Clinical analysis of severe community-acquired <i>Chlamydia psittaci</i> pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YAO Xiujuan , LU Fengfeng , YUE Wenxiang , XIE Baosong ,  CHEN Yusheng

Fujian Provincial Hospital, Fujian Medical University Provincial Clinical Medical College, Fuzhou, Fujian 350001, P. R. China;

Corresponding author：

CHEN Yusheng, Email: 947317696@qq.com

Keywords：

Severe pneumonia; Chlamydia psittaci; diagnosis; treatment

DOI：

10.7507/1671-6205.202011072

Video：

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Objective To investigate the clinical features, imaging features, diagnosis and treatment of severe Chlamydia psittaci pneumonia in order to facilitate early diagnosis and treatment and reduce the mortality rate. Methods The clinical data of 7 patients with severe Chlamydia psittaci pneumonia diagnosed in Fujian Provincial Hospital from October 2019 to July 2020 were retrospectively analyzed. Results Among the 7 cases, there were 5 males and 2 females, aged 59 to 69 years. The main clinical manifestations were fever, cough, sputum, dyspnea, and some symptoms of digestive and nervous systems. The total number of white blood cells was normal or slightly higher in 7 patients, the absolute value of lymphocytes was decreased, C-reactive protein was significantly increased, and respiratory failure occurred in all 7 patients. Chest CT showed large patchy consolidation shadows accompanied by air bronchogram signs, which progressed in a short period, followed by a small amount of pleural effusion. The specific DNA fragments of Chlamydia psittaci were identified by metagenomic next-generation sequencing in all 7 patients. Six patients were treated with doxycycline, 1 with azithromycin, and 7 relieved with improved symptoms and imaging. Conclusions For elderly patients with acute onset, high fever with cough, difficulty breathing, especially with a history of poultry or birds, whose chest images suggest large consolidation effusion shadows, empirical antibiotic for community-acquired pneumonia is invalid, psittacosis chlamydia pneumonia should be highly suspected. Therefore second-generation sequencing of respiratory secretions is necessary so as to determine the pathogens. Tetracycline class antibiotic treatment should be given as soon as possible after the diagnosis of psittacosis chlamydia pneumonia.

Citation： YAO Xiujuan, LU Fengfeng, YUE Wenxiang, XIE Baosong, CHEN Yusheng. Clinical analysis of severe community-acquired Chlamydia psittaci pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(1): 2-6. doi: 10.7507/1671-6205.202011072 Copy

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4.	中华医学会呼吸病学分会. 肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版). 中华结核和呼吸杂志, 2017, 40(8): 578-583.
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8.	Spoorenberg SMC, Bos WJW, van Hannen EJ, et al. Chlamydia psittaci: a relevant cause of community-acquired pneumonia in two Dutch hospitals. Neth J Med, 2016, 74(2): 75-81.
9.	Chen X, Cao K, Wei Y, et al. Metagenomic next-generation sequencing in the diagnosis of severe pneumonias caused by Chlamydia psittaci. Infection, 2020, 48(4): 535-542.
10.	Gacouin A, Revest M, Letheulle J, et al. Distinctive features between community-acquired pneumonia (CAP) due to Chlamydophila psittaci and CAP due to Legionella pneumophila admitted to the intensive care unit (ICU). Eur J Clin Microbiol Infect Dis, 2012, 31(10): 2713-2718.
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12.	Opota O, Brouillet R, Greub G, et al. Methods for real-time PCR-based diagnosis of chlamydia pneumoniae, chlamydia psittaci, and chlamydia abortus infections in an opened molecular diagnostic platform. Methods Mol Biol, 2017, 1616: 171-181.
13.	Wilson MR, Sample HA, Zorn KC, et al. Clinical metagenomic sequencing for diagnosis of meningitis and encephalitis. N Engl J Med, 2019, 380(24): 2327-2340.
14.	Zhang H, Zhan D, Chen D, et al. Next-generation sequencing diagnosis of severe pneumonia from fulminant psittacosis with multiple organ failure: a case report and literature review. Ann Transl Med, 2020, 8(6): 401.
15.	朱逸敏, 张文宏. 二代测序在脓毒血症患者病原学诊断中的应用. 微生物与感染, 2018, 13(2): 97-101.
16.	Cillóniz C, Torres A, Niederman M, et al. Community-acquired pneumonia related to intracellular pathogens. Intensive Care Med, 2016, 42(9): 1374-1386.
17.	Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis, 2007, 44 Suppl 2(Suppl 2): S27-S72.
18.	Vanrompay D, Harkinezhad T, van de Walle M, et al. Chlamydophila psittaci transmission from pet birds to humans. Emerg Infect Dis, 2007, 13: 1108-1110.

1. Balsamo G, Maxted AM, Midla JW, et al. Compendium of measures to control Chlamydia psittaci infection among humans (Psittacosis) and pet birds (Avian Chlamydiosis), 2017. J Avian Med Surg, 2017, 31(3): 262-282.
2. 朱榕生, 罗汝斌, 王选锭. 鹦鹉热衣原体致重症社区获得性肺炎一例. 中华结核和呼吸杂志, 2019, 42(7): 548-551.
3. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.
4. 中华医学会呼吸病学分会. 肺部感染性疾病支气管肺泡灌洗病原体检测中国专家共识(2017年版). 中华结核和呼吸杂志, 2017, 40(8): 578-583.
5. Beeckman DSA, Vanrompay DCG. Zoonotic Chlamydophila psittaci infections from a clinical perspective. Clin Microbiol Infect, 2009, 15(1): 11-17.
6. Hogerwerf L, DE Gier B, Baan B, et al. Chlamydia psittaci (psittacosis) as a cause of community-acquired pneumonia: a systematic review and meta-analysis. Epidemiol Infect, 2017, 145(15): 3096-3105.
7. Raeven VM, Spoorenberg SM, Boersma WG, et al. Atypical aetiology in patients hospitalised with community-acquired pneumonia is associated with age, gender and season; a data-analysis on four Dutch cohorts. BMC Infect Dis, 2016, 16: 299.
8. Spoorenberg SMC, Bos WJW, van Hannen EJ, et al. Chlamydia psittaci: a relevant cause of community-acquired pneumonia in two Dutch hospitals. Neth J Med, 2016, 74(2): 75-81.
9. Chen X, Cao K, Wei Y, et al. Metagenomic next-generation sequencing in the diagnosis of severe pneumonias caused by Chlamydia psittaci. Infection, 2020, 48(4): 535-542.
10. Gacouin A, Revest M, Letheulle J, et al. Distinctive features between community-acquired pneumonia (CAP) due to Chlamydophila psittaci and CAP due to Legionella pneumophila admitted to the intensive care unit (ICU). Eur J Clin Microbiol Infect Dis, 2012, 31(10): 2713-2718.
11. Nieuwenhuizen AA, Dijkstra F, Notermans DW, et al. Laboratory methods for case finding in human psittacosis outbreaks: a systematic review. BMC Infect Dis, 2018, 18(1): 442.
12. Opota O, Brouillet R, Greub G, et al. Methods for real-time PCR-based diagnosis of chlamydia pneumoniae, chlamydia psittaci, and chlamydia abortus infections in an opened molecular diagnostic platform. Methods Mol Biol, 2017, 1616: 171-181.
13. Wilson MR, Sample HA, Zorn KC, et al. Clinical metagenomic sequencing for diagnosis of meningitis and encephalitis. N Engl J Med, 2019, 380(24): 2327-2340.
14. Zhang H, Zhan D, Chen D, et al. Next-generation sequencing diagnosis of severe pneumonia from fulminant psittacosis with multiple organ failure: a case report and literature review. Ann Transl Med, 2020, 8(6): 401.
15. 朱逸敏, 张文宏. 二代测序在脓毒血症患者病原学诊断中的应用. 微生物与感染, 2018, 13(2): 97-101.
16. Cillóniz C, Torres A, Niederman M, et al. Community-acquired pneumonia related to intracellular pathogens. Intensive Care Med, 2016, 42(9): 1374-1386.
17. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis, 2007, 44 Suppl 2(Suppl 2): S27-S72.
18. Vanrompay D, Harkinezhad T, van de Walle M, et al. Chlamydophila psittaci transmission from pet birds to humans. Emerg Infect Dis, 2007, 13: 1108-1110.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical analysis of severe community-acquired Chlamydia psittaci pneumonia

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