20例鹦鹉热的临床特征及诊治分析

Clinical features and treatment of 20 patients with psittacosis

目的总结鹦鹉热的临床表现、影像学特征及诊治方法。方法回顾性分析云南省第一人民医院、金平县人民医院和云南省监狱管理局中心医院经宏基因组学二代测序(mNGS)诊断的鹦鹉热患者的临床资料,总结该病的临床特征及诊治策略。结果共收集20例鹦鹉热患者,其中男性12例,女性8例;年龄31~71岁,中位年龄57.5岁。9例(45%)有禽类接触史,主要临床症状为发热、咳嗽,其他症状包括乏力(10例,50%)、肌痛(8例,40%)、呼吸困难(7例,35%)、咳痰(6例,30%)、头痛(4例,20%)、恶心呕吐(4例,20%)、咽干(1例,5%)和意识障碍(1例,5%)等,多数患者白细胞总数正常,但中性粒细胞比例及降钙素原升高,7例(35%)有贫血,8例(40%)有转氨酶轻度升高,影像学以肺部渗出和实变为主,6例(30%)有少量胸腔积液。所有患者经过喹诺酮类、四环素类或大环内酯类抗生素治疗后均好转。结论鹦鹉热衣原体感染患者临床表现缺乏特异性,mNGS检查有助于早期诊断;喹诺酮类、四环素类或大环内酯类等抗菌药均可取得良好疗效。

Objective To summarizing the clinical manifestations,imaging features,and diagnostic and treat-ment methods of psittacosis.Methods The clinical data of patients with psittacosis confirmed by metagenomic next-generation sequencing(mNGS)from the People's Hospital of Jinping County and the Central Hospital of the Prison Management Bureau of Yunnan were retrospectively analyzed to summarize the clinical features and diagnostic and treat-ment strategies of the disease.Results A total of 20 patients with psittacosis were collected,including 12 males and 8 females,aged 31 to 71 years,with a median of 57.5.Nine patients(45%)had a history of exposure to poultry.The main clinical symptoms were fever and cough,and other symptoms included fatigue(10 cases,50%),myalgia(8 cases,40%),dyspnea(7 cases,35%),expectoration(6 cases,30%),headache(4 cases,20%),nausea and vomiting(4 cases,20%),dry throat(1 case,5%),and disturbance of consciousness(1 case,5%).Most patients had normal total white blood cell count,but increased neutrophil ratio and procalcitonin levels,with 7 cases(35%)of anemia and 8 cases(40%)of mildly elevated transaminases.Imaging examination mainly showed pulmonary exudation and consolidation,with 6 cases(30%)having a small amount of pleural effusion.All patients improved after treatment with quinolones,tetracyclines or macrolide antibiotics.Conclusion The clinical manifestations of patients with chlamydia psittaci infection are lack of specificity,and mNGS examination is helpful for early diagnosis.Antibacterial drugs such as quinolones,tetracyclines or macrolides can achieve good efficacy.