Severe pneumonia caused by <i>Chlamydia psittaci</i> in an immuno-compromised patient: a case report and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

SONG Huihui ,  TANG Hao

Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Naval Medical University, Shanghai 200003, P. R. China;

Corresponding author：

TANG Hao, Email: 13816033045@126.com

Keywords：

Psittacosis; Chlamydia psittaci; severe pneumonia; metagenomic next-generation sequencing

DOI：

10.7507/1671-6205.202102033

Video：

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Objective To investigate the clinical manifestations, diagnosis, treatment and prognosis of psittacosis patients. Methods The clinical features, treatment and prognosis of severe pneumonia caused by Chlamydia psittaci were analyzed and relevant literatures were reviewed. Results An 83-year-old male with a history of type 2 diabetes mellitus was admitted to the hospital for "fever, cough for 5 days and dyspnea for 3 days". Chest CT showed a large mass of increased density in the right lung; CD4⁺ T lymphocytes had an absolute value of 23 cells/μL; Blood gas analysis showed type Ⅰ respiratory failure; Chlamydia psittaci was detected by metagenomic next-generation sequencing. The patient was diagnosed of severe pneumonia (Chlamydia psittaci), type 2 diabetes mellitus, suspected central nervous system infection. This patient was treated with doxycycline and macrolides antibiotics and discharged from hospital after complete recovery. Literature review showed that patients got infected from contacting sick bird, manifested with multiple system involvement. Respiratory symptoms were common, while central nervous system infection seemed to be rare. The diagnosis of psittacosis depended on serology, nucleic acid detection, pathogen isolation and culture. Metagenomic next-generation sequencing had superiority in the diagnosis of psittacosis. Tetracyclines were the preferable treatment, such as doxycycline or tetracycline, with a duration of at least 10 to 14 days. The prognosis of psittacosis was well, and most of the severe and even life-threatening cases were caused by unclear diagnosis and delayed treatment, and the overall mortality rate was about 1%. Conclusions Psittacosis is one kind of zoonoses. History of poultry exposure is helpful in diagnosis, and metagenomic next-generation sequencing has advantages in diagnosing psittacosis. Tetracyclines are preferred with adequate course of treatment. The overall prognosis is good.

Citation： SONG Huihui, TANG Hao. Severe pneumonia caused by Chlamydia psittaci in an immuno-compromised patient: a case report and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(1): 12-19. doi: 10.7507/1671-6205.202102033 Copy

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.	Vande Weygaerde Y, Versteele C, Thijs E, et al. An unusual presentation of a case of human psittacosis. Respir Med Case Rep, 2018, 23: 138-142.
3.	Radomski N, Einenkel R, Muller A, et al. Chlamydia-host cell interaction not only from a bird's eye view: some lessons from Chlamydia psittaci. FEBS Lett, 2016, 590(21): 3920-3940.
4.	Sachse K, Laroucau K, Hotzel H, et al. Genotyping of Chlamydophila psittaci using a new DNA microarray assay based on sequence analysis of ompA genes. BMC Microbiol, 2008, 8: 63.
5.	Knittler MR, Sachse K. Chlamydia psittaci: update on an underestimated zoonotic agent. Pathog Dis, 2015, 73(1): 1-15.
6.	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.
7.	Harkinezhad T, Geens T, Vanrompay D. Chlamydophila psittaci infections in birds: a review with emphasis on zoonotic consequences. Vet Microbiol, 2009, 135(1-2): 68-77.
8.	Telfer BL, Moberley SA, Hort KP, et al. Probable psittacosis outbreak linked to wild birds. Emerg Infect Dis, 2005, 11(3): 391-397.
9.	Mair-Jenkins J, Lamming T, Dziadosz A, et al. A psittacosis outbreak among English office workers with little or no contact with birds, August 2015. PLoS Curr, 2018, 10: ecurrents.
10.	Beeckman DS, Vanrompay DC. Zoonotic Chlamydophila psittaci infections from a clinical perspective. Clin Microbiol Infect, 2009, 15(1): 11-17.
11.	Branley JM, Weston KM, England J, et al. Clinical features of endemic community-acquired psittacosis. New Microbes New Infect, 2014, 2(1): 7-12.
12.	Chu J, Durrani MI: Psittacosis. In StatPearls; StatPearls Publishing StatPearls Publishing LLC. : Treasure Island (FL), 2019.
13.	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): S27-S72.
14.	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.
15.	冯兰. 鹦鹉热肺炎1例报告. 中国现代医学杂志, 1995, 5(1): 80.
16.	李丽, 倪安平, 于维琴. 鹦鹉热衣原体肺炎一例. 中华结核和呼吸杂志, 1999, 22(11): 21.
17.	綦利平, 谢志年. 鹦鹉热肺炎1例. 临床军医杂志, 2003, 31(4): 7.
18.	钱进, 丁彦红. 鹦鹉热肺炎1例. 中国综合临床, 2003, 19(9): 797.
19.	张郡, 唐光健, 王淑兰, 等. 鹦鹉热肺炎的影像学表现. 中华放射学杂志, 2005, 39(11): 1134-1137.
20.	张文源, 杨保华. 鹦鹉热肺炎2例报道. 临床肺科杂志, 2009, 14(7): 978.
21.	张旋, 田雪丽, 范骏, 等. 鹦鹉热衣原体肺炎1例及文献复习. 中外健康文摘, 2012, 9(22): 61-63.
22.	刘领, 吴文杰, 耿艳杰, 等. 鹦鹉热衣原体肺炎1例报告并文献复习. 临床肺科杂志, 2015, 20(8): 1543-1544.
23.	朱榕生, 罗汝斌, 王选锭, 等. 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.
24.	史兰萍, 李阳. 鹦鹉热衣原体重症肺炎1例. 中国感染与化疗杂志, 2019, 19(3): 309-311.
25.	邱崇荣, 刘向红, 肖小六, 等. 基因二代测序检测鹦鹉热衣原体肺炎1例. 赣南医学院学报, 2019, 39(9): 940-942.
26.	代红. 鹦鹉热衣原体合并CR-AB引起重症肺炎死亡1例报告. 医药前沿, 2019, 9(36): 254-255.
27.	陈清, 于晓佳, 陈罡, 等. 1例鹦鹉热衣原体感染患者治疗的药学监护. 中国临床药理学杂志, 2020, 36(15): 2320-2322.
28.	贺晓艳, 王雅琴, 谭钰珍. 1例原发性干燥综合征感染鹦鹉热衣原体病例报告. 临床肺科杂志, 2020, 25(3): 483-484.
29.	陈蓉, 陈虹, 周敏, 等. 二代测序诊断鹦鹉热衣原体血流感染二例. 中华结核和呼吸杂志, 2020, 43(9): 796-798.
30.	朱贞贞, 张宜文. 伐木工人感染鹦鹉热衣原体导致多脏器功能衰竭一例. 中华临床感染病杂志, 2020, 13(3): 218-220.
31.	杨昭, 皮泓韬, 徐一笑, 等. 非典型病原菌鹦鹉热衣原体感染合并呼吸衰竭临床分析. 实用休克杂志(中英文), 2020, 4(3): 182-185.
32.	张戈, 朱良梅, 周晶, 等. 鹦鹉热衣原体肺炎危重症病例的救治与护理. 中华临床感染病杂志, 2020, 13(2): 134-137.
33.	赵仁淹, 柴海娜, 郑瑞强. 病原体二代测序辅助诊断鹦鹉热衣原体重症肺炎一例. 中华内科杂志, 2020, 59(12): 989-991.
34.	Chiu CY, Miller SA. Clinical metagenomics. Nat Rev Genet, 2019, 20(6): 341-355.
35.	Miller JM, Binnicker MJ, Campbell S, et al. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis, 2018, 67(6): e1-e94.
36.	Crosse BA. Psittacosis: a clinical review. J Infect, 1990, 21(3): 251-259.
37.	Al-Kawi MZ, Madkour MM. Brain stem encephalitis in ornithosis. J Neurol Neurosurg Psychiatry, 1986, 49(5): 603-604.
38.	Walder G, Schonherr H, Hotzel H, et al. Presence of Chlamydophila psittaci DNA in the central nervous system of a patient with status epilepticus. Scand J Infect Dis, 2003, 35(1): 71-73.
39.	Grattan CE, Berman P. Chlamydial infection as a possible aetiological factor in the Guillain-Barre syndrome. Postgrad Med J, 1982, 58(686): 776-777.
40.	Walton KW. The pathology of a fatal case of psittacosis showing intracytoplasmic inclusions in the meninges. J Pathol Bacteriol, 1954, 68(2): 565-572.

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. Vande Weygaerde Y, Versteele C, Thijs E, et al. An unusual presentation of a case of human psittacosis. Respir Med Case Rep, 2018, 23: 138-142.
3. Radomski N, Einenkel R, Muller A, et al. Chlamydia-host cell interaction not only from a bird's eye view: some lessons from Chlamydia psittaci. FEBS Lett, 2016, 590(21): 3920-3940.
4. Sachse K, Laroucau K, Hotzel H, et al. Genotyping of Chlamydophila psittaci using a new DNA microarray assay based on sequence analysis of ompA genes. BMC Microbiol, 2008, 8: 63.
5. Knittler MR, Sachse K. Chlamydia psittaci: update on an underestimated zoonotic agent. Pathog Dis, 2015, 73(1): 1-15.
6. 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.
7. Harkinezhad T, Geens T, Vanrompay D. Chlamydophila psittaci infections in birds: a review with emphasis on zoonotic consequences. Vet Microbiol, 2009, 135(1-2): 68-77.
8. Telfer BL, Moberley SA, Hort KP, et al. Probable psittacosis outbreak linked to wild birds. Emerg Infect Dis, 2005, 11(3): 391-397.
9. Mair-Jenkins J, Lamming T, Dziadosz A, et al. A psittacosis outbreak among English office workers with little or no contact with birds, August 2015. PLoS Curr, 2018, 10: ecurrents.
10. Beeckman DS, Vanrompay DC. Zoonotic Chlamydophila psittaci infections from a clinical perspective. Clin Microbiol Infect, 2009, 15(1): 11-17.
11. Branley JM, Weston KM, England J, et al. Clinical features of endemic community-acquired psittacosis. New Microbes New Infect, 2014, 2(1): 7-12.
12. Chu J, Durrani MI: Psittacosis. In StatPearls; StatPearls Publishing StatPearls Publishing LLC. : Treasure Island (FL), 2019.
13. 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): S27-S72.
14. 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.
15. 冯兰. 鹦鹉热肺炎1例报告. 中国现代医学杂志, 1995, 5(1): 80.
16. 李丽, 倪安平, 于维琴. 鹦鹉热衣原体肺炎一例. 中华结核和呼吸杂志, 1999, 22(11): 21.
17. 綦利平, 谢志年. 鹦鹉热肺炎1例. 临床军医杂志, 2003, 31(4): 7.
18. 钱进, 丁彦红. 鹦鹉热肺炎1例. 中国综合临床, 2003, 19(9): 797.
19. 张郡, 唐光健, 王淑兰, 等. 鹦鹉热肺炎的影像学表现. 中华放射学杂志, 2005, 39(11): 1134-1137.
20. 张文源, 杨保华. 鹦鹉热肺炎2例报道. 临床肺科杂志, 2009, 14(7): 978.
21. 张旋, 田雪丽, 范骏, 等. 鹦鹉热衣原体肺炎1例及文献复习. 中外健康文摘, 2012, 9(22): 61-63.
22. 刘领, 吴文杰, 耿艳杰, 等. 鹦鹉热衣原体肺炎1例报告并文献复习. 临床肺科杂志, 2015, 20(8): 1543-1544.
23. 朱榕生, 罗汝斌, 王选锭, 等. 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.
24. 史兰萍, 李阳. 鹦鹉热衣原体重症肺炎1例. 中国感染与化疗杂志, 2019, 19(3): 309-311.
25. 邱崇荣, 刘向红, 肖小六, 等. 基因二代测序检测鹦鹉热衣原体肺炎1例. 赣南医学院学报, 2019, 39(9): 940-942.
26. 代红. 鹦鹉热衣原体合并CR-AB引起重症肺炎死亡1例报告. 医药前沿, 2019, 9(36): 254-255.
27. 陈清, 于晓佳, 陈罡, 等. 1例鹦鹉热衣原体感染患者治疗的药学监护. 中国临床药理学杂志, 2020, 36(15): 2320-2322.
28. 贺晓艳, 王雅琴, 谭钰珍. 1例原发性干燥综合征感染鹦鹉热衣原体病例报告. 临床肺科杂志, 2020, 25(3): 483-484.
29. 陈蓉, 陈虹, 周敏, 等. 二代测序诊断鹦鹉热衣原体血流感染二例. 中华结核和呼吸杂志, 2020, 43(9): 796-798.
30. 朱贞贞, 张宜文. 伐木工人感染鹦鹉热衣原体导致多脏器功能衰竭一例. 中华临床感染病杂志, 2020, 13(3): 218-220.
31. 杨昭, 皮泓韬, 徐一笑, 等. 非典型病原菌鹦鹉热衣原体感染合并呼吸衰竭临床分析. 实用休克杂志(中英文), 2020, 4(3): 182-185.
32. 张戈, 朱良梅, 周晶, 等. 鹦鹉热衣原体肺炎危重症病例的救治与护理. 中华临床感染病杂志, 2020, 13(2): 134-137.
33. 赵仁淹, 柴海娜, 郑瑞强. 病原体二代测序辅助诊断鹦鹉热衣原体重症肺炎一例. 中华内科杂志, 2020, 59(12): 989-991.
34. Chiu CY, Miller SA. Clinical metagenomics. Nat Rev Genet, 2019, 20(6): 341-355.
35. Miller JM, Binnicker MJ, Campbell S, et al. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis, 2018, 67(6): e1-e94.
36. Crosse BA. Psittacosis: a clinical review. J Infect, 1990, 21(3): 251-259.
37. Al-Kawi MZ, Madkour MM. Brain stem encephalitis in ornithosis. J Neurol Neurosurg Psychiatry, 1986, 49(5): 603-604.
38. Walder G, Schonherr H, Hotzel H, et al. Presence of Chlamydophila psittaci DNA in the central nervous system of a patient with status epilepticus. Scand J Infect Dis, 2003, 35(1): 71-73.
39. Grattan CE, Berman P. Chlamydial infection as a possible aetiological factor in the Guillain-Barre syndrome. Postgrad Med J, 1982, 58(686): 776-777.
40. Walton KW. The pathology of a fatal case of psittacosis showing intracytoplasmic inclusions in the meninges. J Pathol Bacteriol, 1954, 68(2): 565-572.

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Severe pneumonia caused by Chlamydia psittaci in an immuno-compromised patient: a case report and literature review

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