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An outbreak of ornithosis in Norway in 1981.

During 1981 there were 508 laboratory confirmed cases of ornithosis in Norway. This represents a 7-fold increase compared with previous years. Among 370 patients examined by the National Institute of Public Health, Oslo, 148 stated some contact with birds. There were also small family outbreaks and cases of ornithosis in school friends etc. where no bird exposure had occurred, suggesting that interhuman transmission might be involved. The clinical picture was that of a respiratory disease with pneumonia in more than half the cases. The clinical course was mild to moderately severe. At present we have no explanation for this change in the epidemiologic pattern of ornithosis in Norway.

Adolescent↗

Carcinoembryonic antigen (CEA) in blood in cases of pneumonia.

Serum levels of carcinoembryonic antigen (CEA) were analysed in patients with pneumonia of different etiology. Significant (p less than 0.01) increases in blood CEA levels occurred in all groups of pneumonia of bacterial etiology, i.e., pneumococcal, gram-negative or chlamydial. In viral pneumonia similar increases were observed, but the changes were not statistically significant, probably due to the small number of patients. In pneumonia of unknown etiology CEA behaved as in bacterial pneumonias. Maximal values between 5 and 15 micrograms/l CEA were common in pneumonia, the basal level usually being less than 5 micrograms/l. The severity of pneumonia, as judged by maximal erythrocyte sedimentation rate, correlated weakly with CEA levels in the bacterial group (p less than 0.05). In pneumonias of unknown etiology white blood cell counts and C-reactive protein levels correlated significantly with maximal CEA (p less than 0.01). In conclusion we have demonstrated, that in pneumonias of different etiology strongly but transiently increased blood CEA levels are the rule. The severity of pneumonia is not clearly correlated with CEA levels.

Bacterial Infections↗

Diagnosis of infection caused by Chlamydia pneumoniae (strain TWAR) in patients with "ornithosis" in southern Sweden 1981-1987.

Serological distinction between ornithosis and infection by Chlamydia pneumoniae (strain TWAR) was attempted by microimmunofluorescence (MIF) of 156 cases previously considered as ornithosis on the ground of a positive complement fixation test with a chlamydia group antigen. At least 23% of these cases were TWAR infections according to the results at retesting by MIF. The highest frequency of TWAR infections was demonstrated during 1981 with a decreasing number and proportion thereafter. We contend that the sudden increase in the reported number of ornithosis cases in 1981 may have been caused by TWAR infections which seem to vary in incidence over time. Family clusters of respiratory infections were much more common with TWAR infections than with ornithosis.

Antibodies, Bacterial↗

A clinical and epidemiological study of "ornithosis" caused by Chlamydia psittaci and Chlamydia pneumoniae (strain TWAR).

Ornithosis is a notifiable disease in Sweden since 1954. In 1981 and 1982 a sharp increase in the number of notifications occurred. Since then the number has declined but is still high. A changed epidemiology characterized by no history of bird contact and no common source, raised the suspicion of a new agent. Serological data now suggest that the epidemic was to a substantial part due to Chlamydia pneumoniae (strain TWAR) (48% of the patients during 1981-1982 compared to 9% during 1984-1987). During recent years TWAR infections have thus become uncommon but reappearance can be expected in the near future. The clinical picture as well as the complications appear to be very similar in infections caused by C. pneumoniae and C. psittaci.

Adolescent↗

Erythromycin for treatment of ornithosis.

Patients with pneumonia not responding to treatment with betalactam drugs and patients where an "atypical" etiology is suspected from the beginning, are often given erythromycin to cover mycoplasma and legionella. Erythromycin has also been effective for Chlamydia pneumoniae. If, however, ornithosis is suspected the recommended drug has been tetracycline. Since we noted that several patients had a favourable course on erythromycin despite a final serological diagnosis of ornithosis, we retrospectively studied patients admitted with acute lower respiratory tract infection and a 4-fold titer rise to C. psittaci. We found 35 patients treated with a betalactam drug (n = 12), tetracycline (n = 2), or erythromycin (n = 5) alone, or with a betalactam, which because of non-responsiveness was followed by either tetracycline (n = 4) or erythromycin (n = 12). The data were analysed with survival analysis by a Cox' regression model. There was a significant (p less than 0.001) effect of treatment on the time to defervescence, mainly due to a difference between the erythromycin treated group and the betalactam treated group. We found erythromycin to be at least as effective as tetracycline for treating C. psittaci pneumonia. Since erythromycin has to be used to cover legionella in patients with severe pneumonia when an atypical etiology cannot be excluded, it is an important conclusion that this drug seems to cover C. psittaci as well.

Anti-Bacterial Agents↗

Chlamydia pneumoniae infections in Norway 1981-87 earlier diagnosed as ornithosis.

Ornithosis has been a notifiable disease in Norway since 1957. During an outbreak of respiratory disease in 1981-82, described as ornithosis, contact with birds was stated in only 50% of the cases, suggesting that the infection was spread by interhuman transmission. A similar outbreak occurred in the western part of Norway in 1987. Serum specimens from altogether 260 patients, collected during the outbreaks in 1981-82 and in 1987, were investigated for antibodies against Chlamydia pneumoniae (strain TWAR). Evidence of recent infection with C. pneumoniae was found in 67.7% of the cases. The results indicate that the increased incidence of ornithosis in 1981-82 and in 1987 was due mainly to C. pneumoniae infections.

Chlamydia Infections↗

An outbreak of ornithosis.

An outbreak of ornithosis occurred in Lidköping, a small town in Southwest Sweden, in January 1967 through May 1969. 24 proved cases were known, aged from 10 to 72 years, 19 patients gave a history of contact with birds (parrots, canaries, parakeets), 13 of them with birds from the same pet shop. Five patients had visited the pet shop only once before their illness. Attempts to prove infection with ornithosis agent in 7 birds from the pet shop were unsuccessful. Three patients, 2 of them in the same household, had no contact with birds and infection from person to person was strongly suspected. All patients had pneumonia. Fever, cough and headache were predominant clinical symptoms. There were relapses in 4 patients and 2 patients had symptoms of encephalitis. No deaths occurred.

Adolescent↗

Ornithosis as a nosocomial infection.

An outbreak of ornithosis in the department of infectious diseases of a general hospital is described. The outbreak comprised 12 cases aged 18-80 years. The index case had a history of contact with birds. He developed a serious illness and died. 11 persons contracted the disease after contact with the index case; 8 of them were personnel of the clinic of infectious diseases and 1 case was a patient hospitalized in the same room as the index case. All of the patients showed a typical pneumonia and one of them had symptoms of encephalitis. Treatment with doxycycline was successful. 200 healthy contacts were treated prophylactically with doxycycline. None of these displayed any symptoms of disease.

Adolescent↗

Chlamydiae as pathogens: new species and new issues.

The recognition of genital chlamydial infection as an important public health problem was made first by the recognition of its role in acute clinical syndromes, as well as in serious reproductive and ocular complications, and secondly by our awareness of its prevalence when diagnostic tests became widely accessible. The recent availability of effective single dose oral antimicrobial therapy and sensitive molecular amplification tests that allow the use of noninvasive specimens for diagnosis and screening is expected to have a major impact in reducing the prevalence of disease in the next decade. Clinical manifestations associated with Chlamydia pneumoniae infection continue to emerge beyond respiratory illness. In particular, its association with atherosclerosis deserves further investigation. Chlamydia pecorum, a pathogen of ruminants, was recently recognized as a new species. The continued application of molecular techniques will likely elucidate an expanding role for chlamydiae in human and animal diseases, delineate the phylogenetic relationships among chlamydial species and within the eubacteria domain, and provide tools for detection and control of chlamydial infections.

Anti-Bacterial Agents↗

Chlamydophila psittaci in Fulmars, the Faroe Islands.

Chlamydophila psittaci was detected in 10% of 431 fulmars examined from the Faroe Islands. Analysis of ompA showed a sequence almost identical to that of the type strain. The origin of C. psittaci outbreaks in fulmars is discussed. Despite a high level of exposure, the risk for transmission of C. psittaci to humans is low.

Animals↗