鹦鹉热衣原体感染肺炎患者的临床特征分析

Clinical characteristics analysis of patients with pneumonia infected by Chlamydia psittaci

目的分析鹦鹉热衣原体感染肺炎患者的临床特征。方法通过回顾性分析铜陵市人民医院2019年7月至2020年1月收治的3例鹦鹉热衣原体感染肺炎患者的接触史、临床表现、实验室检查、影像学特征和演变、病原学、治疗过程及结局,从而为鹦鹉热衣原体感染肺炎的诊断及防治提供经验。结果本组3例鹦鹉热衣原体感染肺炎患者的特征:均有明确的禽类、鸟类、野生动物接触史,高热(体温>39℃)、咳嗽、咳痰、胸闷、呼吸困难;病情进展迅速,以重度急性呼吸窘迫综合征(ARDS)、休克为主要表现,对心、肝、肾的损伤较轻;实验室检查:C-反应蛋白(CRP,均>200 mg/L)和中性粒细胞比例(Neut%,>0.90)均明显升高,白细胞计数(WBC)和降钙素原(PCT)升高不明显;影像学检查:胸部CT表现为肺部炎性浸润伴间质性改变,可为单侧,也可为双侧;胸部X线表现为大片状模糊阴影,呈扇形或楔形,达胸膜边缘。治疗7 d行床旁计算机X线摄影(CR)显示病灶缩小、渗出减轻,治疗11~13 d复查胸部CT显示病灶明显缩小。确诊依赖于宏基因病原微生物DNA高通量基因检测;对喹诺酮类及四环素类药物敏感。患者经抗感染治疗2~3 d后体温降至正常,均为10 d后撤离有创机械通气。好转后转入普通病房,总病程20~30 d。结论鹦鹉热衣原体感染肺炎患者病情危重,中重度ARDS及休克多见;早期诊断有赖于基因检测,经合理救治,患者愈后良好。

Objective To explore the clinical characteristics of pneumonia infected by Chlamydophila psittaci(C.psittaci).Methods A retrospective analysis was performed on 3 cases of C.psittaci pneumonia admitted to People's Hospital of Tongling City from July 2019 to January 2020.The patients'contact history,clinical manifestations,laboratory examination,imaging characteristics and evolution,etiology,treatment process and outcome were analyzed,so as to provide experience for the diagnosis and prevention of C.psittaci pneumonia.Results The 3 patients had been infected through pet or zoonotic exposures.All symptoms included high fever(body temperature>39℃),cough,sputum,chest tightness and dyspnea.The disease progressed rapidly,with severe acute respiratory distress syndrome(ARDS)and shock as the main manifestations,but the damages to the heart,liver and kidney were mild.Laboratory tests showed that C-reactive protein(CRP,all>200 mg/L)and neutrophil proportion(Neut%,>0.90)were significantly increased,while white blood cell count(WBC)and procalcitonin(PCT)were not significantly increased.Chest computed tomography(CT)showed inflammatory infiltration with interstitial changes,either unilateral or bilateral.Chest X-ray showed large areas of inflammatory infiltrations,fan-shaped or wedge-shaped to the edge of pleura.After 7 days of treatment,the bedside computed X-ray(CR)showed absorption of infiltration.After 11-13 days,the CT reexamination indicated lung infection was basically absorbed.Metagenomic next-generation sequencing(mNGS)confirmed the presence of C.psittaci in patients'sputum.It was sensitive to quinolones and tetracyclines.The patients'body temperature dropped to normal after 2-3 days of antibiotics,and all patients were extubated and transferred to normal ward 10 days later.The total course of illness was 20-30 days.Conclusions The patients with C.psittaci pneumonia are critically ill,and clinical manifestations of moderate to severe ARDS and shock are common.Early diagnosis depends on mNGS,and reasonable treatment is important for prognosis.