以發熱并發氣促、咯血為表現的鸚鵡熱衣原體肺炎一例報告并文獻復習_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

謝廷逸 ¹ , 黃智蘭 ¹ ,  謝緯 ² , 呂萌 ²

1. ;
2. ;

Corresponding?author：

謝緯, Email: xiew0703@163.com

Keywords：

鸚鵡熱; 咯血; 支氣管鏡冷凍治療

DOI：

10.7507/1671-6205.202312026

Video：

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目的總結鸚鵡熱衣原體感染的臨床特征，探討鸚鵡熱衣原體感染出現咯血的發生機制及治療手段，提高臨床對本病的認識。方法報道國內首例經支氣管鏡冷凍技術治療鸚鵡熱衣原體感染出現咯血患者的診療經過，并回顧國內外數據庫建庫至今，篩選及總結分析鸚鵡熱衣原體感染導致咯血的文獻報道。結果患者為38歲女性，以發熱并發氣促、咯血為主要表現，經肺泡灌洗液宏基因組二代測序（metagenomics next-generation sequencing，mNGS）檢測診斷為鸚鵡熱衣原體肺炎。通過藥物對癥處理以及經支氣管鏡冷凍治療后病情好轉。結合相關文獻和該病例，共10例患者因鸚鵡熱衣原體感染出現咯血的表現。結論鸚鵡熱衣原體感染早期臨床表現無特異性，臨床問診需追溯鳥類及家禽接觸史，mNGS能較為精準鑒定病原體。現鸚鵡熱衣原體感染治療首選四環素類藥物，大環內酯類及喹諾酮類抗生素也有效。本例通過支氣管鏡冷凍技術治療后病情好轉，為臨床治療鸚鵡熱衣原體感染出現咯血提供經驗參考，但關于發生機制及其他診療思路仍值得深入研究。

Citation： 謝廷逸, 黃智蘭, 謝緯, 呂萌. 以發熱并發氣促、咯血為表現的鸚鵡熱衣原體肺炎一例報告并文獻復習. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(5): 346-351. doi: 10.7507/1671-6205.202312026 Copy

1.	Sun L, Li P, Pang B, et al. Gestational psittacosis with secondary hemophagocytic syndrome: a case report and literature review. Front Med (Lausanne), 2021, 8: 755669.
2.	Zhu Z, Wang X, Zhao J, et al. Clinical characteristics of six patients with chlamydia psittaci infection diagnosed by metagenomic next-generation sequencing: a case series. Infect Drug Resist, 2023, 16: 869-878.
3.	Dai J, Lian X, Mo J, et al. Case report: a clinical case study of six patients with Chlamydia psittaci pneumonia. Front Cell Infect Microbiol, 2023, 13: 1084882.
4.	Chau S, Tso EY, Leung WS, et al. Three cases of atypical pneumonia caused by Chlamydophila psittaci. Hong Kong Med J, 2015, 21(3): 272-275.
5.	Wu Y, Xu X, Liu Y, et al. Case Report: clinical analysis of a cluster outbreak of chlamydia psittaci pneumonia. Front Cell Infect Microbiol, 2023, 13: 1214297.
6.	張長強, 郭松喜, 劉茜, 等. 北京市密云區11例鸚鵡熱衣原體肺炎臨床及流行病特征分析. 中外醫學研究, 2022, 20: 25-29.
7.	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): 662-662.
8.	Knittler MR, Sachse K. Chlamydia psittaci: update on an underestimated zoonotic agent. Pathog Dis, 2015, 73(1): 1-15.
9.	Feng Y, Feng YM, Zhang ZH, et al. Prevalence and genotype of Chlamydia psittaci in faecal samples of birds from zoos and pet markets in Kunming, Yunnan, China. J Zhejiang Univ Sci B, 2016, 17(4): 311-316.
10.	Pang Y, Cong F, Zhang X, et al. A recombinase polymerase amplification-based assay for rapid detection of Chlamydia psittaci. Poult Sci, 2021, 100(2): 585-591.
11.	Hogerwerf L, Roof I, de Jong MJK, et al. Animal sources for zoonotic transmission of psittacosis: a systematic review. BMC Infect Dis, 2020, 20(1): 192.
12.	Huang W, Wang F, Cai Q, et al. Epidemiological and clinical characteristics of psittacosis among cases with complicated or atypical pulmonary infection using metagenomic next-generation sequencing: a multi-center observational study in China. Ann Clin Microbiol Antimicrob, 2023, 22(1): 80.
13.	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.
14.	Zhang Z, Zhou H, Cao H, et al. Human-to-human transmission of Chlamydia psittaci in China, 2020: an epidemiological and aetiological investigation. Lancet Microbe, 2022, 3(7): e512-e520.
15.	Yin Q, Li Y, Pan H, et al. Atypical pneumonia caused by Chlamydia psittaci during the COVID-19 pandemic. Int J Infect Dis, 2022, 122: 622-627.
16.	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.
17.	Ni Y, Zhong H, Gu Y, et al. Clinical features, treatment, and outcome of psittacosis pneumonia: a multicenter study. Open Forum Infect Dis, 2023, 10(2): ofac518.
18.	Yang F, Li J, Qi B, et al. Clinical symptoms and outcomes of severe pneumonia caused by Chlamydia psittaci in Southwest China. Front Cell Infect Microbiol, 2021, 11: 727594.
19.	郭鋒, 陳素婷, 董利民, 等. 鸚鵡熱衣原體肺炎臨床特點及診治分析. 中國感染控制雜志, 2022, 21: 675-680.
20.	朱巧珍, 陳柯穎, 陳濟明, 等. 五例宏基因組高通量測序診斷鸚鵡熱衣原體肺炎的診治及臨床特點分析. 中國呼吸與危重監護雜志, 2022, 21(1): 7-11.
21.	Kong CY, Zhu J, Lu JJ, et al. Clinical characteristics of Chlamydia psittaci pneumonia. Chin Med J (Engl), 2021, 134(3): 353-355.
22.	Liu J, Gao Y. Tigecycline in the treatment of severe pneumonia caused by Chlamydia psittaci: a case report and literature review. Front Med (Lausanne), 2022, 9: 1040441.
23.	李田田, 朱淼, 左華芹, 等. 重癥鸚鵡熱衣原體肺炎的早期影像學特征分析. 臨床放射學雜志, 2023, 42: 1238-1242.
24.	金琳羚, 劉晨陽, 孔輝, 等. 鸚鵡熱衣原體肺炎21例臨床特征分析. 中國呼吸與危重監護雜志, 2023, 22(8): 559-565.
25.	Smith KA, Bradley KK, Stobierski MG, et al. Compendium of measures to control Chlamydophila psittaci (formerly Chlamydia psittaci) infection among humans (psittacosis) and pet birds, 2005. J Am Vet Med Assoc, 2005, 226(4): 532-539.
26.	Cui Z, Meng L. Psittacosis pneumonia: diagnosis, treatment and interhuman transmission. Int J Gen Med, 2023, 16: 1-6.
27.	陸曉旻, 朱際平, 陳揚, 等. 基于宏基因組二代測序診斷的鸚鵡熱衣原體肺炎的流行病學特征分析. 中國臨床研究, 2022, 35: 1-5.
28.	Shi Y, Chen J, Shi X, et al. A case of Chlamydia psittaci caused severe pneumonia and meningitis diagnosed by metagenome next-generation sequencing and clinical analysis: a case report and literature review. BMC Infect Dis, 2021, 21(1): 621.
29.	Stewardson AJ, Grayson ML. Psittacosis. Infect Dis Clin North Am, 2010, 24(1): 7-25.
30.	方昌全, 徐麗敏, 盧健聰, 等. 鸚鵡熱衣原體肺炎16例臨床特征分析. 中華危重病急救醫學, 2021, 33: 1366-1369.
31.	Yung AP, Grayson ML. Psittacosis--a review of 135 cases. Med J Aust, 1988, 148(5): 228-233.
32.	Chen Q, Li Y, Yan X, et al. Chlamydia psittaci plasmid-encoded CPSIT_P7 elicits inflammatory response in human monocytes via TLR4/Mal/MyD88/NF-κB signaling pathway. Front Microbiol, 2020, 11: 578009.
33.	Zhang Z, Wang P, Ma C, et al. Host inflammatory response is the major factor in the progression of Chlamydia psittaci pneumonia. Front Immunol, 2022, 13: 929213.
34.	Wu H, Wang C, Jiang C, et al. Localization and characterization of two putative TMH family proteins in Chlamydia psittaci. Microbiol Res, 2016, 183: 19-25.
35.	Su S, Su X, Zhou L, et al. Severe Chlamydia psittaci pneumonia: clinical characteristics and risk factors. Ann Palliat Med, 2021, 10(7): 8051-8060.
36.	田雪婧, 李南, 朱毅, 等. 炎癥在肺血栓栓塞癥發生及發展中的作用. 國際呼吸雜志, 2022, 42: 222-226.
37.	北京醫師協會呼吸內科專科醫師分會咯血診治專家共識編寫組. 咯血診治專家共識. 中國呼吸與危重監護雜志, 2020, 19(1): 1-11.
38.	徐平, 何亞榮, 曹鈺. 急性呼吸窘迫綜合征肺毛細血管內皮細胞損傷的生物標志物研究進展. 中華急診醫學雜志, 2022, 31: 564-567.
39.	徐歡, 朱曉維, 朱星星. 鸚鵡熱肺炎11例臨床特征分析. 浙江醫學, 2021, 43: 1332-1334.
40.	戴曉琴, 馬純雪, 蔡月, 等. 頭孢哌酮鈉舒巴坦鈉致凝血功能異常的危險因素分析及護理. 護理學報, 2013, 20: 59-61.
41.	盧曄, 崔會芳, 陳旭君, 等. 冷凍技術在呼吸介入治療中的應用進展及其并發癥防治淺析. 山東大學學報(醫學版), 2017, 55: 19-22.
42.	陳慶, 鄒俊, 陳麗娟, 等. 經支氣管鏡冷凍取血栓治療安全性及療效分析. 國際呼吸雜志, 2015, 35: 131-135.
43.	Gatt D, Golan Tripto I, Tsaregorodtsev S, et al. Blood clot removal by flexible bronchoscopic cryotherapy in a young child. Pediatr Int, 2023, 65(1): e15420.
44.	Schumann C, Hetzel J, Babiak AJ, et al. Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions. J Thorac Cardiovasc Surg, 2010, 140(2): 417-421.
45.	Hosna A, Haseeb Ul Rasool M, Noff NC, et al. Cryotherapy for the treatment of tracheal stenosis: a systematic review. Cureus, 2023, 15(6): e41012.

1. Sun L, Li P, Pang B, et al. Gestational psittacosis with secondary hemophagocytic syndrome: a case report and literature review. Front Med (Lausanne), 2021, 8: 755669.
2. Zhu Z, Wang X, Zhao J, et al. Clinical characteristics of six patients with chlamydia psittaci infection diagnosed by metagenomic next-generation sequencing: a case series. Infect Drug Resist, 2023, 16: 869-878.
3. Dai J, Lian X, Mo J, et al. Case report: a clinical case study of six patients with Chlamydia psittaci pneumonia. Front Cell Infect Microbiol, 2023, 13: 1084882.
4. Chau S, Tso EY, Leung WS, et al. Three cases of atypical pneumonia caused by Chlamydophila psittaci. Hong Kong Med J, 2015, 21(3): 272-275.
5. Wu Y, Xu X, Liu Y, et al. Case Report: clinical analysis of a cluster outbreak of chlamydia psittaci pneumonia. Front Cell Infect Microbiol, 2023, 13: 1214297.
6. 張長強, 郭松喜, 劉茜, 等. 北京市密云區11例鸚鵡熱衣原體肺炎臨床及流行病特征分析. 中外醫學研究, 2022, 20: 25-29.
7. 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): 662-662.
8. Knittler MR, Sachse K. Chlamydia psittaci: update on an underestimated zoonotic agent. Pathog Dis, 2015, 73(1): 1-15.
9. Feng Y, Feng YM, Zhang ZH, et al. Prevalence and genotype of Chlamydia psittaci in faecal samples of birds from zoos and pet markets in Kunming, Yunnan, China. J Zhejiang Univ Sci B, 2016, 17(4): 311-316.
10. Pang Y, Cong F, Zhang X, et al. A recombinase polymerase amplification-based assay for rapid detection of Chlamydia psittaci. Poult Sci, 2021, 100(2): 585-591.
11. Hogerwerf L, Roof I, de Jong MJK, et al. Animal sources for zoonotic transmission of psittacosis: a systematic review. BMC Infect Dis, 2020, 20(1): 192.
12. Huang W, Wang F, Cai Q, et al. Epidemiological and clinical characteristics of psittacosis among cases with complicated or atypical pulmonary infection using metagenomic next-generation sequencing: a multi-center observational study in China. Ann Clin Microbiol Antimicrob, 2023, 22(1): 80.
13. 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.
14. Zhang Z, Zhou H, Cao H, et al. Human-to-human transmission of Chlamydia psittaci in China, 2020: an epidemiological and aetiological investigation. Lancet Microbe, 2022, 3(7): e512-e520.
15. Yin Q, Li Y, Pan H, et al. Atypical pneumonia caused by Chlamydia psittaci during the COVID-19 pandemic. Int J Infect Dis, 2022, 122: 622-627.
16. 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.
17. Ni Y, Zhong H, Gu Y, et al. Clinical features, treatment, and outcome of psittacosis pneumonia: a multicenter study. Open Forum Infect Dis, 2023, 10(2): ofac518.
18. Yang F, Li J, Qi B, et al. Clinical symptoms and outcomes of severe pneumonia caused by Chlamydia psittaci in Southwest China. Front Cell Infect Microbiol, 2021, 11: 727594.
19. 郭鋒, 陳素婷, 董利民, 等. 鸚鵡熱衣原體肺炎臨床特點及診治分析. 中國感染控制雜志, 2022, 21: 675-680.
20. 朱巧珍, 陳柯穎, 陳濟明, 等. 五例宏基因組高通量測序診斷鸚鵡熱衣原體肺炎的診治及臨床特點分析. 中國呼吸與危重監護雜志, 2022, 21(1): 7-11.
21. Kong CY, Zhu J, Lu JJ, et al. Clinical characteristics of Chlamydia psittaci pneumonia. Chin Med J (Engl), 2021, 134(3): 353-355.
22. Liu J, Gao Y. Tigecycline in the treatment of severe pneumonia caused by Chlamydia psittaci: a case report and literature review. Front Med (Lausanne), 2022, 9: 1040441.
23. 李田田, 朱淼, 左華芹, 等. 重癥鸚鵡熱衣原體肺炎的早期影像學特征分析. 臨床放射學雜志, 2023, 42: 1238-1242.
24. 金琳羚, 劉晨陽, 孔輝, 等. 鸚鵡熱衣原體肺炎21例臨床特征分析. 中國呼吸與危重監護雜志, 2023, 22(8): 559-565.
25. Smith KA, Bradley KK, Stobierski MG, et al. Compendium of measures to control Chlamydophila psittaci (formerly Chlamydia psittaci) infection among humans (psittacosis) and pet birds, 2005. J Am Vet Med Assoc, 2005, 226(4): 532-539.
26. Cui Z, Meng L. Psittacosis pneumonia: diagnosis, treatment and interhuman transmission. Int J Gen Med, 2023, 16: 1-6.
27. 陸曉旻, 朱際平, 陳揚, 等. 基于宏基因組二代測序診斷的鸚鵡熱衣原體肺炎的流行病學特征分析. 中國臨床研究, 2022, 35: 1-5.
28. Shi Y, Chen J, Shi X, et al. A case of Chlamydia psittaci caused severe pneumonia and meningitis diagnosed by metagenome next-generation sequencing and clinical analysis: a case report and literature review. BMC Infect Dis, 2021, 21(1): 621.
29. Stewardson AJ, Grayson ML. Psittacosis. Infect Dis Clin North Am, 2010, 24(1): 7-25.
30. 方昌全, 徐麗敏, 盧健聰, 等. 鸚鵡熱衣原體肺炎16例臨床特征分析. 中華危重病急救醫學, 2021, 33: 1366-1369.
31. Yung AP, Grayson ML. Psittacosis--a review of 135 cases. Med J Aust, 1988, 148(5): 228-233.
32. Chen Q, Li Y, Yan X, et al. Chlamydia psittaci plasmid-encoded CPSIT_P7 elicits inflammatory response in human monocytes via TLR4/Mal/MyD88/NF-κB signaling pathway. Front Microbiol, 2020, 11: 578009.
33. Zhang Z, Wang P, Ma C, et al. Host inflammatory response is the major factor in the progression of Chlamydia psittaci pneumonia. Front Immunol, 2022, 13: 929213.
34. Wu H, Wang C, Jiang C, et al. Localization and characterization of two putative TMH family proteins in Chlamydia psittaci. Microbiol Res, 2016, 183: 19-25.
35. Su S, Su X, Zhou L, et al. Severe Chlamydia psittaci pneumonia: clinical characteristics and risk factors. Ann Palliat Med, 2021, 10(7): 8051-8060.
36. 田雪婧, 李南, 朱毅, 等. 炎癥在肺血栓栓塞癥發生及發展中的作用. 國際呼吸雜志, 2022, 42: 222-226.
37. 北京醫師協會呼吸內科專科醫師分會咯血診治專家共識編寫組. 咯血診治專家共識. 中國呼吸與危重監護雜志, 2020, 19(1): 1-11.
38. 徐平, 何亞榮, 曹鈺. 急性呼吸窘迫綜合征肺毛細血管內皮細胞損傷的生物標志物研究進展. 中華急診醫學雜志, 2022, 31: 564-567.
39. 徐歡, 朱曉維, 朱星星. 鸚鵡熱肺炎11例臨床特征分析. 浙江醫學, 2021, 43: 1332-1334.
40. 戴曉琴, 馬純雪, 蔡月, 等. 頭孢哌酮鈉舒巴坦鈉致凝血功能異常的危險因素分析及護理. 護理學報, 2013, 20: 59-61.
41. 盧曄, 崔會芳, 陳旭君, 等. 冷凍技術在呼吸介入治療中的應用進展及其并發癥防治淺析. 山東大學學報(醫學版), 2017, 55: 19-22.
42. 陳慶, 鄒俊, 陳麗娟, 等. 經支氣管鏡冷凍取血栓治療安全性及療效分析. 國際呼吸雜志, 2015, 35: 131-135.
43. Gatt D, Golan Tripto I, Tsaregorodtsev S, et al. Blood clot removal by flexible bronchoscopic cryotherapy in a young child. Pediatr Int, 2023, 65(1): e15420.
44. Schumann C, Hetzel J, Babiak AJ, et al. Cryoprobe biopsy increases the diagnostic yield in endobronchial tumor lesions. J Thorac Cardiovasc Surg, 2010, 140(2): 417-421.
45. Hosna A, Haseeb Ul Rasool M, Noff NC, et al. Cryotherapy for the treatment of tracheal stenosis: a systematic review. Cureus, 2023, 15(6): e41012.

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以發熱并發氣促、咯血為表現的鸚鵡熱衣原體肺炎一例報告并文獻復習

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