Human psittacosis: a review with emphasis on surveillance in Belgium.

Chlamydia psittaci causes psittacosis in humans, mainly in persons in contact with birds in either the setting of occupational or companion bird exposure. Infection is associated with a range of clinical manifestations from asymptomatic infection to severe atypical pneumonia and systemic disease. This paper reviews new knowledge on psittacosis, its legal and regulatory aspects and presents epidemiological data on psittacosis in Belgium. In Belgium, the number of reported positive laboratory results increased slowly since 2010, and in 2017, the number almost doubled compared to the two previous years. The number of psittacosis cases in Belgium, as in other countries, is probably highly underestimated, because of underdiagnoses and underreporting. Over the 3-year period, the mandatory notification system registered 24% only of all reported positive laboratory result. Therefore, increased awareness among general and occupational physicians, clinicians and the public is needed. Policies aimed at reducing psittacosis disease burden are justified, nevertheless national health authorities should provide more legal and financial support to implement more adequate C. psittaci diagnostic tools.

MOMP and MIP DNA-loaded bacterial ghosts reduce the severity of lung lesions in mice after Chlamydia psittaci respiratory tract infection.

Chlamydia psittaciis a well known zoonotic pathogen that can lead to severe respiratory disease in poultry, pet birds and humans. Development of an effective and safe vaccine would be the most effective way to control C. psittaci infection. In this study, we used bacterial ghosts (BGs) as a delivery vehicle to evaluate the protective effects of major outer membrane protein (MOMP) and macrophage infectivity potentiator (MIP) DNA vaccines in mice. We found that MOMP/MIP DNA-loaded BGs elicited a better immune response than a naked DNA vaccine, giving increased IgG titers, lymphocyte proliferation responses and higher levels of IFN-γ. After challenge infection, MOMP/MIP DNA-loaded BGs-immunized mice showed lower chlamydial load and inflammation pathology in lung tissues. In addition, we found that MOMP and MIP co-immunization or a heterologous prime-boost strategy could induce stronger immune responses and better protective efficacy against C. psittaci infection. Together, the above results suggest that BGs can act as an effective delivery vehicle for C. psittaci DNA vaccines, and co-immunization or heterologous prime-boost strategy can enhance protective efficacy against infection, thereby providing an alternative strategy for the design of vaccines against C. psittaci.

Atypical pneumonia due to Chlamydophila psittaci: 3 case reports and review of literature.

Chlamydophila psittaci is the causative agent of psittacosis or ornithosis. The disease is transmitted to men predominantly from birds. Most commonly noted symptoms are fever, headache and cough, but a number of other symptoms or complications may arise such as renal impairment, hepatitis or neurological symptoms. In this article 3 cases of psittacosis are presented, with a review of the literature with emphasis on laboratory diagnosis.

Psittacosis.

Psittacosis is a systemic zoonotic infection with protean clinical features. The major risk factor is exposure to birds; bird owners, veterinarians, those involved with breeding and selling birds, and commercial poultry processors are most at risk. Patients typically present with 1 week of fevers, headache, myalgias, and a nonproductive cough. Although pneumonia is the most common manifestation, all organ systems can be involved. Serology remains the mainstay of diagnosis; however, polymerase chain reaction techniques offer a rapid and specific alternative. Doxycycline is the treatment of choice.

Brote de psitacosis en San Miguel de Tucumán y Gran San Miguel / Outbreak of psitacosis in San Miguel de Tucumán and Gran San Miguel

Desde la 2ª a la 7ª semana epidemiológica de 2004 (periodo comprendido entre el 12/01/04 al 17/02/04), se registraron 15 casos sospechosos de psitacosis, en 8 familias residentes en San Miguel de Tucumán y Gran San Miguel de Tucumán, específicamente Banda del Río Salí y Tafí Viejo. El rango etario comprende desde los 21 meses a 53 años. Los pacientes presentaron cuadro clínico compatible, antecedente epidemiológico y respuesta inmediata al tratamiento específico. En todos los casos las fuentes animales fueron aves psitácidas (loros o cotorras) adquiridos durante los meses de diciembre de 2003 y primeros días de enero de 2004, a vendedores callejeros, en una feria itinerante que recorre distintos barrios y el último caso registrado, en una pajarería habilitada.

Sepsis due to gestational psittacosis: A multidisciplinary approach within a perinatological center--review of reported cases.

Chlamydia psittaci is associated with significant morbidity and mortality during pregnancy, and its rarity can delay early diagnosis and treatment. A farmer's wife presented at 31 weeks with febrile illness and developed signs of septic shock, indicating immediate delivery. The child developed uneventfully. The mother survived after symptomatic mechanical ventilation, including extracorporeal lung assistance, for 11 days due to multi-organ failure. Only two weeks after admission antibody titres against Chlamydia were rising. The placenta demonstrated acute intervillositis and destruction of throphoblastic cells. Retrospectively, the infection was presumed to derive from infected pregnant sheep. Pregnant women should be advised to avoid contact with sheep and their gestational products. Proper history, early recognition and appropriate management is mandatory for survival of both mother and child.

A case of fulminant psittacosis.

Psittacosis is a systemic disease that causes fever, headache and pneumonia. Although potentially serious, it is rarely fatal unless respiratory or renal failure occurs. In this case report we describe a case of psittacosis with an unusual clinical picture for this disease and where, despite multi-organ failure, the patient survived.

Ocular adnexal lymphoma: a clinicopathologic study of a large cohort of patients with no evidence for an association with Chlamydia psittaci.

Non-Hodgkin lymphomas are among the most common primary tumors occurring in the ocular adnexa. Herein, we present a 14-year single-institution experience in 62 patients with primary ocular adnexal lymphomas (OALs). Association with Chlamydia psittaci infection is examined in 57 tumor specimens. Extranodal marginal zone lymphoma (EMZL) was the most frequent histologic subtype (89%). The majority of patients with EMZL (84%) presented with stage E-extranodal (IE), however only 16% had an advanced stage. All stage IE patients were treated with local radiotherapy, whereas patients with disseminated disease received systemic therapy with or without local irradiation. All but 1 patient with EMZL achieved complete remission (CR). During a median follow-up of 52 months (range, 3-153 months), the estimated 5-year overall survival (OS) and freedom from progression (FFP) were 96% and 79%, respectively. During the follow-up, 22% of patients relapsed, mainly in extranodal sites, and 4% transformed to diffuse large B-cell lymphoma. None of the patients exhibited local orbital failure in the radiation field. None of the OAL specimens harbored C psittaci DNA. Our study demonstrates that EMZLs, accounting for the majority of primary OALs, are characterized by an indolent natural history with frequent, continuous extranodal relapses. In South Florida, OALs are not associated with C psittaci infections.

Successful use of ECMO in adults with life-threatening infections.

Two cases of critically ill patients who received extracorporeal membrane oxygenation (ECMO) using different forms of circuitry and for different indications are presented. Both patients had life-threatening infections with septic shock and were not able to be supported by conventional means. The first patient had staphylococcal septicaemia and received venoarterial ECMO for circulatory failure. The second patient had psittacosis and received venovenous ECMO for respiratory failure. We discuss the expanding indications for this technology and the role it has to play in adult intensive care.

Compendium of measures to control Chlamydia psittaci infection among humans (psittacosis) and pet birds (avian chlamydiosis), 2000. Centers for Disease Control and Prevention.

Psittacosis--also known as parrot fever and ornithosis--is spread by a bacterial infection of birds that can cause severe pneumonia and other serious health problems among humans. From 1988 through 1998, 813 cases of psittacosis (infection with Chlamydia psittaci) were reported to CDC, and most resulted from exposure to infected pet birds, usually cockatiels, parakeets, parrots, and macaws. In birds, C. psittaci infection is referred to as avian chlamydiosis (AC). Infected birds shed the bacteria through feces and nasal discharges, and humans become infected from exposure to these materials. This compendium provides information about psittacosis and AC to public health officials, physicians, veterinarians, the pet bird industry, and others concerned about controlling these diseases and protecting public health. The recommendations in this compendium provide standardized procedures for controlling AC in birds, a vital step to protecting human health.

Chlamydiosis in pen-raised bobwhite quail (Colinus virginianus) and chukar partridge (Alectoris chukar) with high mortality.

In a flock of 12,000 bobwhite quail (Colinus virginianus) and 7200 chukar partridge (Alectoris chukar), the owner had 100% morbidity and 40%-50% mortality in birds between the ages of 2 and 4 wk. Affected birds were stunted and anorexic and had yellow/green diarrhea. Two- and 4-wk-old birds submitted for necropsy all had slight nasal discharge. Histopathologic examination revealed mild (bobwhite) to severe (chukar) rhinitis. Immunohistochemistry was positive for Chlamydia psittaci in all birds. Chlamydia psittaci organisms were demonstrated histopathologically in hematoxylin and eosin and Gimenez-stained slides. Management sanitation and treatment with chlortetracycline stopped further excessive losses. The owners were also infected. Treatment by their local physician with tetracycline alleviated symptoms.

Fulminant psittacosis requiring mechanical ventilation and demonstrating serological cross-reactivity between Legionella longbeachae and Chlamydia psittaci.

Chlamydia psittaci infection typically causes a mild respiratory illness in humans. Severe respiratory failure requiring mechanical ventilation or intensive care therapy is an uncommon development. The aetiological agents causing severe community acquired pneumonia often remain undetermined. Serological tests may aid in diagnosis. We present two cases of fulminant psittacosis, one demonstrating early cross-reactivity with Legionella longbeachae.

[Psittacosis (chlamydiosis) of birds and the necessity of government disease control]. / Die Psittakose (Chlamydiose) der Vögel und die Notwendigkeit einer staatlichen Bekämpfung.

Psittacosis--induced by Chlamydia psittaci--occurs at present as individual cases but not any more as an endemic or epidemic disease. The diagnosis does not pose unsurmountable difficulties. The dominant sources of infection for men are--unlike in previous times--now budgerigars and cockatiels from domestic breeding sources but also--as far as it is known at all--different domestic mammals. A targeted therapy of diseases in humans and birds is successfully possible with chlortetracycline, doxycycline or fluoroquinolone-containing drugs. Therefore, government-imposed control measures focussing entirely on imported psittacines such as quarantine, long-term medication and possibly eradication of Chlamydia psittaci-positive psittacine birds are not essential any more. It is suggested that psittacosis in birds should not be a notifiable disease any longer. The derogation of mandatory treatment during quarantine is also recommended. Governmental control of psittacosis should be replaced by a privately organized eradication program by breeders.

[A very serious course of psittacosis in pregnancy]. / Een zeer ernstig beloop van psittacose in de zwangerschap.

A 33-year-old pregnant woman was admitted because of atypical pneumonia. She developed adult respiratory distress syndrome complicated by premature birth and perinatal mortality. The diagnosis 'psittacosis' was established on clinical grounds and confirmed serologically (complement fixation test). She was treated with doxycycline 200 mg i.v. daily for 3 weeks and was discharged in good condition after three months. Indirect case history revealed infected birds from the neighbours as the likely source of infection. Psittacosis is caused by Chlamydia psittaci and is acquired after inhalation of dry secreta or excreta from infected animals. Retrospective direct questioning often reveals contact with birds. Diagnostic delay can be considerable. Doxycycline is contraindicated in pregnant women, but erythromycine can be prescribed. Pregnant women should be advised to avoid contact with infected birds as they run an increased risk of a severe disease course.

[A case of fulminant psittacosis necessitating mechanical ventilation diagnosed by chlamydial isolation form BALF].

A 51-year-old female was admitted with complaints of fever and general fatigue. Chest X-ray showed diffuse bilateral fine nodular shadows and infiltrates. Complication of hepatic and muscular injury was suspected from increased levels of GOT, GPT and CPK in the serum. Arterial blood gas analysis revealed hypoxemia. Because hypoxemia aggravated despite treatment with intravenous minocycline (200 mg/day), corticosteroids and mechanical ventilation were started, and the administration of minocycline (400 mg/day) and sparfloxacin was added. Consequent, chest X-rays and several laboratory data improved gradually. The final diagnosis was established with a significant rise of both IgG and IgM antibody against Chlamydia psittaci with MIF and identification of Chlamydia with the cell culture method. Chlamydia was successfully isolated from BALF of this patient obtained 5 days after commencement of minocycline treatment. Psittacosis should be considered as a possible cause of severe respiratory failure necessitating emergency care including mechanical ventilation.

Chlamydia psittaci infections: a review with emphasis on avian chlamydiosis.

In the first part of this article the general characteristics of Chlamydia psittaci namely the history, taxonomy, morphology, reproductive cycle, metabolism and genetics are reviewed. For the taxonomy in particular, a considerable amount of new information has become available in recent years, following the application of monoclonal antibodies and restriction enzymes. Using these techniques isolates of Chlamydia psittaci from birds have been subdivided in different serovars, a number of isolates have been classified in a new species (Chlamydia pecorum) and isolates from animals have been classified as Chlamydia trachomatis. In the second part of the article, the current knowledge on avian chlamydiosis is summarized. Emphasis is put on clinical signs, lesions, pathogenesis, epizootiology, immunity, diagnosis, prevention and treatment. Also the public health considerations are reviewed. It is concluded that the diagnosis of avian chlamydiosis is laborious and that there is still a need for more accurate, simple and rapid diagnostic tools, both for antigen and antibody detection in various species of birds.