鹦鹉热衣原体肺炎临床特点及诊治分析

Clinical characteristics,diagnosis and treatment of Chlamydia psittaci pneumonia

目的探讨鹦鹉热衣原体肺炎的临床特点及早期诊治方法。方法选取2019年2月—2022年2月萍乡市人民医院收治、经宏基因二代测序技术(mNGS)诊断为鹦鹉热衣原体肺炎的12例患者,回顾性分析其临床资料,总结该病的临床特征及诊治要点。结果12例鹦鹉热衣原体肺炎患者多数有鸟类、鸽或家禽接触史(8例),以高热(12例)、全身乏力(12例)、咳嗽(10例)、呼吸困难(9例)、头痛(7例)为起病主要表现,病情可迅速进展为呼吸衰竭、感染性休克,甚至多器官功能衰竭。实验室检测12例患者C反应蛋白均升高,9例降钙素原升高,血常规淋巴细胞均下降,10例患者中性粒细胞百分比升高,9例白细胞正常。胸部CT表现为一侧或双侧肺叶炎症渗出和实变。呼吸道标本或血标本mNGS检出鹦鹉热衣原体,结合接触史、临床表现及影像学检查结果明确诊断。喹诺酮类对其中10例鹦鹉热衣原体肺炎治疗有效,1例患者使用喹诺酮类无效患者,改用四环素类治疗,病情短期内仍可好转。结论鹦鹉热衣原体肺炎肺部症状明显,肺外症状常见,病情进展快,mNGS是早期诊断的重要检测技术,可减少诊断延迟。及时启动靶向抗菌药物治疗,鹦鹉热衣原体肺炎患者愈后良好。

Objective To explore the clinical characteristics as well as early diagnosis and treatment of Chlamydia psittaci(C.psittaci)pneumonia.Methods 12 patients admitted in Pingxiang People’s Hospital from February 2019 to February 2022 and diagnosed as C.psittaci pneumonia by metagenomic next-generation sequencing(mNGS)were selected,clinical data were analyzed and clinical characteristics as well as key points of diagnosis and treatment of the disease were summarized retrospectively.Results Most of the 12 patients with C.psittaci pneumonia had a history of contact with birds,pigeons or poultry(n=8),the main manifestations of the disease onset were high fever(n=12),general fatigue(n=12),cough(n=10),dyspnea(n=9)and headache(n=7),disease could rapidly progress to respiratory failure,septic shock,and even multiple organ failure.Laboratory tests showed that C-reactive protein increased in 12 patients,procalcitonin increased in 9 patients,blood routine lymphocytes all decreased,percentage of neutrophils increased in 10 patients,and white blood cells were normal in 9 patients.Chest CT showed inflammatory exudation and consolidation of one or both pulmonary lobes.Respiratory tract specimens or blood specimens were detected C.psittaci by mNGS,and the diagnosis was confirmed in combination with the contact history,clinical manifestations and imaging examination results.Quinolones were effective for treatment of 10 cases of C.psittaci pneumonia,and 1 patient who failed to use quinolones were treated with tetracyclines,and could still improve in a short time of disease condition.Conclusion C.psittaci pneumonia has obvious pulmonary symptoms,extrapulmonary symptoms are common and can progress rapidly,mNGS is an important detection technique for early diagnosis,which can reduce the delay of diagnosis.Patients with C.psittaci pneumonia recover well after timely initiation of targeted antimicrobial treatment.