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Psittacosis in Egypt: A Case Study.

Psittacosis, also referred to as ornithosis, is a disease primarily of birds, which may be transmitted to humans. Psittacosis is caused by Chlamydia psittaci, an obligate intracellular parasite found worldwide. Humans are infected with C. psittaci when the organism enters the blood stream, usually through inhalation of dried excrement from diseased birds or through wound contamination with infected avian secretions. C. psittaci replicates in the liver and spleen and infects the lung and other organs hematogenously.1 The clinical manifestations of human psittacosis range from a mild respiratory infection to a severe systemic illness.1,2 Symptoms are frequently described as flu-like with fever, headache, body aches, and dry or productive cough. Sore throat, chest pain, abdominal pain, vomiting, and diarrhea are variably present. Physical findings may include a pulse-temperature dissociation, localized lung crackles, hepatomegaly, splenomegaly, and a pale macular skin rash. Chest radiographs may demonstrate lesions that are atelectatic, patchy, miliary, nodular, or consolidated in one or both lungs. White cell counts, erythrocyte sedimentation rates, and liver function tests are usually normal. In severe illness, signs and symptoms of liver dysfunction, neurological impairment, and respiratory and renal failure may be present. Since 1879 when psittacosis was recognized as a disease entity, cases have been reported in North and South America, Europe, Asia, and Australia. However, reports of psittacosis in Africa have been rare. An Ethiopian group, studying community-acquired pneumonia, published what they claimed to be the first report of psittacosis in Africa in 1994.3 The report published here is believed to be the first documented case of human psittacosis in Egypt.

Journal Article↗

[Familial outbreak of psittacosis].

Three familial cases of psittacosis are reported. The first case was a 46-year-old woman, the second case, her 18-year-old daughter. Both of them often visited the house of the third case, a 49-year-old women, who was the elder sister of case 1 and who took care of the chick of a budgerigar which she kept in the house. Case 1 came to our hospital with abrupt onset of fever, headache, nausea and general malaise. Because she was suspected to have meningitis, she was admitted to the Department of Neurology. On admission, her chest X-ray film showed bilateral ground glass shadows. She also had hypoxemia and liver dysfunction. On learning of her history of contact with the chick, psittacosis was suspected. Case 2 suffered from fever and headache. Her chest X-ray film revealed opaque infiltration in the right lower lung field. Case 3 complained of fever, headache and vomiting. Her chest X-ray film showed fan-shaped faint shadows in the left upper, middle and lower lung fields. We interpreted these findings as showing psittacosis based on anamnesis. The result of the complement fixation (CF) antibody titer against chlamydia was 1:32 in cases 2 and 3, enabling a serological diagnosis of psittacosis. The corresponding result was 1:16 in case 1. Although the CF antibody titer showed no increase, we diagnosed the case clinically as psittacosis. It is difficult to correctly diagnose psittacosis only from the physical findings and chest X-ray films. Detailed anamnesis, in particular taking a history of exposure to birds, is an important clue for diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Possible nosocomial transmission of psittacosis.

OBJECTIVES: To investigate a cluster of seven pneumonia cases among persons exposed to a pet-shop worker hospitalized with psittacosis. DESIGN: Epidemiological study of the outbreak, sero-diagnostic evaluation of exposed persons with pneumonia; and retrospective review of the pneumonia cases. SETTING: 450-bed teaching community hospital. PARTICIPANTS: Employees of the nursing unit where the patient with psittacosis was hospitalized. RESULTS: The index case had laboratory and clinical evidence of psittacosis. Four of the seven exposed persons who developed pneumonia had serologic results that met criteria for a diagnosis of psittacosis, and three met criteria for Chlamydia pneumoniae infection, possibly reflecting cross-reactivity between the microimmunofluorescence assays for the two diseases. The epidemiological graph suggested a relationship between the index case and the cluster of pneumonias in exposed individuals. CONCLUSIONS: Psittacosis may have been transmitted person to person in a hospital setting.

Chlamydophila psittaci↗

[Two cases of psittacosis accompanied with rhabdomyolysis].

We experienced two cases of atypical pneumonia accompanied with rhabdomyolysis and diagnosed them as psittacosis based on the results of investigation of paired serum samples. Rhabdomyolysis may be associated with some kinds of viral or bacterial infections, but no report was found in the case of psittacosis as far as we searched and such a description was not found in textbooks. Heretofore, the elevation of GOT and LDH as the laboratory findings in psittacosis was considered as the reflection of liver injury, but that might be brought about by rhabdomyolysis. Although the mechanism(s) of the occurrence of rhabdomyolysis in psittacosis is unknown, when the elevation of muscular origin-enzymes including CPK is recognized in cases of atypical pneumonia, it may be the clue of diagnosis of psittacosis.

Adult↗

[A case of fulminant psittacosis with rhabdomyolysis].

We encountered a case of psittacosis accompanied with rhabdomyolysis in a 66-year-old woman admitted to our hospital because of myalgia, fever, diarrhea, and disorientation. A chest CT scan showed air-space consolidation and ground-glass attenuation in the left lung. Laboratory findings showed elevation of CPK, myoglobin, and aldolase, consistent with rhabdomyolysis. She recovered after administration of intravenous erythromycin and steroid pulse therapy. Psittacosis was diagnosed from the history of exposure to pigeons and from elevation of the IgG titer for Chlamydia psittaci. Rhabdomyolysis is associated with some kinds of viral or bacterial infections. But few case reports have been found in the case of psittacosis. The mechanism whereby rhabdomyolysis complicates psittacosis is unknown. We suggest that psittacosis should be added to the list for differential diagnosis, when rhabdomyolysis develops in a patient with pneumonia.

Aged↗

Community outbreak of psittacosis in a rural Australian town.

BACKGROUND: Health authorities in Victoria, Australia were notified of three men from a rural town with atypical pneumonia, admitted to hospital over 8 days. Initial serological testing suggested Chlamydia psittaci as the cause. We did a case-control study to find risk factors for psittacosis. METHODS: We searched for cases of pneumonia or severe flu-like illness through family physicians and the regional hospital. We selected three controls per case from the region's electoral roll. We collected blood for serological tests and administered questionnaires to all cases and controls. FINDINGS: We found 16 cases of psittacosis and one died. Most cases were clustered within a small geographical area, with a median age of 58 years (range 23-76), 15 (94%) of whom were male. Keeping, handling, or feeding domestic or wild birds was not associated with illness. Cases spent a median of 17.5 h per week in their garden, compared with a median of 5.2 h for controls (p=0.04) and were more likely to have mowed lawns during the 3 weeks before onset of illness than controls (odds ratio 4.81 [95% CI 1.08-33.37]). INTERPRETATION: We showed that psittacosis outbreaks are not limited to direct contact with birds and pose new challenges for disease control. Modifications may be needed to work outdoors to decrease the risk of psittacosis.

Adult↗