鹦鹉热衣原体肺炎误诊分析及文献复习

Misdiagnosis of Chlamydia Psittaci Pneumonia and Literature Review

目的探讨鹦鹉热衣原体肺炎误诊患者临床特征、诊治方法及误诊原因、防范措施。方法对2020年12月—2022年4月收治的曾误诊的鹦鹉热衣原体肺炎4例的临床资料进行回顾性分析。结果本组4例分别以发热和乏力7 d,间断头晕20余天,发热和咳嗽、气短1 d及发热伴咳嗽、咳痰6 d入院,均出现高热,伴乏力、食欲不振及轻微咳嗽、肌肉酸痛等症状,皆出现中性粒细胞和C反应蛋白升高;2例转氨酶升高;2例血钠下降。胸部CT检查主要表现为单叶肺实变伴支气管充气征。3例行支气管镜检查示支气管黏膜充血和肿胀。就诊初期均误诊为细菌性肺炎,误诊时间5~10 d,给予经验性抗感染治疗效果不佳。后经支气管肺泡灌洗液宏基因二代测序(mNGS)等检查并追问病史发现鹦鹉和禽类接触史,确诊鹦鹉热衣原体肺炎。4例确诊后均给予莫西沙星治疗病情好转出院。结论鹦鹉热衣原体肺炎临床常表现为高热和乏力,影像学检查以肺部斑片实变影为主,易出现胸腔积液,支气管肺泡灌洗液mNGS检测能快速准确诊断,早期给予多西环素和(或)莫西沙星治疗效果明显。提高对该病认识、详细病史询问及认真、细致诊断和鉴别诊断可减少或避免鹦鹉热衣原体肺炎误诊误治。

Objective To investigate the clinical characteristics,diagnosis and treatment methods,causes of misdiagnosis and preventive measures of chlamydia psittaci pneumonia.Methods The clinical data of 4 patients with Chlamydia psittaci pneumonia misdiagnosed from December 2020 to April 2022 were analyzed retrospectively.Results The 4 patients in this group were hospitalized with fever and fatigue for 7 d,intermittent dizziness for more than 20 d,fever with cough fever with cough and shortness of breath for 1 d,and expectoration for 6 d,respectively.They all had high fever,fatigue,anorexia,slight cough,and muscle soreness,and all had elevated neutrophils and C-reactive protein(CRP);2 cases had increased liver enzymes and decreased serum sodium.Chest CT examination mainly showed single lobe consolidation with bronchial inflation sign.Bronchoscopy showed congestion and swelling of bronchial mucosa in 3 cases.All patients were misdiagnosed as bacterial pneumonia at the initial diagnosis,and the duration of misdiagnosis was 5-10 d;the effect of empirical anti infection treatment was poor.Afterwards,the contact history between parrots and birds was found through metagenomics next-generation sequencing(mNGS)of bronchoalveolar lavage fluid and the follow-up of the disease history,and the diagnosis of chlamydia psittaci pneumonia was confirmed.After diagnosis,four patients were treated with Moxifloxacin and discharged with improved condition.Conclusion The clinical manifestations of Chlamydia psittaci pneumonia are usually high fever and fatigue.The imaging examination mainly focuses on consolidation of pulmonary patches,which is prone to pleural effusion.The detection of mNGS of bronchoalveolar lavage fluid can quickly and accurately diagnose the disease.Early treatment with Doxycycline and/or Moxifloxacin has obvious effects.Improvement in the understanding of the disease,inquiry about the detailed history and careful diagnosis or differential diagnosis may help reduce or avoid the misdiagnosis and mistreatment of Chlamydia psittaci pneumonia.