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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.	馮蘭. 鸚鵡熱肺炎1例報告. 中國現代醫學雜志, 1995, 5(1): 80.
16.	李麗, 倪安平, 于維琴. 鸚鵡熱衣原體肺炎一例. 中華結核和呼吸雜志, 1999, 22(11): 21.
17.	綦利平, 謝志年. 鸚鵡熱肺炎1例. 臨床軍醫雜志, 2003, 31(4): 7.
18.	錢進, 丁彥紅. 鸚鵡熱肺炎1例. 中國綜合臨床, 2003, 19(9): 797.
19.	張郡, 唐光健, 王淑蘭, 等. 鸚鵡熱肺炎的影像學表現. 中華放射學雜志, 2005, 39(11): 1134-1137.
20.	張文源, 楊保華. 鸚鵡熱肺炎2例報道. 臨床肺科雜志, 2009, 14(7): 978.
21.	張旋, 田雪麗, 范駿, 等. 鸚鵡熱衣原體肺炎1例及文獻復習. 中外健康文摘, 2012, 9(22): 61-63.
22.	劉領, 吳文杰, 耿艷杰, 等. 鸚鵡熱衣原體肺炎1例報告并文獻復習. 臨床肺科雜志, 2015, 20(8): 1543-1544.
23.	朱榕生, 羅汝斌, 王選錠, 等. 鸚鵡熱衣原體致重癥社區獲得性肺炎一例. 中華結核和呼吸雜志, 2019, 42(7): 548-551.
24.	史蘭萍, 李陽. 鸚鵡熱衣原體重癥肺炎1例. 中國感染與化療雜志, 2019, 19(3): 309-311.
25.	邱崇榮, 劉向紅, 肖小六, 等. 基因二代測序檢測鸚鵡熱衣原體肺炎1例. 贛南醫學院學報, 2019, 39(9): 940-942.
26.	代紅. 鸚鵡熱衣原體合并CR-AB引起重癥肺炎死亡1例報告. 醫藥前沿, 2019, 9(36): 254-255.
27.	陳清, 于曉佳, 陳罡, 等. 1例鸚鵡熱衣原體感染患者治療的藥學監護. 中國臨床藥理學雜志, 2020, 36(15): 2320-2322.
28.	賀曉艷, 王雅琴, 譚鈺珍. 1例原發性干燥綜合征感染鸚鵡熱衣原體病例報告. 臨床肺科雜志, 2020, 25(3): 483-484.
29.	陳蓉, 陳虹, 周敏, 等. 二代測序診斷鸚鵡熱衣原體血流感染二例. 中華結核和呼吸雜志, 2020, 43(9): 796-798.
30.	朱貞貞, 張宜文. 伐木工人感染鸚鵡熱衣原體導致多臟器功能衰竭一例. 中華臨床感染病雜志, 2020, 13(3): 218-220.
31.	楊昭, 皮泓韜, 徐一笑, 等. 非典型病原菌鸚鵡熱衣原體感染合并呼吸衰竭臨床分析. 實用休克雜志(中英文), 2020, 4(3): 182-185.
32.	張戈, 朱良梅, 周晶, 等. 鸚鵡熱衣原體肺炎危重癥病例的救治與護理. 中華臨床感染病雜志, 2020, 13(2): 134-137.
33.	趙仁淹, 柴海娜, 鄭瑞強. 病原體二代測序輔助診斷鸚鵡熱衣原體重癥肺炎一例. 中華內科雜志, 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. 馮蘭. 鸚鵡熱肺炎1例報告. 中國現代醫學雜志, 1995, 5(1): 80.
16. 李麗, 倪安平, 于維琴. 鸚鵡熱衣原體肺炎一例. 中華結核和呼吸雜志, 1999, 22(11): 21.
17. 綦利平, 謝志年. 鸚鵡熱肺炎1例. 臨床軍醫雜志, 2003, 31(4): 7.
18. 錢進, 丁彥紅. 鸚鵡熱肺炎1例. 中國綜合臨床, 2003, 19(9): 797.
19. 張郡, 唐光健, 王淑蘭, 等. 鸚鵡熱肺炎的影像學表現. 中華放射學雜志, 2005, 39(11): 1134-1137.
20. 張文源, 楊保華. 鸚鵡熱肺炎2例報道. 臨床肺科雜志, 2009, 14(7): 978.
21. 張旋, 田雪麗, 范駿, 等. 鸚鵡熱衣原體肺炎1例及文獻復習. 中外健康文摘, 2012, 9(22): 61-63.
22. 劉領, 吳文杰, 耿艷杰, 等. 鸚鵡熱衣原體肺炎1例報告并文獻復習. 臨床肺科雜志, 2015, 20(8): 1543-1544.
23. 朱榕生, 羅汝斌, 王選錠, 等. 鸚鵡熱衣原體致重癥社區獲得性肺炎一例. 中華結核和呼吸雜志, 2019, 42(7): 548-551.
24. 史蘭萍, 李陽. 鸚鵡熱衣原體重癥肺炎1例. 中國感染與化療雜志, 2019, 19(3): 309-311.
25. 邱崇榮, 劉向紅, 肖小六, 等. 基因二代測序檢測鸚鵡熱衣原體肺炎1例. 贛南醫學院學報, 2019, 39(9): 940-942.
26. 代紅. 鸚鵡熱衣原體合并CR-AB引起重癥肺炎死亡1例報告. 醫藥前沿, 2019, 9(36): 254-255.
27. 陳清, 于曉佳, 陳罡, 等. 1例鸚鵡熱衣原體感染患者治療的藥學監護. 中國臨床藥理學雜志, 2020, 36(15): 2320-2322.
28. 賀曉艷, 王雅琴, 譚鈺珍. 1例原發性干燥綜合征感染鸚鵡熱衣原體病例報告. 臨床肺科雜志, 2020, 25(3): 483-484.
29. 陳蓉, 陳虹, 周敏, 等. 二代測序診斷鸚鵡熱衣原體血流感染二例. 中華結核和呼吸雜志, 2020, 43(9): 796-798.
30. 朱貞貞, 張宜文. 伐木工人感染鸚鵡熱衣原體導致多臟器功能衰竭一例. 中華臨床感染病雜志, 2020, 13(3): 218-220.
31. 楊昭, 皮泓韜, 徐一笑, 等. 非典型病原菌鸚鵡熱衣原體感染合并呼吸衰竭臨床分析. 實用休克雜志(中英文), 2020, 4(3): 182-185.
32. 張戈, 朱良梅, 周晶, 等. 鸚鵡熱衣原體肺炎危重癥病例的救治與護理. 中華臨床感染病雜志, 2020, 13(2): 134-137.
33. 趙仁淹, 柴海娜, 鄭瑞強. 病原體二代測序輔助診斷鸚鵡熱衣原體重癥肺炎一例. 中華內科雜志, 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.

Previous Article
鸚鵡熱，不容小覷的傳染病
Next Article
Clinical analysis of severe community-acquired Chlamydia psittaci pneumonia

Chinese Journal of Respiratory and Critical Care Medicine

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

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content