新型冠状病毒和鹦鹉热衣原体混合感染致重症肺炎1例

Clinical characteristics of a case of severe pneumonia caused by coinfection of COVID‑19 and Chlamydia Psittaci

患者女,69岁,主诉“咳嗽、发热8 d”。入院时新型冠状病毒核酸检测阳性,胸部CT示双肺斑片状影、实变影迅速进展,动脉血气分析示Ⅰ型呼吸衰竭,初步诊断老年人、无基础疾病的重症社区获得性肺炎,给予吸氧、糖皮质激素抗炎、抗生素哌拉西林他唑巴坦经验性治疗效果差。支气管镜BALF宏基因组二代测序(mNGS)示鹦鹉热衣原体。确诊新冠病毒和鹦鹉热衣原体混合感染所致的重症肺炎。改用多西环素联合莫西沙星针对病因目标治疗及对症治疗显著好转。出院后随访4周痊愈。因此,临床诊治新冠感染时需警惕合并鹦鹉热衣原体混合感染。

A 69‑year‑old female patient was admitted to the Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Xuzhou Medical University due to a“cough and fever for eight days”.On admission,a coronavirus disease(COVID‑19)nucleic acid test was positive,and a chest CT scan showed progressive patchy shadows and consolidation shadows in both lungs.Arterial blood gas analysis showed typeⅠrespiratory failure.The primary diagnosis was severe community‑acquired pneumonia in an older adult without underlying disease.However,oxygen inhalation,steroid,anti‑inflammatory,and antibacterial empirical treatment with piperacillin/tazobactam was ineffective.Metagenomic next‑generation sequencing of bronchoscopy alveolar lavage fluid showed Chlamydia psittaci(C.psittaci).Severe pneumonia was confirmed,caused by coinfection with severe acute respiratory syndrome coronavirus 2 and C.psittaci.A combination of doxycycline and moxifloxacin significantly improved the targeted and symptomatic treatment of the underlying cause.After discharge,the patient recovered within four weeks of follow‑up.Therefore,clinicians should be alert to the possibility of coinfection of C.psittaci in patients already diagnosed with COVID‑19.