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A previously fit man developed psittacosis with marked cerebellar symptoms and signs. He was febrile but not confused, and he responded rapidly to treatment with erythromycin. Even if respiratory symptoms are minimal, psittacosis and other atypical pneumonias should be considered in any patient presenting with fever and cerebellar involvement.
The features of the chest radiographs of 49 adults with legionnaires' disease were compared with those of 91 adults with pneumococcal pneumonia (31 of whom had bacteraemia or antigenaemia), 46 with mycoplasma pneumonia, and 10 with psittacosis pneumonia. No distinctive pattern was seen for any group. Homogeneous shadowing was more frequent in legionnaires' disease (40/49 cases) (p less than 0.005), bacteraemic pneumococcal pneumonia (25/31) (p less than 0.01) and non-bacteraemic pneumococcal pneumonia (42/60) (p less than 0.05) than in mycoplasma pneumonia (23/46). Multilobe disease at presentation was commoner in bacteraemic pneumococcal pneumonia (20/31) than in non-bacteraemic pneumococcal pneumonia (15/60) (p less than 0.001) or legionnaires' disease (19/49) (p less than 0.025). In bacteraemic pneumococcal pneumonia multilobe disease at presentation was associated with increased mortality. Pleural effusions and some degree of lung collapse were seen in all groups, although effusions were commoner in bacteraemic pneumococcal pneumonia. Cavitation was unusual. Lymphadenopathy occurred only in mycoplasma pneumonia (10/46). Radiographic deterioration was particularly a feature of legionnaires' disease (30/46) and bacteraemic pneumococcal pneumonia (14/27), and these groups also showed slow radiographic resolution in survivors. Radiographic resolution was fastest with mycoplasma pneumonia; psittacosis and non-bacteraemic pneumococcal pneumonia cleared at an intermediate rate. Residual intrapulmonary streaky opacities remained in over a quarter of survivors from legionnaires' disease (12/42) and bacteraemic pneumococcal pneumonia (5/19).
Forty three cases of psittacosis infection were identified retrospectively over a five year period. The commonest clinical presentation was of a bronchitic illness with a productive cough and features of systemic upset. In 12 (28%) cases no radiographic abnormality was detected on the chest film. Segmental shadowing was the commonest abnormality but lobar and more extensive consolidation occurred. There were no radiographic features that allowed confident differentiation from other causes of pneumonia. The total and differential white cell counts were usually normal and this feature may help to differentiate psittacosis from bacterial pneumonia.
BACKGROUND: Psittacosis can be transmitted to humans from infected birds, being the cause of atypical pneumonia. This work is aimed at determining the source of a psittacosis outbreak, the characteristics of the subjects exposed and describing the measures to control the outbreak. METHODS: Descriptive study. Notification to the Epidemiological Monitoring System and Autonomic Agriculture authorities, taking the pertinent measures (inspection, sampling, disinfecting and precautionary quarantine of birds), closing the establishment. Case definition and epidemiological survey. Frequency analysis. RESULTS: Seventeen (17) individuals (one of whom died) came into contact with suspicious animals (53% males/47% females), nine of whom (mean age: 30) showed symptoms (100% fever, flu-like symptoms 44.4%). A serology was performed for C. psitacci on 11 of the 17 subjects exposed (68.75%), two of whom (18.18%) tested positive. The presence of C. psittaci DNA was detected in the pulmonary tissue study conducted on the deceased individual. A total of 33% (3/9) of those showing symptoms were confirmed by diagnosis. The Autonomic Agriculture authorities placed 22 animal compounds under quarantine. A total of seven (10%) of the 70 samples taken (60: animal cloacas and 10 birds) revealed a positive antigen, the PCR nucleic acid test being positive in one there-of. CONCLUSIONS: The exposure to diseased animals at the establishments involved caused the outbreak, the common source of contagion being of an occupational nature. The appropriate coordination/collaboration between the local Health and Agriculture authorities made it possible to prevent any further cases from arising.
A 33-year-old pregnant woman was admitted because of atypical pneumonia. She developed adult respiratory distress syndrome complicated by premature birth and perinatal mortality. The diagnosis 'psittacosis' was established on clinical grounds and confirmed serologically (complement fixation test). She was treated with doxycycline 200 mg i.v. daily for 3 weeks and was discharged in good condition after three months. Indirect case history revealed infected birds from the neighbours as the likely source of infection. Psittacosis is caused by Chlamydia psittaci and is acquired after inhalation of dry secreta or excreta from infected animals. Retrospective direct questioning often reveals contact with birds. Diagnostic delay can be considerable. Doxycycline is contraindicated in pregnant women, but erythromycine can be prescribed. Pregnant women should be advised to avoid contact with infected birds as they run an increased risk of a severe disease course.
Between May 1 and Aug 1, 1974, 114 of approximately 1,000 employees in 7 turkey processing plants in Texas (5), Missouri (1), and Nebraska (1) had an illness compatible with psittacosis. The illness was characterized by fever, severe headache, and pneumonia. Treatment with tetracycline was effective in most cases. Psittacosis was confirmed in 41 (36%) of the cases by a fourfold change in complement-fixation titer to the Chlamydia group antigen. Investigations implicated several turkey flocks from Texas as the source of the disease. Control measured, including screening turkey flocks before slaughter and assuring treatment of infected birds, were instituted by a special task force of state and federal veterinarians.
During April-May 1992, CDC was notified of a possible outbreak of psittacosis involving members of two families in Massachusetts and Tennessee who had recently purchased birds as pets. In the subsequent investigation of this problem, human psittacosis was defined as a fourfold rise in complement-fixing antibody titer to > or = 32 or a single titer of > or = 32 in a patient with fever and/or respiratory symptoms. This report summarizes the investigation of this problem.
A 67-year-old man was admitted due to severe pneumonia. Initially he was treated with beta-lactam antibiotics and oxygen. However, he developed respiratory failure and was transferred to the intensive-care unit for mechanical ventilation. He was a bird-keeper who collected many species of exotic birds, including parrots. The diagnosis psittacosis (parrot fever) was confirmed serologically and by PCR on bronchoalveolar lavage fluid. PCR techniques lead to rapid diagnosis which allows for early treatment. The initial treatment of atypical pneumonia with ciprofloxacin failed. After the patient was treated with doxycycline 200 mg i.v. his clinical condition improved and he was cured. The patient was discharged from intensive care after 10 days when acute respiratory-distress syndrome and pericarditis had resolved. Psittacosis is seen sporadically in the Netherlands. It may be encountered more frequently among patients who have had contact with birds and should be considered in the differential diagnosis of atypical pneumonia.
Psittacosis is a systemic disease that causes fever, headache and pneumonia. Although potentially serious, it is rarely fatal unless respiratory or renal failure occurs. In this case report we describe a case of psittacosis with an unusual clinical picture for this disease and where, despite multi-organ failure, the patient survived.
A 55-year-old female was admitted to our hospital because of high fever, nonproductive cough and dyspnea. Initially she had been treated with cephem antibiotics by a local doctor. However, acute respiratory failure due to severe pneumonia developed. The partial pressure of oxygen in arterial blood was 55.5 Torr. Her chest X-ray revealed wide-spread infiltrates with air bronchograms throughout the entire left lung, and pleural effusions were also present in the chest CT scan. Because the patient had a history of the contact with birds, we suspected psittacosis and administered Minocycline immediately. As a result, her clinical condition improved and the abnormal shadow on the chest X-ray film improved markedly in three days. Because the serum titer of a complement fixation test against Chlamydia rose to 1:512, we made the diagnosis of psittacosis. In addition, femoral muscle pain, and a high level of serum GOT, GPT, CK, Aldolase and Myoglobin indicated hepatitis and myositis. In the lung tissue specimens obtained by TBLB performed on the 10th hospital day, slight interstitial pneumonia and intracellular inclusion bodies were found by light microscopy and Chlamydial agents were found electron microscopically.
Three familial cases of psittacosis presented with fever and arthralgia. The first case was a 54-year-old man whose chest X ray film showed ground glass appearance in left S6. Ga scintigraphy revealed stronger accumulation in left lower lobe. Bronchoalveolar lavage fluid was examined in 2 of the cases and activated helper T cells were increased in both of the cases. Lung function was studied in all 3 cases in different phases. Their basic lung functions were different, but there was a similar change in courses, i.e. decrease of small airway flow and the increase of RV. These findings suggest that lung lesion of psittacosis may be related to allergic reaction and diffuse lung disease.
A previously healthy 40-year-old woman was admitted with severe dyspnea, cough and slight fever. Chest X-ray film revealed bilateral widespread opaque infiltration with ground glass shadows around it. The laboratory examination showed moderate hepatic and muscular injury with disseminated intravascular coagulation. In addition her arterial blood gas showed severe hypoxemia (PaO2: 25 Torr under room air). Moreover, about 1 week prior to admission, 2 baby budgerigars she had been raising for half a year died. Because of this history and multi-organ injuries, this disease was considered to be acute pneumonia owing to fulminant psittacosis causing acute respiratory failure. On the first day of admission, she was intubated and ventilated mechanically with an oxygen concentration (FIO2) of 100%. Subsequently, treatment with intravenous minocycline (400 mg/day), heparin for D.I.C. and corticosteroid were started. Abnormal findings in both chest X-ray and several laboratory parameters improved gradually though fever continued for a week. On the 14th day of her hospital stay, she was weaned from the ventilator successfully and the administration of corticosteroid and heparin tapered. On the 41st day, she was discharged without any symptoms. Results of complement fixation (CF) antibodies against chlamydia on paired sera showed a significant rise from 1:32 to 1:256. Moreover, both IgG and IgM antibodies for Chlamydia psittaci with microplate immunofluorescent antibody technique (MFA) showed an 8 times' rise during 10 days after admission. The definitive diagnosis was made with positive isolation of C. psittaci from both the throat swab of this patient and the spleen and liver of the dead budgerigar by the cell culture method. Psittacosis should always be borne in mind as a possible cause of fulminant pneumonia with acute respiratory failure, and such a situation can be handled successfully if emergency care including mechanical ventilation is available.
A 14-year-old boy was admitted to our hospital complaining of dull headache, high fever and decreased visual acuity of his left eye. Physical examination on admission revealed nuchal rigidity, positive Kernig's sign, slight hyperreflexia of deep tendon reflex, and decreased visual acuity of his left eye to 0.1. The chest was clear to percussion and auscultation, and no abnormal findings was observed on chest x-ray examination. On laboratory examination, leukocytosis (12,800/mm3) and increased erythrocyte sedimentation rate (83mm/hr) was observed. Cerebrospinal fluid (CSF) examination showed pleocytosis (308/3, mono 286, poly 22) and slight elevation of protein without decrease of glucose content (52mg/dl). On ophthalmologic examination, characteristic anterior and posterior uveitis was found in both eyes, more on the left. Antibody titer to psittaci was significantly elevated in both serum and CSF in his clinical course, therefore, this case was diagnosed as psittacosis meningitis complicated with uveitis. Minocycline (200mg/day) was administered from the 30th hospital day. The effect of this drug was dramatic, and fever and dull headache rapidly disappeared. In addition, fundus oculi examination on the 85th hospital day, revealed no abnormality in his eyes, and his visual acuity returned to normal level (1.0). This case was considered to be extremely rare case of psittacosis, because in addition to meningitis, the patient complicated with uveitis without any respiratory signs and symptoms.
A 69-yr-old previously healthy woman, presenting with jaundice and the clinical symptoms of an atypical pneumonia, was hospitalized. Haemolytic anaemia due to cold agglutinins was diagnosed, and erythromycin therapy for a suspected Mycoplasma pneumoniae infection was instituted. Serological testing revealed, however, that the infection was attributable to Chlamydia psittaci. The literature on psittacosis and haematological complications is reviewed. Cold agglutinins are sometimes found in association with psittacosis, but a concomitant haemolytic anaemia is rare.
A patient had severe pneumonia, respiratory failure, and disseminated intravascular coagulation caused by Chlamydia psittaci. Cutaneous findings included a maculopapular blanching rash, acrocyanosis, superficial venous thromboses, and splinter hemorrhages under the fingernails. The history of exposure to potential vectors of psittacosis and the presence of some or all the cutaneous findings described herein may lead to the early recognition of psittacosis.
Since 1979, when psittacosis, human infection with Chlamydia psittaci, became a notifiable disease in South Africa, only 4 cases have been reported to the State health authorities. While this is not a common illness and some cases may not be reported, there is a strong possibility that this infection is being overlooked because of lack of awareness of its wide range of manifestations. A characteristic case is described and the complications and management of psittacosis are reviewed with particular reference to South Africa.
A 52-year-old man was admitted to another hospital with complaints of fever and dyspnea. Chest roentgenogram revealed bilateral widespread infiltrative opacities, and laboratory examinations showed severe hypoxia, hepatic injury and acute renal failure. In addition, hemosputum and eruption appeared, and he was transferred to our department because of the development of multi-organ failure. Moreover, about 2 weeks prior to admission, a budgerigar he had been breeding died. Although the treatment was supportive therapy alone, the abnormal shadow on chest roentgenogram and laboratory findings improved markedly. Thereafter, we made the diagnosis of psittacosis, because the serum titer of a complement fixation test against Chlamydia rose from 1:8 on admission to 1:512 after 2 weeks. On admission, PMN and lymphocyte populations increased in bronchoalveolar lavage fluid (BALF), and 2 weeks later lymphocytes alone increased markedly. Thereafter, we observed lymphocytosis in serial BALF findings for 12 weeks. These findings indicate that lymphocyte alveolitis persisted long after the pneumonia had resolved. Moreover, Ga scintigraphy also revealed accumulation in the filed of shadows which had been absorbed and disappeared on the chest roentgenogram. These results suggest that lymphocytes play a leading role in immune host defenses and that immunological reactivity is prolonged in psittacosis.
Psittacosis may occur in epidemic or sporadic form. We report an outbreak of avian and human psittacosis associated with an aviary in Philadelphia, Pa. The epidemic spread among birds in the aviary and then to men and women who were in contact with the birds. Chlamydia psittaci was cultured from infected birds, and the human patients were evaluated clinically and serologically. After proper treatment of the birds, cleaning of their cages, and institution of appropriate bird-handling techniques, the outbreak among the birds resolved. The human patients were treated, and no subsequent cases have been seen.