Two fatal cases of psittacosis caused by Chlamydophila psittaci

Clinical diagnosis and etiology of patients with Chlamydia psittaci pneumonia based on metagenomic next-generation sequencing

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.

Clinical Symptoms and Outcomes of Severe Pneumonia Caused by Chlamydia psittaci in Southwest China

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.

Sixteen cases of severe pneumonia caused by Chlamydia psittaci in South China investigated via metagenomic next-generation sequencing

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.

Prevalence Rate and Phylogenetic Analysis of Chlamydia psittaci in Pigeon and House Sparrow Specimens and the Potential Human Infection Risk in Chahrmahal-va-Bakhtiari, Iran

: Chlamydia psittaci (C. psittaci) is an important zoonotic pathogen in birds and has been reported from urban pigeons (Columba livia) and house sparrows (Passer domesticus) worldwide. Some public areas in Iran, such as parks, have a high density of these birds; thus, they may be regarded as a zoonotic threat to humans. The current study aimed at performing the prevalence assessment as well as the phylogenetic analysis of C. psittaci in cloacal swab samples from these birds. To this aim, a total of 75 specimens of urban pigeon, 75 specimens of the house sparrow, and 30 pharyngeal swabs of humans who work in pet-markets were collected from six different zones of Chaharmal-va-Bakhtiari, a Southwestern Province of Iran. The prevalence of C. psittaci was 25.3% (19 out of 75), 18.6% (14 out of 75), and 10% (3 out of 30) among the pigeon, sparrow and the human samples, respectively. The prevalence of C. psittaci was considerably high in urban pigeons. To determine the genotype of C. psittaci, OmpA gene fragments in positive samples were amplified and sequenced. Phylogenetic analysis revealed that strains from the pigeon and sparrow positive samples belonged to the genotypes B and A, while genotyping was unsuccessful for the positive human samples. Our findings suggest that the prevalence of C. psittaci in pigeons and sparrows is high in Chahrmahal-va-Bakhtiari posing as a potential infection risk to susceptible individuals in public places and parks. Therefore, it is essential to take effective measures for the implementation of proper control programs to prevent the possible infection of people with C. psittaci.

Metagenomic next-generation sequencing in the diagnosis of severe pneumonias caused by Chlamydia psittaci

PURPOSE

Chlamydia psittaci infection in humans can lead to serious clinical manifestations, including severe pneumonia, adult respiratory distress syndrome, and, rarely, death. Implementation of metagenomic next-generation sequencing (mNGS) gives a promising new tool for diagnosis. The clinical spectrum of severe psittacosis pneumonia is described to provide physicians with a better understanding and to highlight the rarity and severity of severe psittacosis pneumonia.

METHODS

Nine cases of severe psittacosis pneumonia were diagnosed using mNGS. Retrospective analysis of the data on disease progression, new diagnosis tool, treatments, and outcomes, and the findings were summarised.

RESULTS

Frequent symptoms included chills and remittent fever (100%), cough and hypodynamia (100%), and headache and myalgia (77.8%). All patients were severe psittacosis pneumonia developed respiratory failure, accompanied by sepsis in 6/9 patients. mNGS takes 48-72 h to provide the results, and help to identify diagnosis of psittacosis. Laboratory data showed normal or slightly increased leucocytes, neutrophils, and procalcitonin but high C-reactive protein levels. Computed tomography revealed air-space consolidation and ground-glass opacity, which began in the upper lobe of one lung, and spread to both lungs, along with miliary, nodular, or consolidated shadows. One patient died because of secondary infection with Klebsiella pneumoniae, while the other eight patients experienced complete recoveries.

CONCLUSIONS

The use of mNGS can improve accuracy and reduce the delay in diagnosis of psittacosis. Severe psittacosis pneumonia responds well to the timely use of appropriate antibiotics.

Animal sources for zoonotic transmission of psittacosis: a systematic review

Background

Human psittacosis, caused by Chlamydia (C.) psittaci, is likely underdiagnosed and underreported, since tests for C. psittaci are often not included in routine microbiological diagnostics. Source tracing traditionally focuses on psittacine pet birds, but recently other animal species have been gaining more attention as possible sources for human psittacosis. This review aims to provide an overview of all suspected animal sources of human psittacosis cases reported in the international literature. In addition, for each animal species the strength of evidence for zoonotic transmission was estimated.

Methods

A systematic literature search was conducted using four databases (Pubmed, Embase, Scopus and Proquest). Articles were included when there was mention of at least one human case of psittacosis and a possible animal source. Investigators independently extracted data from the included articles and estimated strength of evidence for zoonotic transmission, based on a self-developed scoring system taking into account number of human cases, epidemiological evidence and laboratory test results in human, animals, and the environment.

Results

Eighty articles were included, which provided information on 136 different situations of possible zoonotic transmission. The maximum score for zoonotic transmission was highest for turkeys, followed by ducks, owls, and the category ‘other poultry’. Articles reporting about zoonotic transmission from unspecified birds, psittaciformes and columbiformes provided a relatively low strength of evidence. A genotypical match between human and animal samples was reported twenty-eight times, including transmission from chickens, turkeys, guinea fowl, peafowl, pigeons, ducks, geese, songbirds, parrot-like birds and owls.

Conclusions

Strong evidence exists for zoonotic transmission from turkeys, chickens and ducks, in addition to the more traditionally reported parrot-like animal sources. Based on our scoring system, the evidence was generally stronger for poultry than for parrot-like birds. Psittaciformes should not be disregarded as an important source of human psittacosis, still clinicians and public health officials should include poultry and birds species other than parrots in medical history and source tracing.

Risk factors associated with Chlamydia psittaci infections in psittacine birds and bird handlers

AIMS

The aim of this study was to determine the prevalence and potential risk factors associated with Chlamydia psittaci infections in psittacine birds and bird handlers in Egypt.

METHODS AND RESULTS

A total of 190 swabs were collected from psittacine birds (n = 120) and bird handlers (n = 70) and were tested by polymerase chain reaction to detect the C. psittaci ompA gene. Chlamydia psittaci DNA was detected in 63 (52·5%) of 120 samples collected from psittacine birds. The occurrence of C. psittaci infections was high in Cockatiel birds (60%), followed by Fischer's lovebird (51%) and Rosy-faced lovebird (47·5%). Bird age, location (pet markets and households), housing (caged and aviary), and sampling season were considered significant risk factors for C. psittaci infections in psittacine birds. Of the 70 sputum swabs collected from bird handlers, only 4 (6%) were positive for C. psittaci. Positive cases were closely associated with older persons (≥30 years) who had respiratory signs and handled birds in pet markets. Further, wearing protective gloves and washing hands when handling psittacine birds decreased the frequency of C. psittaci infections in bird handlers.

CONCLUSIONS

The prevalence of C. psittaci infections in psittacine birds in Egypt is high, which has a potential threat to human health in this area. Thus, dissemination of effective prevention and control measures is essential to prevent the spread of C. psittaci among psittacine birds, as well as among humans in contact with birds.

SIGNIFICANCE AND IMPACT OF THE STUDY

Results from this study highlighted the risk factors associated with C. psittaci infections in psittacine birds and bird handlers in Egypt and will aid in developing prevention and control measures to reduce the risk of C. psittaci infection.

Chlamydophila psittaci pneumonia associated to exposure to fulmar birds (Fulmaris glacialis) in the Faroe Islands

BACKGROUND

For more than 200 years people in the Faroe Islands have supplemented their food by hunting different species of wild birds in the Faroe Islands. Traditionally, juvenile fulmars (Fulmarus glacialis) are caught at sea in late August. The fulmars may be infected or colonized with the bacterium Chlamydophila psittaci which may infect the hunter by the respiratory route and mostly presents as an atypical pneumonia, also called psittacosis or ornithosis or parrot fever. In the Faroe Islands it is called 'nátasjúka' meaning 'fulmar disease'. Historically, it has also been called 'September Pneumonia' in the Faroe Islands.

METHODS

A case series with patients infected with Chlamydophila psittaci.

RESULTS

All four cases presented in this article occurred around the month of September. Improved hygiene measures during the last 50 years in handling the fulmar birds have led to a decline of verified psittacosis in the Faroe Islands. After the last two hunting seasons (2016-2017), four cases of psittacosis were diagnosed and treated in the Faroe Islands. Only nine cases of verified psittacosis have been reported to the Chief Medical Officer of the Faroe Islands during the last 27 years.

CONCLUSIONS

There is an association between catching and handling Fulmarus glacialis and human psittacosis disease in the Faroe Islands. Clinicians treating patients with contact with fulmars should be aware of this zoonotic disease.

Virulence-related comparative transcriptomics of infectious and non-infectious chlamydial particles

BACKGROUND

Members of the phylum Chlamydiae are obligate intracellular pathogens of humans and animals and have a serious impact on host health. They comprise several zoonotic species with varying disease outcomes and prevalence. To investigate differences in virulence, we focused on Chlamydia psittaci, C. abortus and Waddlia chondrophila. Most threatening is C. psittaci, which frequently infects humans and causes psittacosis associated with severe pneumonia. The closest relative of C. psittaci is C. abortus, which shares the vast majority of genes but less frequently infects humans, and causes stillbirth and sepsis. W. chondrophila is more distantly related, and occasional human infections are associated with respiratory diseases or miscarriage. One possible explanation for differences in virulence originate from species-specific genes as well as differentially expressed homologous virulence factors.

RESULTS

RNA-sequencing (RNA-Seq) was applied to purified infectious elementary bodies (EBs) and non-infectious reticulate bodies (RBs) in order to elucidate the transcriptome of the infectious and replicative chlamydial states. The results showed that approximately half of all genes were differentially expressed. For a descriptive comparison, genes were categorised according to their function in the RAST database. This list was extended by the inclusion of inclusion membrane proteins, outer membrane proteins, polymorphic membrane proteins and type III secretion system effectors. In addition, the expression of fifty-six known and a variety of predicted virulence and immunogenic factors with homologs in C. psittaci, C. abortus and W. chondrophila was analysed. To confirm the RNA-Seq results, the expression of nine factors was validated using real-time quantitative polymerase chain reaction (RT-qPCR). Comparison of RNA-Seq and RT-qPCR results showed a high mean Pearson correlation coefficient of 0.95.

CONCLUSIONS

It was shown that both the replicative and infectious chlamydial state contained distinctive transcriptomes and the cellular processes emphasised in EBs and RBs differed substantially based on the chlamydial species. In addition, the very first interspecies transcriptome comparison is presented here, and the considerable differences in expression of homologous virulence factors might contribute to the differing infection rates and disease outcomes of the pathogens. The RNA-Seq results were confirmed by RT-qPCR and demonstrate the feasibility of interspecies transcriptome comparisons in chlamydia.

Disease burden of psittacosis in the Netherlands

Psittacosis (infection with Chlamydia psittaci) can have diverse presentations in humans, ranging from asymptomatic infection to severe systemic disease. Awareness of psittacosis and its presentations are low among clinicians and the general public. Therefore, underdiagnosis and thereby underestimation of the incidence and public health importance of psittacosis is very likely. We used the methodology developed for the Burden of communicable diseases in Europe toolkit of the European Centre for Disease Prevention and Control, to construct a model to estimate disease burden in disability-adjusted life years (DALYs) attributable to psittacosis. Using this model, we estimated the disease burden caused by psittacosis in the Netherlands to have been 222 DALY per year (95% CI 172-280) over the period 2012-2014. This is comparable with the amount of DALYs estimated to be due to rubella or shigellosis in the same period in the Netherlands. Our results highlight the public health importance of psittacosis and identify evidence gaps pertaining to the clinical presentations and prognosis of this disease.

Underdiagnosis of Chlamydia trachomatis and Chlamydia psittaci revealed by introduction of respiratory multiplex PCR assay with Chlamydiaceae family primers

We describe unanticipated detection of respiratory infection with Chlamydia trachomatis and Chlamydia psittaci after introduction of respiratory multiplex polymerase chain reaction assay that includes Chlamydiaceae family primers. We detected cases of pediatric C. trachomatis and of adult C. psittaci infection in patients with previously unrecognized risk factors. Directed testing for C. trachomatis and C. psittaci based on clinical features and risk factors alone is likely to miss the majority of infected cases.

Review of Nonfoodborne Zoonotic and Potentially Zoonotic Poultry Diseases

Emerging and re-emerging diseases are continuously diagnosed in poultry species. A few of these diseases are known to cross the species barrier, thus posing a public health risk and an economic burden. We identified and synthesized global evidence for poultry nonfoodborne zoonoses to better understand these diseases in people who were exposed to different poultry-related characteristics (e.g., occupational or nonoccupational, operational types, poultry species, outbreak conditions, health status of flocks). This review builds on current knowledge on poultry zoonoses/potentially zoonotic agents transmitted via the nonfoodborne route. It also identifies research gaps and potential intervention points within the poultry industry to reduce zoonotic transmission by using various knowledge synthesis tools such as systematic review (SR) and qualitative (descriptive) and quantitative synthesis methods (i.e., meta-analysis). Overall, 1663 abstracts were screened and 156 relevant articles were selected for further review. Full articles (in English) were retrieved and critically appraised using routine SR methods. In total, eight known zoonotic diseases were reviewed: avian influenza (AI) virus (n = 85 articles), Newcastle disease virus (n = 8), West Nile virus (WNV, n = 2), avian Chlamydia (n = 24), Erysipelothrix rhusiopathiae (n = 3), methicillin-resistant Staphylococcus aureus (MRSA, n = 15), Ornithonyssus sylvarium (n = 4), and Microsporum gallinae (n = 3). In addition, articles on other viral poultry pathogens (n = 5) and poultry respiratory allergens derived from mites and fungi (n = 7) were reviewed. The level of investigations (e.g., exposure history, risk factor, clinical disease in epidemiologically linked poultry, molecular studies) to establish zoonotic linkages varied across disease agents and across studies. Based on the multiple outcome measures captured in this review, AI virus seems to be the poultry zoonotic pathogen that may have considerable and significant public health consequences; however, epidemiologic reports have only documented severe human cases clustered in Asia and not in North America. In contrast, avian Chlamydia and MRSA reports clustered mainly in Europe and less so in North America and other regions. Knowledge gaps in other zoonoses or other agents were identified, including potential direct (i.e., nonmosquito-borne) transmission of WNV from flocks to poultry workers, the public health and clinical significance of poultry-derived (livestock-associated) MRSA, the zoonotic significance of other viruses, and the role of poultry allergens in the pathophysiology of respiratory diseases of poultry workers. Across all pathogens reviewed, the use of personal protective equipment was commonly cited as the most important preventive measure to reduce the zoonotic spread of these diseases and the use of biosecurity measures to reduce horizontal transmission in flock populations. The studies also emphasized the need for flock monitoring and an integrated approach to prevention (i.e., veterinary-public health coordination with regard to diagnosis, and knowledge translation and education in the general population) to reduce zoonotic transmission.

Persistence of Chlamydia psittaci in Various Temperatures and Times

Chlamydia psittaci, an obligate intracellular gram-negative bacteria, causes an important zoonotic disease in humans, namely, psittacosis. The objective of this study was to determine the persistent viability of C. psittaci at various temperature conditions. The cloacal swab samples were collected from feral and racing pigeons to find a C. psittaci field strain. The bacterial isolation showed that 1.3% of feral pigeons were PCR positive, while all samples of racing pigeons were PCR negative. Also, bacterial characterization suggested that it belonged to genotype B, which had bacterial titers 3.2 and 3.89 log 50% lethal dose/ml, respectively. A bacterial persistence test was performed, and the results showed that C. psittaci could survive at 56 C for up to 72 hr. In conclusion, C. psittaci could be found in feral pigeons in central Thailand. The bacteria can survive in equatorial temperature areas. This study was the first to report that C. psittaci could survive and has infectivity at 56 C for 72 hr. Therefore, awareness of C. psittaci infection in humans is necessary and should be a public health concern.

Community-acquired pneumonia related to intracellular pathogens

Community-acquired pneumonia (CAP) is associated with high rates of morbidity and mortality worldwide; the annual incidence of CAP among adults in Europe has ranged from 1.5 to 1.7 per 1000 population. Intracellular bacteria are common causes of CAP. However, there is considerable variation in the reported incidence between countries and change over time. The intracellular pathogens that are well established as causes of pneumonia are Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, and Coxiella burnetii. Since it is known that antibiotic treatment for severe CAP is empiric and includes coverage of typical and atypical pathogens, microbiological diagnosis bears an important relationship to prognosis of pneumonia. Factors such as adequacy of initial antibiotic or early de-escalation of therapy are important variables associated with outcomes, especially in severe cases. Intracellular pathogens sometimes appear to cause more severe disease with respiratory failure and multisystem dysfunction associated with fatal outcomes. The clinical relevance of intracellular pathogens in severe CAP has not been specifically investigated. We review the prevalence, general characteristics, and outcomes of severe CAP cases caused by intracellular pathogens.

Assessment of Chlamydia psittaci Shedding and Environmental Contamination as Potential Sources of Worker Exposure throughout the Mule Duck Breeding Process

Chlamydia psittaci is an obligate intracellular bacterium responsible for avian chlamydiosis, otherwise known as psittacosis, a zoonotic disease that may lead to severe atypical pneumonia. This study was conducted on seven mule duck flocks harboring asymptomatic birds to explore the circulation and persistence of C. psittaci during the entire breeding process and assess the potential sources of worker exposure. Cloacal swabs and air samples were taken on each occasion requiring humans to handle the birds. In parallel, environmental samples, including dust, water, and soil, were collected. Specific real-time PCR analyses revealed the presence of C. psittaci in all flocks but with three different shedding patterns involving ducks about the age of 4, 8, and 12 weeks with heavy, moderate, and low excretion levels, respectively. Air samples were only positive in flocks harboring heavy shedders. Dust in flocks with heavy or moderate shedders carried chlamydial loads strongly associated with the loads detected in avian and soil samples. Environmental contamination, significantly correlated with shedding dynamics, was considered to be the most probable source of exposure. The high prevalence of bacteriophage Chp1 in all flocks, mostly jointly present with chlamydia, suggests an important factor in C. psittaci persistence, thus creating a greater risk for humans. A survey conducted in these flocks regarding farming practices and activities showed that disinfection seems to be the most promising practice for reducing C. psittaci prevalence in ducks and that the place and the duration of action during operations seem to be potential risk factors. Strict adherence to good practices is strongly recommended.

Seroprevalence and risk factors of Chlamydia psittaci infection in domestic geese Anser domestica, in Hainan province of China

Chlamydia psittaci, the agent of psittacosis in humans, infects a wide range of bird species. To assess the risk of psittacosis posed by domestic geese in China, the seroprevalence of C. psittaci infection in domestic geese in Hainan province, tropical China was examined using indirect hemagglutination assay (IHA). The overall seroprevalence was estimated at 25.6% (461/1800; 95% CI: 23.6-27.6). The C. psittaci seroprevalence ranged from 19% (95% CI: 14.6-23.4) to 34% (95% CI: 28.6-39.4) among different regions in Hainan province, and the differences were statistically significant (P<0.01). The risk factors significantly associated with C. psittaci seroprevalence were the presence of hygiene conditions, age, gender, and environment of geese in the farms. The results of the present investigation indicated the high seroprevalence of C. psittaci infection in geese in Hainan province, tropical China. Close contact with these geese is associated with a risk of zoonotic transmission of C. psittaci. Public education should be implemented to reduce the risk of avian to human transmission of such a pathogenic agent. To the best of our knowledge, this is the first report documenting the occurrence of C. psittaci seroprevalence in geese in China.

Host preference and zoonotic potential of Chlamydia psittaci and C. gallinacea in poultry

Chlamydia psittaci and C. gallinacea are obligate intracellular bacteria infecting poultry. We conducted a survey in two poultry slaughterhouses that were processing either exclusively ducks (A) or various poultry species except ducks (B). Cloacal swabs were collected from all incoming poultry flocks in the course of a week, and blood samples and pharyngeal swabs were taken from workers. Swabs were examined using PCR and sera were analyzed with two immunoassays. PCR testing revealed the presence of C. psittaci in 9/38 duck flocks and the complete absence of C. gallinacea in these flocks (slaughterhouse A), whereas 16/33 Chlamydiaceae-positive poultry flocks handled in slaughterhouse B harbored C. gallinacea only. In an episode of psittacosis in slaughterhouse A, where one PCR-positive worker presented clinical signs, seroconversions were detected in 10 workers. In contrast, serological responses of slaughterhouse B workers to C. psittaci were generally low. This is in line with the almost complete absence of C. psittaci in handled flocks, where in additional sampling campaigns the agent was detected only once in the course of a year. Our study indicates that C. psittaci has a certain preference for ducks, whereas C. gallinacea was the predominant chlamydial agent in chickens and guinea fowl flocks.

Psittacosis

Psittacosis, also known as ornithosis, is an acute infectious disease caused by Chlamydia psittaci (Cps) and commonly prevails in poultry and other species of bird. Humans infected by Chlamydia psittaci may suffer from unapparent subclinical infection, with symptoms ranging from mild flulike illness to severe SARS. As a typical animal-based infectious disease, psittacosis rarely has pulmonary signs but a long illness course, despite its clinical manifestation characterized by severe pulmonary lesions. Repeated onsets of psittacosis may lead to chronic diseases.

Chlamydia psittaci in ducks: a hidden health risk for poultry workers

Chlamydia psittaci is a zoonotic pathogen associated primarily with avian chlamydiosis also referred as psittacosis. Human psittacosis can lead to severe cases of respiratory disease. The mule duck is one of the main bird hybrids associated with human cases of psittacosis in France. In order to better understand the epidemiology of avian chlamydiosis, monitoring studies were performed in both breeder flocks and mule duck flocks. Surveys conducted in one professional duck bredding organization revealed little shedding in breeder flocks, whereas heavy but asymptomatic C. psittaci shedding was observed in most of the mule duck flocks, mostly when birds were reared in open range conditions on farms. Human cases of psittacosis linked to duck breeder flocks and their progeny led to detection of heavy shedders in all the suspected flocks despite no birds showing clinical signs. Offspring of one of the infected female flocks was analyzed and also proved to be infected by C. psittaci. Field studies suggest that C. psittaci infections in duck farms involve horizontal and probably vertical transmission but that the environment also plays an important role in maintaining infection on farms. In the light of the widespread occurrence of C. psittaci on duck farms, it has become urgent to clearly identify sources of contamination in order to take appropriate field management measures to minimize worker exposure.

Seroprevalence and genotype of Chlamydia in pet parrots in China

Parrots are one of the most popular pet birds in China, and can harbour Chlamydia which has significance for human and animal health. We investigated, by indirect haemagglutination assay, the seroprevalence of Chlamydia infection in four species of parrots, namely budgerigars (Melopsittacus undulatus), lovebirds (Agapornis sp.), cockatiels (Nymphicus hollandicus) and Alexandrine parakeets (Psittacula eupatria) that were collected from Weifang and Beijing cities, North China and explored the association between potential risk factors and chlamydial seropositivity. We further determined the genotype of Chlamydia in 21 fresh faecal samples based on the ompA sequence by reconstruction of phylogenetic relationships. Of the 311 parrots examined, 35·37% (95% confidence interval 30·06–40·68) were seropositive, and species, gender, age, season and geographical location were identified as risk factors. Two PCR-positive samples represented Chlamydia psittaci genotype A. The occurrence of C. psittaci genotype A in the droppings of two pet parrots in China suggests potential environmental contamination with Chlamydiaceae and may raise a public health concern.

Risk factors associated with Chlamydia psittaci infection in psittacine birds

Chlamydia psittaci is the aetiological agent of chlamydiosis in birds, especially Psittaciformes. The objective of the present study was to detect C. psittaci by means of semi-nested PCR among psittacine birds sold at pet markets and kept as pet birds in Salvador, Bahia, Brazil. Questionnaires were used to identify risk factors involved in the epidemiology of the disease. In addition, the management of birds and cages was observed at each location studied. The frequency of C. psittaci infection was 10.6 % (33/311) in the psittacine birds studied. Birds kept in households were less frequently positive (3.4 %; 5/148) than those at pet markets (17.2 %; 28/163). Among the several factors analysed in the epidemiology of the disease, only population density (P = 0.001) and cage hygiene (P = 0.041) in birds at pet markets were significantly associated with C. psittaci infection. These results demonstrate the presence of C. psittaci infection in Psittaciformes kept as pets and held at pet markets in Salvador, Bahia, showing that this micro-organism is a public health concern. Control measures should be encouraged to prevent the spread of the agent among birds, as well as among employees and customers.

Evaluation of pulmonary dysfunctions and acid-base imbalances induced by Chlamydia psittaci in a bovine model of respiratory infection

Background

Chlamydia psittaci (Cp) is a respiratory pathogen capable of inducing acute pulmonary zoonotic disease (psittacosis) or persistent infection. To elucidate the pathogenesis of this infection, a translational large animal model was recently introduced by our group. This study aims at quantifying and differentiating pulmonary dysfunction and acid–base imbalances induced by Cp.

Methods

Forty-two calves were grouped in (i) animals inoculated with Cp (n = 21) and (ii) controls sham-inoculated with uninfected cell culture (n = 21). For pulmonary function testing, impulse oscillometry, capnography, and FRC (functional residual capacity) measurement were applied to spontaneously breathing animals. Variables of acid–base status were assessed in venous blood using both (i) traditional Henderson-Hasselbalch and (ii) strong ion approach.

Results

Both obstructive and restrictive pulmonary disorders were induced in calves experimentally inoculated with Cp. Although disorders in respiratory mechanics lasted for 8–11 days, the pattern of spontaneous breathing was mainly altered in the period of acute illness (until 4 days post inoculation, dpi). Expiration was more impaired than inspiration, resulting in elevated FRC. Ventilation was characterised by a reduction in tidal volume (−25%) combined with an increased percentage of dead space volume and a significant reduction of alveolar volume by 10%. Minute ventilation increased significantly (+50%) due to a compensatory doubling of respiratory rate. Hyperventilatory hypocapnia at 2–3 dpi resulted in slightly increased blood pH at 2 dpi. However, the acid–base equilibrium was additionally influenced by metabolic components, i.e. the systemic inflammatory response, all of which were detected with help of the strong ion theory. Decreased concentrations of albumin (2–10 dpi), a negative acute-phase marker, resulted in a decrease in the sum of non-volatile weak acids (A_tot), revealing an alkalotic effect. This was counterbalanced by acidic effects of decreased strong ion difference (SID), mediated by the interplay between hypochloraemia (alkalotic effect) and hyponatraemia (acidic effect).

Conclusions

This bovine model was found to be suitable for studying pathophysiology of respiratory Cp infection and may help elucidating functional host-pathogen interactions in the mammalian lung.

Chlamydia psittaci exposure in pet birds

Chlamydia psittaci is a zoonotic pathogen with a wide range of avian hosts and may be transmitted to humans and cause severe disease. To assess the risk of psittacosis posed by pet birds, the seroprevalence of Chlamydia psittaci antibodies in 360 Eurasian siskins (Carduelis spinus), 289 oriental skylarks (Alauda arvensis) and 36 black-tailed grosbeaks (Coccothraustes migratorius) in Gansu province, north-western China was detected by an indirect haemagglutination assay. Twenty-seven out of 289 (9.34 %) Alauda arvensis, 45 out of 360 (12.50 %) Carduelis spinus and 2 out of 36 (5.56 %) Coccothraustes migratorius were positive for Chlamydia psittaci infection at a cut-off dilution of 1 : 16. The prevalence of Chlamydia psittaci was higher in Carduelis spinus (12.5 %) than in Alauda arvensis (9.34 %) and Coccothraustes migratorius (5.56 %); however, the differences were not statistically significant (P>0.05). Statistical analysis indicated that Chlamydia psittaci seroprevalence in adult pet birds (12.4 %, 67/540) was significantly higher than that in juvenile pet birds (4.83 %, 7/145) (P<0.01). There was no statistical difference in Chlamydia psittaci seroprevalence between male (12.4 %) and female (8.27 %) birds. To our knowledge, this is the first report indicating the seroprevalence of Chlamydia psittaci exposure in pet birds in China. Our results indicate that close contact with pet birds poses the risk of zoonotic transmission of Chlamydia psittaci.

Seroprevalence of Chlamydia infection in pigs in Jiangxi province, south-eastern China

Chlamydia are Gram-negative obligate bacteria that cause a wide range of diseases in humans and animals. To assess the risk of zoonosis posed by pigs, a total of 920 serum samples were collected from pigs in 11 administrative cities in Jiangxi province, south-eastern China, and the seroprevalence of Chlamydia antibodies was investigated by an indirect haemagglutination assay. The pathogen-specific antibodies were detected in 539 (58.59 %) pigs with seroprevalence ranging from 33.33 % (Jingdezhen) to 90.91 % (Pingxiang) among different cities (P<0.05). The highest prevalence was found in pregnant sows (80.89 %, 127/157), followed by breeding boars (79.37 %, 50/63), suckling sows (77.01 %, 67/87), fattening pigs (69.32 %, 61/88) and non-pregnant sows (62.5 %, 180/288). Piglets had the lowest prevalence of 22.78 % (54/237). The seroprevalence of Chlamydia infection among different categories of pigs was also significantly different (P<0.05). These results indicate that Chlamydia is highly prevalent in pigs in Jiangxi province and our results indicate that the presence of Chlamydia exposure in pigs may pose a potential threat to human health.

Seroprevalence of Chlamydia psittaci infection in market-sold adult chickens, ducks and pigeons in north-western China

Chlamydia psittaci, the agent of psittacosis in humans, infects a wide range of avian species. To assess the risk of psittacosis posed by domestic birds in the urban environment, the prevalence of C. psittaci antibodies in 413 chickens (Gallus domesticus; 305 caged and 108 free-range), 334 ducks (Anas spp.; 111 caged and 223 free-range) and 312 pigeons (Columba livia) in Lanzhou, north-western China, was detected using the indirect haemagglutination assay. The specific antibodies were found in sera of 55 (13.32 %) chickens, 130 (38.92 %) ducks and 97 (31.09 %) pigeons. Statistical analysis showed that the seroprevalence of C. psittaci infection in chickens was significantly lower than that in ducks and pigeons (P<0.05). The C. psittaci seroprevalence in caged and free-range chickens was 7.54 % and 29.63 %, respectively, and the difference was statistically significant (P<0.05). The C. psittaci seroprevalence in caged and free-range ducks was 26.13 % and 45.29 %, respectively (P<0.05). To our knowledge, this is the first study indicating the presence of C. psittaci infection in market-sold chickens, ducks and pigeons in north-western China. Close contact with these birds is associated with a risk of zoonotic transmission of C. psittaci. Public education should be implemented to reduce the risk of avian to human transmission of such a pathogenic agent.

Comparative analysis of Chlamydia psittaci genomes reveals the recent emergence of a pathogenic lineage with a broad host range

Chlamydia psittaci is an obligate intracellular bacterium. Interest in Chlamydia stems from its high degree of virulence as an intestinal and pulmonary pathogen across a broad range of animals, including humans. C. psittaci human pulmonary infections, referred to as psittacosis, can be life-threatening, which is why the organism was developed as a bioweapon in the 20th century and is listed as a CDC biothreat agent. One remarkable recent result from comparative genomics is the finding of frequent homologous recombination across the genome of the sexually transmitted and trachoma pathogen Chlamydia trachomatis. We sought to determine if similar evolutionary dynamics occurred in C. psittaci. We analyzed 20 C. psittaci genomes from diverse strains representing the nine known serotypes of the organism as well as infections in a range of birds and mammals, including humans. Genome annotation revealed a core genome in all strains of 911 genes. Our analyses showed that C. psittaci has a history of frequently switching hosts and undergoing recombination more often than C. trachomatis. Evolutionary history reconstructions showed genome-wide homologous recombination and evidence of whole-plasmid exchange. Tracking the origins of recombinant segments revealed that some strains have imported DNA from as-yet-unsampled or -unsequenced C. psittaci lineages or other Chlamydiaceae species. Three ancestral populations of C. psittaci were predicted, explaining the current population structure. Molecular clock analysis found that certain strains are part of a clonal epidemic expansion likely introduced into North America by South American bird traders, suggesting that psittacosis is a recently emerged disease originating in New World parrots.

Chlamydia psittaci is classified as a CDC biothreat agent based on its association with life-threatening lung disease, termed psittacosis, in humans. Because of the recent remarkable findings of frequent recombination across the genome of the human sexually transmitted and ocular trachoma pathogen Chlamydia trachomatis, we sought to determine if similar evolutionary dynamics occur in C. psittaci. Twenty C. psittaci genomes were analyzed from diverse strains that may play a pathogenic role in human disease. Evolution of the strains revealed genome-wide recombination occurring at a higher rate than for C. trachomatis. Certain strains were discovered to be part of a recent epidemic clonal expansion originating in South America. These strains may have been introduced into the United States from South American bird traders, suggesting that psittacosis is a recently emerged disease originating in New World parrots. Our analyses indicate that C. psittaci strains have a history of frequently switching hosts and undergoing recombination.

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.

The Chlamydia psittaci genome: a comparative analysis of intracellular pathogens

BACKGROUND

Chlamydiaceae are a family of obligate intracellular pathogens causing a wide range of diseases in animals and humans, and facing unique evolutionary constraints not encountered by free-living prokaryotes. To investigate genomic aspects of infection, virulence and host preference we have sequenced Chlamydia psittaci, the pathogenic agent of ornithosis.

RESULTS

A comparison of the genome of the avian Chlamydia psittaci isolate 6BC with the genomes of other chlamydial species, C. trachomatis, C. muridarum, C. pneumoniae, C. abortus, C. felis and C. caviae, revealed a high level of sequence conservation and synteny across taxa, with the major exception of the human pathogen C. trachomatis. Important differences manifest in the polymorphic membrane protein family specific for the Chlamydiae and in the highly variable chlamydial plasticity zone. We identified a number of psittaci-specific polymorphic membrane proteins of the G family that may be related to differences in host-range and/or virulence as compared to closely related Chlamydiaceae. We calculated non-synonymous to synonymous substitution rate ratios for pairs of orthologous genes to identify putative targets of adaptive evolution and predicted type III secreted effector proteins.

CONCLUSIONS

This study is the first detailed analysis of the Chlamydia psittaci genome sequence. It provides insights in the genome architecture of C. psittaci and proposes a number of novel candidate genes mostly of yet unknown function that may be important for pathogen-host interactions.

Real-time detection and identification of Chlamydophila species in veterinary specimens by using SYBR green-based PCR assays

Infections caused by members of the Chlamydiaceae family have long been underestimated due to the requirement of special laboratory facilities for the detection of this group of intracellular pathogens. Furthermore, new studies of this group of intracellular pathogens have revealed that host specificity of different species is not as clear as recently believed. As most members of the genus Chlamydophila have shown to be transmissible from animals to humans, sensitive and fast detection methods are required. In this study, SYBR green-based real-time assays were developed that detect all members of Chlamydiaceae and differentiate the most prevalent veterinary Chlamydophila species: Cp. psittaci, Cp. abortus, Cp. felis, and Cp. caviae. By adding bovine serum albumin to the master mixes, target DNA could be detected directly in crude lysates of enzymatically digested conjunctival or pharyngeal swabs or tissue specimens from heart, liver, and spleen without further purification. The assays were evaluated on veterinary specimens where all samples were screened using a family-specific PCR, and positive samples were further tested using species-specific PCRs. Cp. psittaci was detected in 47 birds, Cp. felis was found in 10 cats, Cp. caviae was found in one guinea pig, and Cp. abortus was detected in one sheep. The screening assay appeared more sensitive than traditional microscopical examination of stained tissue smears. By combining a fast, robust, and cost-effective method for sample preparation with a highly sensitive family-specific PCR, we were able to screen for Chlamydiaceae in veterinary specimens and confirm the species in positive samples with additional PCR assays.

A case of acute psittacosis with severe abdominal pain

We report the case of a psittacosis patient with severe abdominal pain who subsequently developed acute respiratory failure. The main symptoms of psittacosis are considered to be upper respiratory inflammation and influenza-like symptoms. However, it should be emphasized that digestive symptoms can be prominent in psittacosis patients. Early diagnosis of this condition is difficult and there is a need for an effective method for rapid diagnosis.

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.

Bacterial and parasitic zoonoses of exotic pets

Zoonoses are estimated to make up to 75% of today's emerging infectious diseases. Many of these diseases are carried and transmitted by exotic pets and wildlife. Exotic animal practitioners must be aware of these risks not only to protect their health but also to safeguard the health of staff and clients. This article reviews selected bacterial and parasitic zoonoses associated with exotic animals.

Zoonotic potential of Chlamydophila

The purpose of this article is to present the diseases induced in humans and animals by the different species of Chlamydophila, after providing an overview on the history of these infectious agents and their taxonomy. The route of transmission and the available methods for prevention and control in the different animal species are reviewed.