Severe human psittacosis requiring artificial ventilation: case report and review

Persistent renal replacement requirement following fulminant psittacosis infection in pregnancy

Chlamydia psittaci is a zoonotic bacterial infection that most commonly causes mild flu-like symptoms in humans. However, in pregnancy, it can present as fulminant psittacosis associated with systemic illness, disseminated intravascular coagulation, renal and hepatic failure. We describe a case of a veterinary nurse in her 30s who presented at 32 weeks' gestation with rapidly progressive multiorgan failure, with positive, C. psittaci serology. Further history revealed that she had delivered a number of dead lambs in the preceding weeks to her illness, highlighting the importance of a thorough social history. C. psittaci should be suspected in the differential as a causative organism for severe pneumonia with multiorgan failure particularly in pregnant women with animal or bird contacts.

Tigecycline in the treatment of severe pneumonia caused by Chlamydia psittaci: A case report and literature review

Psittacosis is a zoonotic disease caused by Chlamydia psittaci. Systemic infections are mainly transmitted through the respiratory tract. The most common related disease is human atypical pneumonia, which is a rare pathogen of community-acquired pneumonia. Due to the difficulty of diagnosis, there have been few reports of C. psittaci pneumonia in the past. In recent years, with the widespread application of metagenomic next-generation sequencing (mNGS), the number of reported cases of C. psittaci has increased year by year. However, at present, most hospitals have little understanding of C. psittaci, especially for severe patients, and lack experience in diagnosis and treatment. Herein, we report the case of a 71-year-old woman with severe pneumonia that caused by C. psittaci. This patient was diagnosed through mNGS and was treated with tigecycline successfully. The level of IL-6 in the BALF was significantly increased. We discontinued tigecycline after mNGS of the blood was negative. In this review, we analyzed 53 cases to summarize the etiology, clinical manifestations, diagnosis and treatment strategies of severe C. psittaci pneumonia and hope to raise clinicians' awareness of this disease.

Diagnosis and Analysis of Clinical Characteristics of Chlamydia psittaci Pneumonia

Objective: We assessed the clinical characteristics of three patients with Chlamydia psittaci-associated pneumonia. Methods: Clinical data for three patients with C. psittaci-associated pneumonia admitted to our hospital from June 2020 to December 2020 were retrospectively analyzed, and the diagnosis, clinical features, and treatment of the disease are summarized. Results: Fever, headache, and fatigue were the main symptoms in all three patients, whereas local respiratory symptoms such as cough and expectoration were not obvious. Not all patients had a definite contact history with poultry and birds. Chest computed tomography (CT) showed inflammatory exudation, consolidation, and bronchial inflation signs on one side of the lungs, which progressed rapidly. Treatment with beta-amides did not result in positive clinical responses. Combined with clinical manifestations, the disease was confirmed by detection of C. psittaci nucleic acid sequences in alveolar lavage fluid and blood by metagenomic second-generation sequencing technology. Fever and malaise were rapidly relieved after the administration of moxifloxacin-based regimens and levels of infectious blood markers decreased; and the consolidation shadow on chest CT was gradually absorbed. Conclusion: Early application of metagenomic second-generation sequencing in patients with community-acquired pneumonia due to rare and complex pathogens that cannot be diagnosed by conventional tests and for whom empirical anti-infective therapy is ineffective is important for definitive diagnosis and selection of appropriate antibacterial drugs.

Severe psittacosis progressing to suspected organizing pneumonia and the role of corticosteroids

Background

Psittacosis is a systemic disease usually with respiratory involvement, caused by the obligate intracellular bacterium Chlamydia psittaci. Exposure to birds, the main zoonotic reservoir, is a major risk factor for infection. The spectrum of disease is highly variable, ranging from subclinical infection to severe pneumonia requiring mechanical ventilation. There is limited data on psittacosis progressing to organizing pneumonia and management of such cases.

Case presentation

A 63-year-old man was referred to a rural hospital with 11 days of fevers to 39 °C, myalgia, lethargy and several days of dry cough. After initial treatment with benzylpenicillin and doxycycline for left lower pneumonia found on CXR, the patient deteriorated with extensive bilateral consolidation on chest CT requiring mechanical ventilation. Atypical pneumonia screening was negative, however, exposure to a sick bird prior to symptom onset triggered testing for C. psittaci which was positive. Doxycycline was recommenced with minimal benefit, and organizing pneumonia was later suspected. The patient slowly improved with a weaning course of corticosteroids started after 19 days and was discharged from hospital. He unfortunately was re-admitted and died several months later.

Conclusion

Severe pneumonia is a rare, but potentially life-threatening complication of psittacosis. We present a case of psittacosis which progressed to suspected organizing pneumonia despite appropriate antibiotics, and subsequent treatment with corticosteroids. This case suggests it may be useful to consider corticosteroids early in therapy for patients with severe psittacosis. Our paper underlines the need for further research to determine the best management of severe psittacosis to improve patient outcomes.

A patient with psittacosis from a pigeon: A reminder of the importance of detailed interviews and relative bradycardia

A 43-year-old man was brought to our hospital with fever. The initial diagnosis was bacterial pneumonia, and ampicillin/sulbactam was administered. However, defervescence was not achieved, and relative bradycardia was observed. Detailed history-taking revealed that the patient had been involved in caring for a wild pigeon before hospitalization. We changed the antimicrobial therapy to minocycline and the patient' s condition improved. Chlamydophila psittaci antibody was subsequently found to be increased four-fold, and psittacosis was diagnosed. This case acts a reminder to clinicians of the importance of both the history of exposure to any birds and vital signs, including relative bradycardia.

Multi-organ failure with necrotic skin lesions due to infection with Chlamydia psittaci

Presented is a patient with dyspnea and painful ulcers finally resulting in multi-organ failure. A detailed history resulted in positive PCR testing for Chlamydia psittaci. We emphasize the importance of a definitive history in establishing the correct diagnosis. When clinicians observe dyspnea with multi-organ failure, they should be aware of psittacosis.

Chlamydia felis exposure in companion dogs and cats in Lanzhou, China: a public health concern

BACKGROUND

Chlamydiaceae is a family of obligate intracellular pathogens with a worldwide distribution in many animal species, including humans. No information exists on the prevalence of Chlamydia felis infections in cats and dogs in Lanzhou, the geographical center of China. The aim of this study was to carry out a census of cats and dogs in Lanzhou and document the seroprevalence of C. felis exposure in these companion animals.

RESULTS

In this study, blood samples were collected from 485 animals (221 cats and 264 pet dogs) in Lanzhou between November 2010 and July 2011 to identify antibodies against C. felis. Thirteen of 221 (5.9%) cats and 32 of 264 (12.1%) pet dogs were positive for C. felis infection using indirect hemagglutination at a cutoff of 1:16. The seroprevalence in household and stray cats was 3.9% and 14.3%, respectively, and the difference was statistically significant (P < 0.05). Among different age groups, the seroprevalence in cats varied from 1.9 to 7.9%, and that in dogs ranged from 9.6 to 20.4%; however, the differences were not statistically significant (P > 0.05).

CONCLUSIONS

This is the first report of the seroprevalence of C. felis exposure in cats and dogs in Lanzhou, northwestern China. Our results indicate that the presence of C. felis exposure in cats and dogs may pose a potential threat to human health.

Distinctive features between community-acquired pneumonia (CAP) due to Chlamydophila psittaci and CAP due to Legionella pneumophila admitted to the intensive care unit (ICU)

The spectrum of community-acquired pneumonia (CAP) due to Chlamydophila psittaci ranges from mild, self-limited CAP, to acute respiratory failure. We performed a retrospective study of 13 consecutive patients with CAP due to C. psittaci and 51 patients with legionellosis admitted in one intensive care unit (ICU) (1993-2011). As compared to patients with legionellosis, patients with psittacosis were younger (median age 48 [38-59] vs. 60 [50-71] years, p = 0.007), less frequently smokers (38 vs. 79 %, p < 0.001), with less chronic disease (15 vs. 57 %, p = 0.02), and longer duration of symptoms before admission (median 6 [5-13] vs. 5 [3-7] days, p = 0.038). They presented with lower Simplified Acute Physiology Score II (median 28 [19-38] vs. 39 [28-46], p = 0.04) and less extensive infiltrates on chest X-rays (median 2 [1-3] vs. 3 [3-4] lobes, p = 0.007). Bird exposure was mentioned in 100 % of psittacosis cases, as compared to 5.9 % of legionellosis cases (p < 0.0001). Extrapulmonary manifestations, biological features, and mortality (15.4 vs. 21.6 %, p = 0.62) were similar in both groups. In conclusion, severe psittacosis shares many features with severe legionellosis, including extrapulmonary manifestations, biological features, and outcome. Psittacosis is an important differential diagnosis for legionellosis, especially in cases of bird exposure, younger age, and more limited disease progression over the initial few days.

Ornithosis – case report and actual questions

A szerzők egy kritikus állapotú, intenzív osztályon ápolt beteg esetének ismertetése kapcsán foglalják össze az ornithosisdiagnosztika jelenlegi lehetőségeit, epidemiológiai, valamint terápiás vonatkozásait. A kórkép egyéb atípusos bakteriális kórképektől való elkülönítése a klinikai tünetek alapján megbízhatóan nem lehetséges, éppen ezért döntő, olykor életmentő jelentőséggel bír a madárkontaktus felderítése. Az anamnesztikus adatokat rögzítő klinikust mindez egyből a helyes diagnózis felé terelheti, ami az adekvát terápia révén gyors gyógyulást eredményezhet. E bejelentendő kórkép feltehetően mindmáig a gyakran félre- vagy későn diagnosztizált infekciók közé tartozik, így az alulreprezentáltnak tekinthető esetszám nem tükrözi a hazai valós epidemiológiai helyzetet. A szerzők célja, hogy felhívják a figyelmet erre a nem is olyan ritka, ám akár halálos kimenetelű megbetegedésre.

Two fatal cases of psittacosis caused by Chlamydophila psittaci

Two fatal cases of psittacosis are described in two poultry-processing-plant employees presenting with pneumonia and respiratory failure. Diagnosis was confirmed by serological and PCR methods. Psittacosis due to Chlamydophila psittaci infection usually has a good recovery rate, although diagnostic delay and mistreatment can lead to severe complications and even death. This report emphasizes the need for rapid differential diagnosis and management of suspected cases of atypical pneumonia to prevent fatal outcomes.

PNEUMONIA | Atypical

‘Atypical pneumonia’ refers to a clinical syndrome associated with pneumonia (typically mild, nonlobar) and diverse upper respiratory tract and extrapulmonary manifestations. Clinical features overlap with bacterial pneumonia, and co-infection with both typical (e.g., Streptococcus pneumoniae or other bacteria) and atypical pathogens may occur. ‘Atypical’ pathogens include Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella spp. In large epidemiological studies, Mycoplasma pneumoniae has been implicated in 2–18% of community-acquired pneumonias; Chlamydia pneumoniae, in 2–8%; Legionella sp., 1–4%. Atypical pathogens lack cell walls and are resistant to β-lactam antibiotics but are usually susceptible to tetracyclines, macrolides, ketolides, and fluoroquinolone antibiotics. In this article, we also review other unusual causes of pneumonia which are transmitted by insects or vectors (e.g., Rocky Mountain spotted fever, cat scratch fever, Q fever, ehrlichiosis, Lyme disease, and tularemia). These diverse organisms are not found on Gram stain, and diagnosis requires special culture techniques or serological assays. We review the salient clinical and laboratory features of these various disorders, and discuss diagnostic and therapeutic strategies.

[Severe multiorgan psittacosis in a 10-year-old boy]

Psittacosis is rare among children and severe cases appear exceptional. We describe a child with psittacosis and multiorgan involvement.

CASE REPORT

T., a ten-year-old boy, was admitted for a prolonged fever associated with meningism. Laboratory tests showed an important inflammatory response, mild renal failure and coagulation disorders. On admission, the chest X-Ray and the cerebrospinal fluid were normal. He rapidly developed shock, acute abdomen, oxygenodependency, pneumonia and bilateral pleural effusion. No improvement was observed after 48 hours of cefotaxime therapy. History revealed the presence of two parrots at home. Treatment by intravenous clarithromycin was therefore initiated. Serology for Chlamydia psittaci was strongly positive. All symptoms disappeared a few days later.

CONCLUSION

The case reported was particular for two reasons: severe disease with multi-organ involvement and young age of the patient. We emphasize the need to search for a history of contact with birds in any case of unexplained pneumonia.

Pneumonia grave por "Chlamydia psittaci"

A psitacose, também conhecida como ornitose, é causada pela Chlamydia psittaci; caracteriza-se por doença de início insidioso, sintomas brandos e inespecíficos, lembrando infecção de vias aéreas superiores. Acomete principalmente o pulmão, sendo raramente doença sistêmica e fatal. Descreve-se um caso raro de pneumonia por Chlamydia psittaci que evoluiu para insuficiência respiratória aguda, necessitando de ventilação mecânica. Destaca-se a importância em considerar o diagnóstico, especialmente em casos de pneumonia comunitária que evolui de modo insatisfatório, que não responde à terapia antimicrobiana e cuja epidemiologia é positiva para exposição às aves. O diagnóstico precoce é fundamental devido à excelente resposta terapêutica. O diagnóstico tardio pode levar a curso grave e fatal da doença.

Fulminant psittacosis requiring mechanical ventilation and demonstrating serological cross-reactivity between Legionella longbeachae and Chlamydia psittaci

Chlamydia psittaci infection typically causes a mild respiratory illness in humans. Severe respiratory failure requiring mechanical ventilation or intensive care therapy is an uncommon development. The aetiological agents causing severe community acquired pneumonia often remain undetermined. Serological tests may aid in diagnosis. We present two cases of fulminant psittacosis, one demonstrating early cross-reactivity with Legionella longbeachae.

Severe psittacosis during pregnancy and suppression of antibody response with early therapy

A cluster of 3 cases of psittacosis occurred among members of one family. The initial case was a pregnant woman who presented with extensive multilobar infiltrates and severe respiratory distress necessitating mechanical ventilation. Her respiratory failure worsened during 36 h of erythromycin therapy. Improvement coincided with the termination of pregnancy and the initiation of doxycycline treatment. The remaining patients developed milder illness. Serologic assessment of the affected subjects suggests that early treatment may suppress antibody response.