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Gao Y, Wu Y, Xu D, Bao L, Ding X, Lv L, Ma C, Bian T, Han S. Chlamydia psittaci pneumonia in Wuxi, China: retrospective analysis of 55 cases and predictors of severe disease. Front Med (Lausanne) 2023; 10:1150746. [PMID: 37671399 PMCID: PMC10475936 DOI: 10.3389/fmed.2023.1150746] [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: 01/24/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023] Open
Abstract
Purpose More and more patients with community-acquired pneumonia have been detected with Chlamydia psittaci (C. psittaci) infected using metagenomic next-generation sequencing (mNGS). Previously, this was unheard of, and several patients presented with severe pneumonia and even required ECMO. We aimed to clarify the clinical characteristics of C. psittaci pneumonia and find out if there are any possible predictors of severe C. psittaci pneumonia. Methods In this retrospective study, we included all confirmed cases of C. psittaci pneumonia in Wuxi. Epidemiological, clinical, and radiological features, as well as laboratory data, were collected and analyzed. Results We enrolled 55 patients with C. psittaci pneumonia, with 30 (54.5%) having a history of exposure to birds or their internal organs. 50 (90.9%) patients were diagnosed by mNGS. Patients with C. psittaci pneumonia had many complications, among which, that deserve sufficient attention from clinicians were vascular embolic events (3, 5.5%). High fever was the most common clinical manifestation (41, 74.5%). The majority of patients had a significant increase in neutrophils ratio, neutrophils to lymphocytes ratio (NLR), rapid c-reactive protein, creatine kinase (CK), and lactate dehydrogenase (LDH), as well as a decrease in lymphocytes ratio, albumin, serum sodium, serum potassium, and serum phosphorus. Chest computed tomography scans revealed unilateral pneumonia (70.9%), consolidation (87.3%), air bronchogram (76.4%), and ground-glass opacity (69.1%). The neutrophil ratio, NLR, LDH, and CK were all factors that could identify severe pneumonia. Both AUCs exceeded 0.8; the respective 95% CIs were 0.715-0.944, 0.710-0.963, 0.677-0.937, and 0.718-0.950; all p < 0.05 (0.01, 0.001, 0.007, 0.007 respectively). The ORs were 10.057, 9.750, 10.057, and 9.667, respectively; the 95% CIs were 2.643-38.276, 2.339-40.649, and 2.643-38.276, respectively; all p-values were less than 0.05 (0.001, 0.002, 0.001, 0.001 respectively). Conclusion C. psittaci pneumonia is a very complex disease that changes all the time. Some patients showed severe pneumonia. Patients will have a poor prognosis if they are not treated promptly and effectively. We discovered that many clinical indicators were typical. Meanwhile, significant increases in neutrophil ratio, NLR, LDH, and CK predicted severe pneumonia. Timely detection of mNGS provided substantial help for clinical diagnosis and early treatment.
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Affiliation(s)
- Ying Gao
- Department of Respiratory and Critical Care Medicine, Wuxi No.2 People’s Hospital (Jiangnan University Medical Center), Wuxi, China
| | - Yan Wu
- Department of Respiratory and Critical Care Medicine, The Wuxi People’s Hospital, Wuxi, China
| | - Dan Xu
- Department of Respiratory and Critical Care Medicine, The Xishan People’s Hospital of Wuxi City, Wuxi, China
| | - Liang Bao
- Department of Respiratory and Critical Care Medicine, Wuxi No.2 People’s Hospital (Jiangnan University Medical Center), Wuxi, China
| | - Xiao Ding
- Department of Respiratory and Critical Care Medicine, The Wuxi Fifth People’s Hospital (Jiangnan University Medical Center), Wuxi, China
| | - Lei Lv
- Department of Respiratory and Critical Care Medicine, Wuxi No.2 People’s Hospital (Jiangnan University Medical Center), Wuxi, China
| | - Chenhui Ma
- Department of Respiratory and Critical Care Medicine, Wuxi No.2 People’s Hospital (Jiangnan University Medical Center), Wuxi, China
| | - Tao Bian
- Department of Respiratory and Critical Care Medicine, The Wuxi People’s Hospital, Wuxi, China
| | - Shuguang Han
- Department of Respiratory and Critical Care Medicine, Wuxi No.2 People’s Hospital (Jiangnan University Medical Center), Wuxi, China
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Yang M, Yang DH, Yang H, Ding SZ, Liu CH, Yin HM, Liu D, Chen P, Luo H. Clinical Characteristics of Chlamydia psittaci Pneumonia Infection in Central South China. Infect Dis Ther 2022; 11:1631-1647. [PMID: 35723864 PMCID: PMC9207437 DOI: 10.1007/s40121-022-00662-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Chlamydia psittaci pneumonia has been a global public health hotspot in recent years. Although some scattered cases of C. psittaci pneumonia have been reported, there is a lack of large case studies worldwide. Methods In this multicenter, observational study, we recruited all consecutive patients with confirmed C. psittaci pneumonia from October 4, 2018, to October 23, 2020, in nine tertiary general hospitals in Central-South China. Epidemiologic and clinical data from patients’ electronic medical records were collected and analyzed. Results One hundred and sixteen patients with C. psittaci pneumonia were included in the study. The mean age was 59.7 years. Fever (96.6%) and cough (65.5%) were the most common clinical symptoms. Most patients presented with an increase in the proportion of neutrophils, neutrophil to lymphocyte ratio, LDH, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and a significant decrease in lymphocytes. The main CT lung findings were consolidation (81%) and pleural effusion (35.3%), and bilateral lung consolidation was mainly found in severe patients. Chlamydia psittaci DNA was detected in BALF (bronchoalveolar lavage fluid) or blood samples by metagenomic next-generation sequencing (mNGS) in all patients. Use of quinolone was associated with shorter length of hospital stay and fever duration after antibiotic use. Multivariate logistic regression analysis indicated that respiratory support was associated with both severe pneumonia and in-hospital death. Conclusions The clinical phenotype of C. psittaci pneumonia is complex and variable. mNGS is helpful in the diagnosis and treatment of C. psittaci pneumonia, and early treatment with quinolone may benefit patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00662-4.
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Affiliation(s)
- Min Yang
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, 410011, Hunan, China
| | - Dan-Hui Yang
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, 410011, Hunan, China
| | - Huan Yang
- Department of Respiratory Medicine, Hunan Provincial People's Hospital (the First Affiliated Hospital of Normal University), Changsha, 410011, Hunan, China
| | - Shui-Zi Ding
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, 410011, Hunan, China
| | - Cai-Hong Liu
- Department of Respiratory Medicine, The Third Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hui-Ming Yin
- Department of Respiratory Medicine, The First Affiliated Hospital of Hunan Medical College (Huaihua Third People's Hospital), Huaihua, 418001, Hunan, China
| | - Dan Liu
- Department of Respiratory Medicine, Changsha Hospital of Traditional Chinese Medicine (Changsha Eighth Hospital), Changsha, 410100, China
| | - Ping Chen
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, 410011, Hunan, China.
| | - Hong Luo
- Department of Pulmonary and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Research Unit of Respiratory Disease, Central South University, Changsha, 410011, Hunan, China.
- Hunan Diagnosis and Treatment Center of Respiratory Disease, Changsha, 410011, Hunan, China.
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Rohner L, Marti H, Torgerson P, Hoffmann K, Jelocnik M, Borel N. Prevalence and molecular characterization of C. pecorum detected in Swiss fattening pigs. Vet Microbiol 2021; 256:109062. [PMID: 33848714 DOI: 10.1016/j.vetmic.2021.109062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
Chlamydia (C.) pecorum, an obligate intracellular bacterial species commonly found in ruminants, can also occur in pigs. However, its significance as a potential porcine pathogen, or commensal, is still unclear. In a previous study (Hoffmann et al. 2015), mixed infections of C. suis and C. pecorum were detected in 14 Swiss fattening pig farms. Using these samples, we aimed to investigate the infection dynamics of C. suis and C. pecorum mixed infections in these farms. In addition, we analyzed the genetic diversity of Swiss porcine C. pecorum strains in relation to globally circulating strains. In total, 1284 conjunctival and rectal swabs from 391 pigs, collected at the beginning and end of the fattening period, were tested during the course of this study. We determined the bacterial loads of C. suis and C. pecorum using species-specific real-time PCR (qPCR) and compared these results to already existing DNA-microarray and Chlamydiaceae qPCR data. Overall, C. suis and Chlamydiaceae copy numbers decreased in the course of the fattening period, whereas C. pecorum copy numbers increased. No association was found between clinical signs (conjunctivitis, lameness and diarrhea) and the bacterial loads. Preventive antibiotic treatment at the beginning of the fattening period significantly lowered the chlamydial load and outdoor access was associated with higher loads. Proximity to the nearest ruminants correlated with increased C. pecorum loads, indicating that C. pecorum could be transmitted from ruminants to pigs. Multi-locus sequence typing (MLST) and major outer membrane protein (ompA) genotyping revealed two novel sequence types (STs) (301, 302) and seven unique ompA genotypes (1-7) that appear to form a specific clade separate from other European C. pecorum strains.
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Affiliation(s)
- Lea Rohner
- Institute of Veterinary Pathology, Vetsuisse-Faculty University Zurich, Zurich, 8057, Switzerland; Center for Clinical Studies, Vetsuisse-Faculty, University of Zurich, Zurich, 8057, Switzerland
| | - Hanna Marti
- Institute of Veterinary Pathology, Vetsuisse-Faculty University Zurich, Zurich, 8057, Switzerland; Center for Clinical Studies, Vetsuisse-Faculty, University of Zurich, Zurich, 8057, Switzerland.
| | - Paul Torgerson
- Section of Veterinary Epidemiology, Vetsuisse-Faculty, University of Zurich, Zurich, 8057, Switzerland
| | - Karolin Hoffmann
- Institute of Veterinary Pathology, Vetsuisse-Faculty University Zurich, Zurich, 8057, Switzerland; Center for Clinical Studies, Vetsuisse-Faculty, University of Zurich, Zurich, 8057, Switzerland
| | - Martina Jelocnik
- Genecology Research Centre, University of the Sunshine Coast, Sippy Downs, 4556, Queensland, Australia
| | - Nicole Borel
- Institute of Veterinary Pathology, Vetsuisse-Faculty University Zurich, Zurich, 8057, Switzerland; Center for Clinical Studies, Vetsuisse-Faculty, University of Zurich, Zurich, 8057, Switzerland
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Hoque MM, Adekanmbi F, Barua S, Rahman KS, Aida V, Anderson B, Poudel A, Kalalah A, Bolds S, Madere S, Kitchens S, Price S, Brown V, Lockaby BG, Kyriakis CS, Kaltenboeck B, Wang C. Peptide ELISA and FRET-qPCR Identified a Significantly Higher Prevalence of Chlamydia suis in Domestic Pigs Than in Feral Swine from the State of Alabama, USA. Pathogens 2020; 10:pathogens10010011. [PMID: 33375583 PMCID: PMC7823902 DOI: 10.3390/pathogens10010011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022] Open
Abstract
Chlamydia suis is an important, highly prevalent, and diverse obligate intracellular pathogen infecting pigs. In order to investigate the prevalence and diversity of C. suis in the U.S., 276 whole blood samples from feral swine were collected as well as 109 fecal swabs and 60 whole blood samples from domestic pigs. C. suis-specific peptide ELISA identified anti-C. suis antibodies in 13.0% of the blood of feral swine (26/276) and 80.0% of the domestic pigs (48/60). FRET-qPCR and DNA sequencing found C. suis DNA in 99.1% of the fecal swabs (108/109) and 21.7% of the whole blood (13/60) of the domestic pigs, but not in any of the assayed blood samples (0/267) in feral swine. Phylogenetic comparison of partial C. suis ompA gene sequences and C. suis-specific multilocus sequencing typing (MLST) revealed significant genetic diversity of the C. suis identified in this study. Highly genetically diverse C. suis strains are prevalent in domestic pigs in the USA. As crowding strongly enhances the frequency and intensity of highly prevalent Chlamydia infections in animals, less population density in feral swine than in domestic pigs may explain the significantly lower C. suis prevalence in feral swine. A future study is warranted to obtain C. suis DNA from feral swine to perform genetic diversity of C. suis between commercial and feral pigs.
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Affiliation(s)
- Md Monirul Hoque
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Folasade Adekanmbi
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Subarna Barua
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Kh. Shamsur Rahman
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Virginia Aida
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Brian Anderson
- Swine Research and Education Center, Auburn University, Auburn, AL 36830, USA;
| | - Anil Poudel
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Anwar Kalalah
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Sara Bolds
- School of Forestry and Wildlife Sciences, Auburn University, Auburn, AL 36849, USA; (S.B.); (S.M.); (B.G.L.)
| | - Steven Madere
- School of Forestry and Wildlife Sciences, Auburn University, Auburn, AL 36849, USA; (S.B.); (S.M.); (B.G.L.)
| | - Steven Kitchens
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Stuart Price
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Vienna Brown
- National Feral Swine Damage Management Program, Wildlife Services, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, CO 80521, USA;
| | - B. Graeme Lockaby
- School of Forestry and Wildlife Sciences, Auburn University, Auburn, AL 36849, USA; (S.B.); (S.M.); (B.G.L.)
| | - Constantinos S. Kyriakis
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Bernhard Kaltenboeck
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
| | - Chengming Wang
- College of Veterinary Medicine, Auburn University, Auburn, AL 36849, USA; (M.M.H.); (F.A.); (S.B.); (K.S.R.); (V.A.); (A.P.); (A.K.); (S.K.); (S.P.); (C.S.K.); (B.K.)
- Correspondence:
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