鹦鹉热衣原体致重症社区获得性肺炎伴胰腺损伤一例并文献复习

A case of severe community-acquired pneumonia with pancreatic injury caused by Chlamydia psittaci and literatures review

目的探讨鹦鹉热衣原体感染的临床特征。方法分析2022年4月安化县人民医院收治的1例鹦鹉热衣原体所致重症社区获得性肺炎伴胰腺损伤患者的诊治过程并复习相关文献。结果该患者有明确的禽类接触史,起病时主要表现为咳嗽、咯痰、发热、乏力等不适;入院1周后病情逐渐加重并出现多器官功能障碍。转入重症监护室后完善支气管肺泡灌洗液的宏基因组二代测序检查明确鹦鹉热衣原体感染,给予莫西沙星0.4g/次、次/d静脉滴注21 d联合多西环素0.1 g/次、次/12 h口服35 d后,病情好转。期间虽然胰酶升高(峰值:血淀粉酶:710 U,脂肪酶:548.6 IU/L),但总体预后良好。随访2个月并复查肺部CT示病灶基本吸收,患者器官功能基本恢复正常。结论鹦鹉热衣原体感染病情进展迅速,明确诊断对控制病情极为重要,给予有效药物治疗后总体预后良好,但治疗过程中需密切监测胰腺等器官功能,并做好药物警戒工作。

Objective To investigate the clinical characteristics of Chlamydia psittaci infection.Methods The diagnosis and treatment of a patient admitted to Anhua County People’s Hospital in April 2022 with severe community-acquired pneumonia caused by Chlamydia psittaci and pancreatic injury were analyzed,while the relevant literatures were reviewed.Results This patient had a clear history of contact with poultry,and the main symptoms were cough,sputum,fever and fatigue at the onset of the disease;one week later after admission,the condition gradually worsened and multiple organ dysfunction occurred.In Intensive Care Unit,the patient was confirmed to be infected with Chlamydia psittaci by metagenomic next-generation sequencing of the bronchial alveolar lavage fluid.After 21 days of intravenous infusion of moxifloxacin(0.4 g/time once a day)and 35 days of oral administration of doxycycline(0.1 g/time twice a day),the condition improved.Although pancreatic enzymes increased(the peak value:Serum amylase 710 U,lipase 548.6 IU/L)during the period,the overall prognosis was good.Follow-up for 2 months and lung CT re-examination showed that the lesions were basically absorbed,and the organ functions of this case basically returned to normal.Conclusions Chlamydia psittaci infection progresses rapidly,and definite diagnosis is extremely important to control the disease.After effective drug treatment,the overall prognosis is good,but it is necessary to closely monitor pancreas and other organ functions,and manage well at pharmacovigilance during the treatment.