鹦鹉热衣原体肺炎特征的临床研究

Clinical research on the characteristics of Chlamydia psittaci pneumonia

目的 分析鹦鹉热衣原体肺炎患者的临床特征、诊疗方法,并探讨宏基因组二代测序(mNGS)技术在鹦鹉热衣原体肺炎诊断中的应用价值。方法 回顾性分析中国科学技术大学附属第一医院收治的17例鹦鹉热衣原体肺炎患者病历资料,对其临床表现、影像学演变、病原学检查及药物治疗等进行分析。结果 17例患者均以高热、呼吸困难为主要临床表现;其中11例患者既往有鸟禽类或其粪便接触史;外周血白细胞计数正常或轻度升高,血C反应蛋白及降钙素原水平升高明显;肺部CT表现为某一肺叶或多个肺叶炎症渗出或实变,所有患者应用mNGS技术检测肺泡灌洗液或血液中鹦鹉热衣原体核酸序列呈阳性表达,用以莫西沙星或多西环素为基础的抗感染方案治疗有效。14例患者病情好转出院,3例患者死亡。结论 鹦鹉热衣原体肺炎临床表现、影像学特征不典型,应用mNGS技术可提高鹦鹉热衣原体肺炎诊断的及时性,积极治疗可改善患者预后。

Objective To analyze the clinical characteristics, diagnosis and treatment of patients with Chlamydia psittaci pneumonia, and to explore the value of macrogenomic second-generation sequencing(mNGS) technology in the diagnosis of Chlamydia psittaci pneumonia.Methods Seventeen patients with Chlamydia psittaci pneumonia admitted to the First Affiliated Hospital of University of Science and Technology of China from August 2019 to January 2022 were retrospectively analyzed for their clinical manifestations, pharmacological treatment, imaging evolution and pathogenetic examination.Results Seventeen patients had high fever and dyspnea as the main clinical manifestations.Eleven patients had a history of previous exposure to birds and their secretions.The peripheral blood leukocyte count was normal or mildly elevated, and blood C reactive protein and PCT levels were elevated significantly.The lung CT showed inflammatory exudation or consolidation in the lung lobes, and all patients showed positive expression of alveolar lavage fluid or blood Chlamydia psittaci nucleic acid sequences by mNGS technique.A moxifloxacin-or doxycycline-based treatment regimen was effective.14 patients were discharged in improved condition and 3 patients died.Conclusions The clinical manifestations and imaging features of psittacosis pneumonia are atypical, and the application of mNGS technology can provide a basis for timely diagnosis of psittacosis chlamydia pneumonia.The active and reasonable treatment can improve the prognosis of patients.