鹦鹉热衣原体肺炎2例报告及文献复习

doi:10.13481/j.1671-587X.20220128

摘要/Abstract

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

何罗玮,王野,于杜娟,陈志营. 鹦鹉热衣原体肺炎2例报告及文献复习[J]. 吉林大学学报(医学版), 2022, 48(1): 222-227.

Luowei HE,Ye WANG,Dujuan YU,Zhiying CHEN. Chlamydia psittaci pneumonia:A report of 2 cases and literature review[J]. Journal of Jilin University(Medicine Edition), 2022, 48(1): 222-227.

图/表 2

参考文献 20

1	汪洋，鲁厚清，邵仁德，等. 鹦鹉热衣原体感染肺炎患者的临床特征分析［J］. 中华危重病急救医学， 2020， 32（11）： 1388-1390.
2	BRANLEY J M， WESTON K M， ENGLAND J，et al. Clinical features of endemic community-acquired psittacosis［J］. New Microbes New Infect， 2014， 2（1）： 7-12.
3	刘领，吴文杰，耿艳杰，等. 鹦鹉热衣原体肺炎1例报告并文献复习［J］. 临床肺科杂志， 2015， 20（8）： 1543-1544.
4	张秀香，袁子国，李兆南，等. 鹦鹉热的诊断与防治［J］. 吉林畜牧兽医， 2007， 28（11）： 34-35.
5	朱贞贞，张宜文. 伐木工人感染鹦鹉热衣原体导致多脏器功能衰竭一例［J］. 中华临床感染病杂志， 2020， 13（3）： 218-220.
6	陈清，于晓佳，陈罡，等. 1例鹦鹉热衣原体感染患者治疗的药学监护［J］. 中国临床药理学杂志， 2020， 36（15）： 2320-2322.
7	杨昭，皮泓韬，徐一笑，等. 非典型病原菌鹦鹉热衣原体感染合并呼吸衰竭临床分析［J］. 实用休克杂志（中英文）， 2020， 4（3）： 182-185.
8	骆煜，金文婷，马玉燕，等. 5例鹦鹉热衣原体肺炎的诊断及临床特点［J］. 中华医院感染学杂志， 2020， 30（22）： 3394-3398.
9	代红. 鹦鹉热衣原体合并CR-AB引起重症肺炎死亡1例报告［J］. 医药前沿， 2019， 9（36）： 254-255.
10	张郡，唐光健，王淑兰，等. 鹦鹉热肺炎的影像学表现［J］. 中华放射学杂志， 2005， 39（11）： 1134-1137.
11	梁思聪，陈愉.军团菌肺炎的诊治策略［J］.中国实用内科杂志， 2020，40（5）： 357-361.
12	钮月英，吴晓虹，应可净. 肺泡灌洗液宏基因二代测序技术对下呼吸道感染病原体检测的优势［J］. 中国实用内科杂志， 2020， 40（9）： 754-758.
13	LI H， GAO H， MENG H， et al. Detection of pulmonary infectious pathogens from lung biopsy tissues by metagenomic next-generation sequencing［J］. Front Cell Infect Microbiol， 2018， 8： 205.
14	宏基因组分析和诊断技术在急危重症感染应用专家共识组. 宏基因组分析和诊断技术在急危重症感染应用的专家共识［J］.中华急诊医学杂志，2019，28（2）：151-155.
15	SUN W， LU Z， YAN L. Clinical efficacy of metagenomic next-generation sequencing for rapid detection of Mycobacterium tuberculosis in smear-negative extrapulmonary specimens in a high tuberculosis burden area［J］. Int J Infect Dis， 2021， 103： 91-96.
16	GOSBELL I B， ROSS A D， TURNER I B. Chlamydia psittaci infection and reinfection in a veterinarian［J］. Aust Vet J， 1999， 77（8）： 511-513.
17	LI M， ZHANG X M， HUANG K， et al. Presence of Chlamydia trachomatis and Mycoplasma spp.， but not Neisseria gonorrhoeae and Treponema pallidum， in women undergoing an infertility evaluation： high prevalence of tetracycline resistance gene Tet（M）［J］. AMB Express， 2017， 7（1）： 1-9.
18	CUNHA B A. The atypical pneumonias： clinical diagnosis and importance［J］. Clin Microbiol Infect， 2006， 12（）： 12-24.
19	EL-JAKEE J， EL-HARIRI M D， EL-SHABRAWY M A，et al. Efficacy of a prepared tissue culture-adapted vaccine against Chlamydia psittaci experimentally in mice［J］. Vet World， 2020， 13（11）： 2546-2554.
20	WANG C， LI Y， WANG S， et al. Evaluation of a tandem Chlamydia psittaci Pgp3 multiepitope peptide vaccine against a pulmonary chlamydial challenge in mice［J］. Microb Pathog， 2020， 147： 104256.