9例聚集性鹦鹉热肺炎临床和流行病学特征

Clinical and epidemiological characteristics of nine cases of clustered Chlamydia psittaci pneumonia

  • 摘要: 目的 探讨新型冠状病毒感染的肺炎疫情下9例聚集性鹦鹉热肺炎患者的临床特点。方法 收集2020年12月由密云区医院(8例)及密云中医院(1例)收治的9例聚集性发病的鹦鹉热肺炎患者,对其临床资料回顾性分析,总结其临床及诊疗特点。结果 9例患者发病时间集中,均有鸽子养殖区活动或居住史行为。均有不同程度发热,77.80%为高热,伴咳嗽、咳痰;白细胞计数基本正常,中性粒细胞比例均升高;8例C-反应蛋白水平升高;6例D-二聚体升高。胸部CT表现为单肺叶片状高密度实变影,内见支气管充气征象,下肺为著,少数为双肺改变;1例死亡病例为双肺多肺叶磨玻璃影改变;8例治疗后复查,炎性改变基本完全吸收。2例行宏基因二代测序技术,检测出鹦鹉热衣原体核酸序列;7例行鹦鹉热衣原体血清抗体检测,均为阳性;6例进行呼吸道病原学检测,合并肺炎克雷伯菌感染。8例使用喹诺酮类抗生素,或单用或联合其他药物;2例联合使用四环素类。8例治愈出院,1例临床死亡。结论 面对不明原因的聚集病例,应详细询问接触史。宏基因二代测序技术有利于及早确诊病原体,最终降低疾病负担。除外四环素类,喹诺酮类在鹦鹉热肺炎的治疗中表现出较好的治疗作用。

     

    Abstract: OBJECTIVE To explore the clinical characteristics of nine cases of clustered Chlamydia psittaci pneumonia under the COVID-19 pandemic. METHODS Total of nine cases diagnosed with C. psittaci pneumonia during Dec 2020 were enrolled in the study, of whom eight cases were treated in the Department of Miyun District of Peking University First Hospital and one case were from TCM Hospital of Beijing Miyun Traditional Chinese Medicine Hospital. The clinical data of the patients were retrospectively analyzed, and the clinical characteristics of the disease and treatment were summarized. RESULTS The onset time of nine patients was concentrated, and all of them had activities or living history in pigeon breeding area. All patients had different degrees of fever, 77.80% of whom were high fever, accompanied by cough and expectoration. The white blood cell count was normal and the neutrophils were increased. C-reactive protein level in 8 cases was increased and D-dimer was elevated in six cases. Chest CT scanning showed high-density consolidation in unilateral lungs, with bronchial inflatable signs, especially in lower lungs, but bilateral lung changes were not common. One death was reported as multiple variations in ground-glass opacity of bilateral lungs. Eight patients were treated and recovered with no observable inflammatory lesions and esidual fibrosis. Two patients’ specimens were detected with C. psittaci nucleic acid by metagenomics next-generation sequencing(mNGS) technology. Seven patients underwent serum antibody test for C. psittaci, all of which were positive. Six patients were under respiratory tract pathogenic testing, all of which were the combined infection of Klebsiella. Quinolone antibiotics were used in the treatment of eight patients, either alone or in combination with other drugs. Two patients were treated with tetracyclines. Eight patients were cured, and one died clinically. CONCLUSION Patients should be inquired their contact history in detail when encountering an unexpected clustered outbreak of pneumonia. The mNGS is efficient in identifying the pathogenic bacteria, which can help to reduce the burden of disease ultimately. Except for tetracyclines, quinolones have shown good therapeutic effects in the treatment of C. psittaci pneumonia.

     

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