吉林大学学报(医学版) ›› 2022, Vol. 48 ›› Issue (1): 222-227.doi: 10.13481/j.1671-587X.20220128

• 临床医学 • 上一篇    下一篇

鹦鹉热衣原体肺炎2例报告及文献复习

何罗玮,王野,于杜娟,陈志营()   

  1. 吉林大学中日联谊医院呼吸内科,吉林 长春 130033
  • 收稿日期:2021-05-10 出版日期:2022-01-28 发布日期:2022-01-17
  • 通讯作者: 陈志营 E-mail:zychen@jlu.edu.cn
  • 作者简介:何罗玮(1997-),女,安徽省滁州市人,在读硕士研究生,主要从事呼吸系统疾病临床方面的研究。
  • 基金资助:
    吉林省财政厅卫生科研人才专项项目(2019SCZ042)

Chlamydia psittaci pneumonia:A report of 2 cases and literature review

Luowei HE,Ye WANG,Dujuan YU,Zhiying CHEN()   

  1. Department of Respiratory Medicine,China-Japan Union Hospital,Jilin University,Changchun 130033,China
  • Received:2021-05-10 Online:2022-01-28 Published:2022-01-17
  • Contact: Zhiying CHEN E-mail:zychen@jlu.edu.cn

摘要: 目的

分析鹦鹉热衣原体肺炎患者的临床表现、诊断方法和治疗过程,提高临床医生对该病的认识,以进一步提高其临床诊治效率并改善其预后。

方法

收集2例鹦鹉热衣原体肺炎患者的临床资料,对诊治经过进行总结,分析患者的感染指标、氧合功能和肺部影像学的动态变化,对比培养法、血清学方法和宏基因组二代测序技术(mNGS)等病原学诊断方法,分析喹诺酮类和四环素类药物治疗鹦鹉热衣原体肺炎的效果。

结果

2例患者均以发热、咳嗽和咳痰为首发症状,病情进展较快,分别于发病的第8天和第3天出现呼吸困难,1例患者于发病第10天进展为急性呼吸窘迫综合征(ARDS),需机械通气辅助治疗。2例患者血常规中白细胞计数分别为12.69×109 L-1和4.4×109 L-1,降钙素原分别为0.27和0.06 μg·L-1,气道分泌物常规培养及血清学检查未能明确病原体。2例患者初步诊断均为社区获得性肺炎,经验性应用喹诺酮类药物治疗效果均不佳。采用mNGS方法并结合鸟类接触史,最终确诊为鹦鹉热衣原体肺炎,采用四环素类抗生素治疗后,患者症状、体征和影像学异常均明显好转,随访复查肺部CT,病灶基本吸收。

结论

鹦鹉热衣原体肺炎的发生与鸟类接触史有关,病情进展比较迅速。mNGS技术可作为快速病原学诊断方法,有利于鹦鹉热衣原体肺炎的早期诊断和及时选用敏感药物治疗,从而改善该病预后。以多西环素和替加环素为代表的新一代四环素类药物对鹦鹉热衣原体肺炎的疗效肯定。

关键词: 鹦鹉热衣原体肺炎, 社区获得性肺炎, 宏基因组二代测序技术, 四环素类抗生素

Abstract: Objective

To analyze the clinical manifestations, diagnostic methods and treatment process of the patients with Chlamydia psittaci pneumonia and improve the understanding of clinicians, and improve the efficiency of clinical diagnosis and treatment and the prognosis of the disease.

Methods

The clinical data of 2 patients with Chlamydia psitsiti pneumonia were collected, and the diagnosis and treatment process was summarized;the infection indicators, oxygenation function, dynamic changes of pulmonary imaging were analyzed;culture method,serological method, metagenomic next-generation sequencing technology (mNGS) and other etiological diagnostic methods were compared,and the effects of quinolones and tetracycline in the treatment of Chlamydia psittaci pneumonia were analyzed.

Results

The first symptoms of two patients were fever, cough and expectum, and the disease progressed rapidly. Dyspnea developed on the 8th day and the 3rd day of onset, respectively. One patient developed acute respiratory distress syndrome(ARDS) on the 10th day of onset, and mechanical ventilation assisted treatment was used. The counts of white blood cells in blood routine examination of two patients were 12.69×109·L-1 and 4.4 ×109·L-1, and procalcitonin were 0.27 and 0.06 μg·L-1, respectively. Routine culture of airway secretes and serological examination failed to identify the pathogen. The initial diagnosis of two patients was community acquired pneumonia, and the effect of empirical treatment with quinolones was not good. The mNGS method combined with bird contact history was used to finally confirm the diagnosis of Chlamydia psittaci pneumonia.The symptoms, signs and imaging abnormalities were significantly improved after treatment with tegecycline, a tetracycline antibiotic. The results of lung CT reexamination of 2 cases after 1 month follow-up showed that the lesions were basically absorbed.

Conclusion

The occurrence of Chlamydia psittaci pneumonia is related to the contact history of birds. The progress of the disease is often rapid. The mNGS technology can be used as a rapid etiological diagnosis method, which is conducive to the early diagnosis of Chlamydia psittaci pneumonia, the timely selection of sensitive antibiotics and the improvement of disease prognosis. A new generation of tetracyclines represented by doxycycline and tigecyclin has a positive effect on Chlamydia psittaci pneumonia.

Key words: Chlamydia psittaci pneumonia, Community acquired pneumonia, Metagenomics next-generation sequencing, Tetracyclines antibiotics

中图分类号: 

  • R563.1