate strains was shown to form a separate species, i.e., C.buteonis. In the present study, 1128 samples from 341 raptors of 16 bird species and 253 corvids representing six species were examined using a stepwise diagnostic approach. Chlamydiaceae DNA was detected in 23.7% of the corvids and 5.9% of the raptors. In corvids, the most frequently detected Chlamydia species was C.psittaci of outer membrane protein A (ompA) genotype 1V, which is known to have a host preference for corvids. The most frequently detected ompA genotype in raptors was M56. Furthermore, one of the raptors harbored C.psittaci 1V, and two others carried genotype A. C.buteonis was not detected in the bird population investigated, so it remains unknown whether this species occurs in Switzerland. The infection rate of Chlamydiaceae in corvids was high compared to rates reported in other wild bird species, but neither Chlamydiaceae-positive corvids nor raptors showed overt signs of disease. Since the Chlamydiaceae of both, raptors and crows were identified as C.psittaci and all C.psittaci genotypes are considered to be zoonotic, it can be suggested that raptors and crows pose a potential hazard to the health of their handlers.
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Zhang H, Zhan D, Chen D, Huang W, Yu M, Li Q, Marcos PJ, Tattevin P, Wu D, Wang L. Next-generation sequencing diagnosis of severe pneumonia from fulminant psittacosis with multiple organ failure: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:401. [PMID: 32355845 PMCID: PMC7186658 DOI: 10.21037/atm.2020.03.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study includes a retrospective analysis of the diagnosis and treatment of a case of severe pneumonia from fulminant psittacosis with multiple organ failure. Next-generation sequencing (NGS) of the pathogen was conducted. The purpose of this study was to summarize the clinical, laboratory, and imaging characteristics of the case and to improve understanding of the value of NGS in the diagnosis of severe community-acquired pneumonia (CAP). Fulminant psittacosis can be manifested as severe pneumonia with rapid progression, acute respiratory distress syndrome, sepsis, and multiple organ failure. Imaging shows unilateral lung consolidation, which is difficult to differentiate from CAP caused by common pathogens. The NGS technology can early detect rare pathogens, thus reducing unnecessary use of antibiotics and shortening the course of the disease.
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Affiliation(s)
- Heng Zhang
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen Institute of Respiratory Diseases, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen 518020, China
| | - Danting Zhan
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen Institute of Respiratory Diseases, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen 518020, China
| | - Dandan Chen
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen Institute of Respiratory Diseases, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen 518020, China
| | - Weibin Huang
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen Institute of Respiratory Diseases, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen 518020, China
| | - Min Yu
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen Institute of Respiratory Diseases, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen 518020, China
| | - Qiuwen Li
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen Institute of Respiratory Diseases, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen 518020, China
| | - Pedro J Marcos
- Pneumology Service, Institute of Biomedical Research of A Coruña (INIBIC), University Hospital Complex of A Coruña (CHUAC), Universidade da Coruna (UDC), A Coruña, Spain
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - Di Wu
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen Institute of Respiratory Diseases, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen 518020, China
| | - Lingwei Wang
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen Institute of Respiratory Diseases, Shenzhen Key Laboratory of Respiratory Diseases, Shenzhen 518020, China
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