老年鹦鹉热衣原体重症肺炎患者的诊断和临床特征分析

Diagnosis and clinical characteristics analysis in elderly patients with severe pneumonia caused by Chlamydia psittaci

目的探讨老年患者鹦鹉热衣原体重症肺炎的诊断和临床特征。方法回顾性分析收集2021年1-6月收治于福建医科大学附属泉州第一医院鲤城东街院区重症医学科的5例老.年鹦鹉热衣原体重症肺炎患者的临床资料,总结老年患者的诊疗过程和临床特征。结果5例鹦鹉热衣原体感染的重症肺炎,年龄64~74岁,合并多种基础疾病(冠心病、慢性心力衰竭、慢性阻塞性肺病等):患者均有确定的家禽接触史.以高热、咳嗽.咳痰、呼吸困难为主要表现,部分以全身或四肢无力为前驱症状,病情进展迅速,导致重度呼吸衰竭、急性肾损伤、休克,有不同程度的肌损伤,亦损害心脏、肝脏和凝血及免疫系统;实验室检查各项炎症指标升高,入院3.5.7 d C反应蛋白214.6(153.9~256.3)mg/L.199.2(115.8~333.8)mg/L.151.0(11.19~173.7)mg/L.白细胞介素6为1241.0(912.1~6822.0)ng/L.779.1(451.2~7122.0)ng/L.631.2(7.0~4321.0)ng/L;营养指标监测提示高代谢状态;影像学检查为实变及毛玻璃样影,并向双肺扩散,伴粟粒、结节性影,也可累及胸膜,可见胸腔积液;随着宏基因二代测序(mNGS)发展,其可作为诊断鹦鹉热衣原体感染的重要证据;病程和预后与疾病严重程度、高龄、基础疾病和及时诊断并有效治疗相关。结论鹦鹉热衣原体肺炎进展为重症可能与高龄、合并较多基础疾病如慢性心肺疾病.吸烟、诊断和治疗及时与否有关.一般实验室检查及影像学无特异性,mNGS对于早期诊断、过渡至目标治疗、改善预后有重要的意义。

Objective To investigate the diagnosis and clinical characteristics of five elderly patients with Chlamydia psittaci-caused severe pneumonia.Methods Through retrospeetive analysis,diagnosis and treatment process and clinical characteristics of five elderly inpatients with severe pneumonia caused by Chlamydia psittaci were summarized in the Department of Critical Care Medicine.Quanzhou First Hospital East Street Branch Area,affiliated to Fujian Medical University between January to June 2021.Results Five patients with severe pneumonia caused by Chlamydia psittaci were aged from 64 to 74 years.with various underlying diseases such as coronary hearl disease.chronic heart failure.chronic obstructive pulmonary disease.etc.AIll patients had an established history of poultry exposure.These cases had high fever.cough.spitting.and dyspnea as the main clinical manifestations.Some of them also had systemic symptoms or weakness of the limbs as the prodromal symptoms.The discase progressed rapidly,with severe respiratory failure,acute kidney injury,and shock appearing soon,accompanied by different degrees of muscle injury,and damage to the heart,liver,blood coagulation,and immune systems at the same time.Laboratory examination showed that levels of inflammatory indicators were increased;at 3.5.7 d after admission,the level of C reaetive prolein was 214.6(153.9-256.3)mg/L.199.2(115.8-333.8)mg/L.151.0(11.19-173.7)mg/L.respetively;and interleukin 6 level was 1241.0(912.1-6822.0)ng/L.779.1(451.2-7122.0)ng/L.631.2(7.0-4321.0)ng/L.respctively.And monitoring results of nutritional index indicated a high metabolic state.The imaging examinations showed that consolidation and ground glass shadows spreaded to both lungs.may accompany the miliary and nodular shadows,and may also involve pleural which caused pleural effusion.After the clinical use of metagenomic next generation sequencing(mNGS).mNGS has been confirmed as an important method for the diagnosis of Chlamydia psittaci infection.The disease course and prognosis were related to the severity of the disease.advanced age.underlying diseases,and timely diagnosis and effective treatment.Conclusions The progression of Chlamydia psittaci pneumonia to severe disease may be related to advanced age.more basic diseases such as chronic cardiopulmonary disease.smoking,and timely diagnosis and treatment.Generally.laboratory and imaging examinations have no diagnostic speeificity.but mNGS is of great significance for early diagnosis.transition to target treatment and improvement of prognosis.