Department of Emergency, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Nursing, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China.
PLoS One. 2022 Jul 11;17(7):e0270896. doi: 10.1371/journal.pone.0270896. eCollection 2022.
Psittacosis pneumonia is a community-acquired pneumonia caused by Chlamydia psittaci. It is usually under-diagnosed due to its atypical clinical presentation and lack of routine laboratory tests.
To better understand the clinical features, 52 patients diagnosed with psittacosis pneumonia by metagenomic next-generation sequencing (mNGS) were enrolled in this study. The clinical, radiological and pathological characteristics were retrospectively analyzed.
The onset of psittacosis pneumonia in this study occurred all year round, with a peak from December to January. Most of the patients were 51-80 years old. About 65.38% of patients had a history of exposure to poultry or parrots. Abnormalities of multiple clinical signals were detected in these patients. Elevated levels of neutrophil ratio, C-reactive protein, erythrocyte sedimentation rate, and procalcitonin were detected in most patients. Radiological evidence revealed air-space consolidation or ground-glass opacities in lungs of all patients, which is the typical feature of psittacosis pneumonia. In addition, hyperemia, swelling of bronchial mucosa, and bronchial patency were detected by bronchoscopy in all patients, and bronchial sub-mucosal edema, inflammatory cells infiltration and alveolar epithelial hyperplasia were identified in the bronchial mucosa and alveolar tissue. Beta-lactam antibiotics were administered for empirical treatment before mNGS in 17 patients but showed no improvement. The treatment was switched to doxycycline or moxifloxacin immediately since psittacosis pneumonia were suspected and confirmed by mNGS detection (within 48 hours). After receiving adjustment of treatment, 94.23% (49/52) of patients were cured successfully.
In conclusion, mNGS may be a promising approach for clinical diagnosis of psittacosis. For patients with a history of exposure to birds, hyperpyrexia, nonproductive cough, multiple elevated inflammatory markers, and air-space consolidation in lung, psittacosis pneumonia should be considered, especially when beta-lactam antibiotics showed limited efficacy.
鹦鹉热肺炎是一种由鹦鹉热衣原体引起的社区获得性肺炎。由于其非典型的临床表现和缺乏常规实验室检测，通常诊断不足。
为了更好地了解临床特征，我们通过宏基因组下一代测序（mNGS）诊断了 52 例鹦鹉热肺炎患者，并对其临床、影像学和病理学特征进行了回顾性分析。
本研究中鹦鹉热肺炎的发病全年均可发生，发病高峰为 12 月至 1 月。大多数患者年龄在 51-80 岁之间。约 65.38%的患者有接触家禽或鹦鹉的病史。这些患者存在多种临床信号异常，大多数患者中性粒细胞比例、C 反应蛋白、红细胞沉降率和降钙素原升高。所有患者的肺部均显示有空腔实变或磨玻璃影，这是鹦鹉热肺炎的典型特征。此外，所有患者的支气管镜检查均显示支气管黏膜充血、肿胀，支气管通畅，支气管黏膜和肺泡组织均可见支气管黏膜下水肿、炎症细胞浸润和肺泡上皮增生。在 mNGS 检测之前，17 例患者接受了经验性β-内酰胺类抗生素治疗，但没有改善。由于疑似鹦鹉热肺炎，并通过 mNGS 检测（48 小时内）确诊，立即更换多西环素或莫西沙星进行治疗。调整治疗后，94.23%（49/52）的患者成功治愈。
总之，mNGS 可能是鹦鹉热临床诊断的一种很有前途的方法。对于有鸟类接触史、高热、无痰咳嗽、多种炎症标志物升高、肺部有空腔实变的患者，应考虑鹦鹉热肺炎，特别是当β-内酰胺类抗生素疗效有限时。
