9例鹦鹉热衣原体肺炎患者临床特征分析

Clinical characteristics of nine patients with chlamydia psittaci pneumonia

目的探讨鹦鹉热衣原体肺炎患者的临床特征,以提高对该病的认识,以助精准诊断和治疗。方法回顾性分析郑州大学第二附属医院2020年10月至2022年8月确诊的9例鹦鹉热衣原体肺炎患者的临床资料。结果9例患者中,男5例,女4例,7例患者有家禽类接触史,年龄为47~69岁,中位年龄为56岁,临床表现主要为高热9例、咳嗽9例、乏力9例、呼吸困难7例、肌肉酸痛5例、头痛4例等,1例迅速进展为呼吸衰竭。白细胞计数正常4例、轻度升高5例,中性粒细胞计数升高9例、淋巴细胞计数下降9例、C反应蛋白(CRP)升高9例,降钙素原(PCT)升高9例,天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)升高5例。胸部CT均表现为斑片状实变影、其中9例伴有支气管充气征,累及单侧肺叶6例、双侧肺叶3例、胸腔积液6例。9例患者均由宏基因二代测序(mNGS)检出鹦鹉热衣原体核酸序列。治疗上7例使用多西环素治疗、2例使用阿奇霉素治疗、7例使用莫西沙星治疗,其中3例使用西维来斯他纳治疗急性呼吸窘迫综合征后呼吸衰竭症状明显好转。9例患者治疗后均好转出院。结论鹦鹉热衣原体肺炎患者有明显肺部症状、病情进展较快、经验性抗生素治疗通常无效,西维来司他钠能有效治疗此病引发的急性呼吸窘迫综合征,应提高对此疾病敏感性,尽早行mNGS检测,精准诊断、精准治疗,改善患者预后。

Objective To investigate the clinical characteristics of patients with chlamydia psitsiti pneumonia,in order to improve the understanding of the disease and help accurate diagnosis and treatment.Methods The clinical data of nine patients with chlamydia psittaci pneumonia diagnosed in the Second Affiliated Hospital of Zhengzhou University from October 2020 to August 2022 were retrospectively analyzed.Results Among the nine patients,five cases were male,four cases were female,and seven cases had contact history with birds,pigeons or poultry,ranging from 47 to 69 years old,with a median age of 56 years old.The main clinical manifestations were lingering high fever in nine cases,cough in nine cases,fatigue in nine cases,dyspnea in seven cases,muscle soreness in five cases,headache in four cases,and one case rapidly progressed to respiratory failure.The white blood cell count was normal in four cases;slightly increased in five cases;neutrophil count was increased in nine cases;lymphocyte count was decreased in nine cases;C-reactive protein was significantly increased;procalcitonin(PCT)was increased in nine cases;aspartate aminotransferase(AST)and alanine aminotransferase(ALT)were increased in five cases.Chest computed tomography(CT)showed patchy consolidation,among which nine cases were accompanied by air bronchogram,six cases involved unilateral lobe,three cases involved bilateral lobe,and six cases had a small amount of pleural effusion.Chlamydia psittaci nucleotide sequence was detected by(metagenomics next-generation sequencing(mNGS)in all nine patients.In the treatment,seven patients were treated with doxycycline,two cases with azithromycin,and seven cases with moxifloxacin.Among them,three patients were treated with sivelestat sodium and their symptoms of respiratory failure were significantly improved.All nine patients were discharged with improvement after treatment.Conclusion Chlamydiapsittaci pneumonia patients have been exposed to birds,pigeons or poultry,and have obvious pulmonary symptoms,rapid progression of the disease,and empirical antibiotic treatment is usually ineffective.sivelestat sodium can effectively treat acute respiratory distress syndrome caused by this disease.Therefore,clinicians should improve the sensitivity of this disease and conduct mNGS detection as soon as possible.Accurate diagnosis and treatment can improve the prognosis of patients.