[Psittacosis and ornithosis in Holland].
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A 56-year-old man with fever, headache, cough and sputum was admitted to another clinic. Chest X-ray examination revealed infiltrates in the upper lobe of the right lung. Cefem and aminoglycoside therapy was not effective, and the infiltrates migrated from the right upper lobe to the right middle and lower lobes and then to the left lung. He was transferred to our clinic, and laboratory data showed that CRP was 6+; ESR, 119 mm/1 h; WBC, 3000/mm3; and CAR, 512. The tentative diagnosis of atypical pneumonia was based on the positive agglutination test for Legionella pneumophila, and treatment with erythromycin, minocycline and rifampicin resulted in alleviation of symptoms and resolution of the infiltrates in the lungs. Complement fixation titer for Chlamydia was 128 at admission and was elevated to 512 after 2 weeks. Indirect fluorescent antibody for Legionella was negative. Transient liver dysfunction was also observed.
Chlamydia psittaci is associated with significant morbidity and mortality during pregnancy, and its rarity can delay early diagnosis and treatment. A farmer's wife presented at 31 weeks with febrile illness and developed signs of septic shock, indicating immediate delivery. The child developed uneventfully. The mother survived after symptomatic mechanical ventilation, including extracorporeal lung assistance, for 11 days due to multi-organ failure. Only two weeks after admission antibody titres against Chlamydia were rising. The placenta demonstrated acute intervillositis and destruction of throphoblastic cells. Retrospectively, the infection was presumed to derive from infected pregnant sheep. Pregnant women should be advised to avoid contact with sheep and their gestational products. Proper history, early recognition and appropriate management is mandatory for survival of both mother and child.
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A 33-year-old previously healthy woman was seen at this hospital after a week of fever and nonproductive cough. A roentgenogram of the chest showed consolidation in the left upper and middle lung fields. Transbronchial lung biopsy from left S1 + 2 revealed an increase of mononuclear leukocytes within the interstitial spaces and slight cell infiltration with in the alveoli. Bronchoalveolar lavage cellular constituents showed 47% alveolar macrophage, 38% lymphocytes and 15% neutrophils. She had kept a parakeet, which died just after her illness. We could isolated organisms from the liver, spleen, kidney, lung, heart and bowel of her pet bird revealing C. psittaci by Giemsa stain, three days after it was buried in the ground. She was given three hundred mg of ofloxacin per day orally for fourteen days and the clinical effect was good. The in vitro activity of ofloxacin was 0.75 microgram/ml.
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