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.

[Isolation of chlamydophila psittaci from avian samples and establishment of a respiratory infection murine model].

OBJECTIVE: To optimize the isolation and culture technique of Chlamydophila psittaci avian strains and to establish an animal model infected with C. psittaci. METHODS: C. psittaci ompA gene was amplified from DNA extracted from bird livers by polymerase chain reactions (PCR). For the PCR positive avian samples, the liver tissues were homogenized and used to incubated with HeLa or Vero cell monolayers for 72 h in different dilutions, and chlamydia inclusion bodies were detected by immunofluorescence or Giemsa staining. Different dose of the avian strains (2 x 10(4), 2 x 10(5), 2 x 10(6) IFUs) were used to attack C57BL/6 mice by intranasal injection,mice were sacrificed on day 5 or day 10 after infection, and the histopathology changes were analyzed by H&E and immunohistochemistry staining in different organs. RESULTS: Six of one hundred avian samples were positive by C. psittaci ompA gene amplification,and three were positive by cell culture. The C. psittaci avian strains were cultured in Vero or HeLa cells. Vero cells showed stronger tolerance of cytolysis after chlamydia infection and chlamydia inclusion bodies were larger and more dense. Successfully establish a murine model of intranasal infection with C. psittaci, and 2 x 10(5) IFU is the suitable amount of organisms to induce respiratory chlamydia infection. CONCLUSION: The isolation and culture condition was optimized for C. psittaci avian strains, and a murine model of respiratory tract infection by C. psittaci was successfully established, which can be applied to the clincal diagnosis of C. psittaci and epidemiological or pathogenetic study.

An outbreak of psittacosis in a bird park in Japan.

An outbreak of psittacosis related to a bird park occurred in Matsue City, Shimane Prefecture, Japan, during winter 2001. Seventeen cases of psittacosis (12 visitors, three staff, and two student interns) were confirmed. A cohort study was conducted among the park staff and students to determine the risk factors for the development of acute serologically confirmed psittacosis (SCP) infection. Being 'bird staff' had an increased risk of SCP infection (RR 3.96, 95% CI 1.48-10.58). Entering the staff building, where ill birds were maintained without proper isolation, was also associated with an increased risk of SCP infection (RR 3.61, 95% CI 1.03-12.6). Isolation of ill birds and quarantine measures were found to be insufficient. Dehumidifiers and a high-pressure water spray under a closed ventilation environment may have raised the concentration of Chlamydophila psittaci in the hothouses. Bird park staff and visitors should be educated about psittacosis.

[Two familial cases of psittacosis].

We report here 2 cases of psittacosis in a family. In the first case, a 51-year-old woman was admitted with fever, dry cough, and a chest radiograph showed increased opacity in the right upper lung field. On a diagnosis of atypical pneumonia, minocycline was given and her clinical symptoms and abnormal laboratory data were improved. The second case was her husband, a 58-year-old man who presented with fever 4 days after his wife's admission. His chest radiograph revealed increased opacity in the left lower lung field. The administration of azithromycin for 3 days attenuated his clinical symptoms and his abnormal laboratory data improved. The serum titer of complement fixation (CF) test and ELISA test against Chlamydophila psittaci were elevated in both cases on analysis of paired acute- and convalescent-phase serum speciments. The antigen of Chlamydophila was revealed from these parrots, which had been raised in their family. Therefore, we concluded that the psittacosis had originated from the parrots.

[Severe multiorgan psittacosis in a 10-year-old boy]. / Psittacose sévère multiviscérale chez un garçon de dix ans.

UNLABELLED: Psittacosis is rare among children and severe cases appear exceptional. We describe a child with psittacosis and multiorgan involvement. CASE REPORT: T., a ten-year-old boy, was admitted for a prolonged fever associated with meningism. Laboratory tests showed an important inflammatory response, mild renal failure and coagulation disorders. On admission, the chest X-Ray and the cerebrospinal fluid were normal. He rapidly developed shock, acute abdomen, oxygenodependency, pneumonia and bilateral pleural effusion. No improvement was observed after 48 hours of cefotaxime therapy. History revealed the presence of two parrots at home. Treatment by intravenous clarithromycin was therefore initiated. Serology for Chlamydia psittaci was strongly positive. All symptoms disappeared a few days later. CONCLUSION: The case reported was particular for two reasons: severe disease with multi-organ involvement and young age of the patient. We emphasize the need to search for a history of contact with birds in any case of unexplained pneumonia.

[Two cases of Chlamydia psittaci infection occurring in employees of the same pet shop].

We report here 2 cases of psittacosis in a pet shop. In the first case, a 44-year-old male was admitted with fever, and a chest radiograph showed an infiltration shadow in the right lower lung. One day later, a colleague of the first patient, a 42-year-old man, developed fever and was admitted. In this patient, chest radiography revealed an infiltration shadow in the left lower lung. Both patients had mild liver dysfunction. The serum titer of a complement fixation (CF) test against Chlamydia psittaci was elevated fourfold in the first case and sixteen-fold in the second on the analysis of paired acute- and convalescent-phase serum specimens. Clinical symptoms and abnormal laboratory data were attenuated by the administration of minocycline for 2 weeks. Since both patients worked in same pet shop and since some parakeets at the shop had died, we speculated that the psittacosis had originated from these birds.

[Ornithosis--studies in correlation with an outbreak]. / Ornithose--Untersuchungen im Zusammenhang mit einem Ausbruch.

An outbreak of ornithosis with 8 cases of ornithosis pneumonia and 2 lethal complications was investigated in workers in a poultry farm and processing plant and a comparative seroepidemiological study of antigen responses was performed in 3 collectives: No. I: n = 82/87 workers in the processing plant, where the outbreak occurred; No. II: n = 83 workers in a chicken slaughter-house; No. III: n = 82 as matched-pair group to collective No. I with the same age and sex, but without occupational risk. The test systems were: genus specific complement fixation reaction (CFR), Ipazyme commercial slide kit containing LGV antigen and a type-specific microimmunofluorescence (MIF) technique with antigens binding C. psittaci, pneumonia and trachomatis IgA, IgG and IgM. 57/82 (71.9%) workers in group No. I were chlamydial antibody-positive, whereas only 22/82 of the population Nr. III--control group (odds ratio 6.2/3.2-12.3 p < or = 0.05). 16/83 (19.3%) of the workers in the chicken slaughterhouse had antibodies against chlamydia group antigens. 30/82 of the collective No. I had serological evidence of a recent or current infection with higher antibody titres in CFR and IPAZYME-Test and/or antibody response against IgA and IgM (MIF). 43.3% of the latter could be serologically detected as specific infections with C. psittaci. 10 of 18 (55%) workers employed in the recent 3 months had serological signs of an acute infection. There was no association between the point of contact with the poultry (live hang areas, slaughtery, evisceration, cooling carcasses) and the prevalence of antibody response. The possible routes of infection, inhalation of dried excretions or aerosols and via hand-to-mouth contacts are discussed. In specimens of cloacal swabs and faeces of the ducks chlamydiae could be found although the animals were asymptomatic. The results of this study demonstrate that in poultry plants, where ducks and other poultry living in an aqueous habitat are slaughtered and processed, a high risk of C. psittaci infection (70.2%) and ornithosis morbidity (25%) with a lethality of 8.3% can exist. Since the eradication of C. psittaci in poultry does not seem to be possible at the moment, preventive measures e.g. gloves, masks, information and medical examinations of the workers must be implemented in those slaughterhouses and plants where C. psittaci is suspected or common.

[Nosocomial ornithosis]. / Nosocomialis ornithosis.

Ornithosis is an occupational hazard to workers in the poultry industry, zoonosis. Own sporadic unusual case is appearing under the hospital circumstances as a nosocomial atypical pneumonia.

Detection of chlamydiosis in a shipment of pet birds, leading to recognition of an outbreak of clinically mild psittacosis in humans.

Avian chlamydiosis was detected in a shipment of > 700 pet birds from a Florida bird distributor that were sold to nine Atlanta-area pet stores in August 1995. Respiratory illness among persons who had recently acquired birds from this shipment was reported to local public health officials. The attack rate of acute respiratory illness was 10.7% among persons in households exposed to birds from the implicated flock vs. 1.8% among control households (odds ratio, 6.60; 95% confidence interval, 1.39-31.2). Illness and serological evidence of infection in the absence of symptoms were more common among persons in households with recently purchased birds that were sick or that had died and among persons who had had direct contact with the birds. Clinical psittacosis or serological evidence of Chlamydia psittaci infection was found in 30.7% of households with birds from the infected flock. Mild illnesses and asymptomatic infections in exposed persons were unusual features of this outbreak.

Chlamydia psittaci infection in sheep: a paradigm for human reproductive tract infection.

Chlamydiae are important reproductive tract pathogens in a wide variety of animals. In humans, chronic or repeated infection of the female genital tract with Chlamydia trachomatis has been identified as a significant factor in the development of occlusive infertility or increased risk of ectopic pregnancy. The spectrum of reproductive disease recognized in sheep to be caused by Chlamydia psittaci has been primarily restricted to pregnant animals because the organism was clearly identified as a major cause of infectious abortion. However, following pregnancy failure, a chronic chlamydial infection can become established in the reproductive tracts of experimentally infected ewes. Persistent infection of the ewe's reproductive tract may eventually result in pathology, similar to that observed in women infected with C. trachomatis, thus decreasing the breeding life of affected ewes. Furthermore, ewes that experienced C. psittaci induced abortion provide a unique opportunity to study the host: parasite dynamic as it relates to persistent infection. This natural model of persistent infection may, in some ways, be superior to more contrived models in which the chlamydial isolate is not a normal reproductive pathogen of the study animal. Thus, the study of persistent chlamydial infection in sheep may be used for the benefit of both human and veterinary medicine.

Interferon-gamma mediates long-term persistent Chlamydia psittaci infection in vitro.

The long-term anti-chlamydial effects of recombinant ovine interferon gamma (rOvIFN-gamma) were studied in ovine ST-6 fibroblasts infected with the S26/3 strain of Chlamydia psittaci. Chlamydial multiplication was assessed by enzyme-linked immunosorbent assay analysis of supernate lipopolysaccharide, titration of inclusion-forming units in culture supernates, and enumeration of inclusion bodies in cultured cells at 7-day intervals. Concentrations of 250 and 1000 U/ml of rOvIFN-gamma resulted in a microbistatic inhibition of C. psittaci growth, which appeared to become microbicidal when rOvIFN-gamma was maintained in the cultures for 14 days or more. There were no signs of C. psittaci multiplication when cultures were maintained in 25 or 100 U/ml of rOvIFN-gamma. However, subsequent removal of rOvIFN-gamma from these cultures resulted in a re-emergence of viable, infectious chlamydiae, which eventually killed all the fibroblasts. This re-emergence was more rapid in cultures initially treated with 25 U/ml of rOvIFN-gamma than in those treated with 100 U/ml.

Studies on the early phase of the pathogenesis of ovine enzootic abortion in the non-pregnant ewe.

The initial phase of infection of non-pregnant sheep by Chlamydia psittaci (ovis) was studied by inoculating naïve and previously exposed sheep by the oro-nasal and subcutaneous routes with the BS isolate of C. psittaci (ovis). Naive animals exhibited a marginal rise in temperature and seroconversion was detected by enzyme-linked immunosorbent assay (ELISA) as early as 9 days after inoculation. Chlamydaemia was detected using culture and an antigen detection ELISA. No faecal shedding of chlamydiae was detected in ewes kept up to 3 weeks after infection. Although chlamydial antigen was demonstrated in epithelial cells or lymphocytes in lungs, liver, spleen, kidney, abomasum, jejunum, tonsils and suprapharyngeal, mandibular, parotid and mesenteric lymph nodes of some of the naïve sheep using an ELISA and streptavidin-biotin and immunofluorescent staining techniques, the organism could not be cultured from these tissues. No chlamydial antigen was demonstrated in any of the tissues of the previously exposed sheep nor in uninoculated controls. It is concluded that previously infected sheep are capable of completely eliminating subsequent infection and that chlamydiae localize in a variety of tissues of infected naïve sheep, especially within epithelial cells and lymphocytes.

Probable transmission of Chlamydia psittaci from a macaw to a cat.

A 5-year-old Siamese cat developed unilateral mucopurulent ocular discharge and conjunctivitis 1 month after the introduction of a macaw into the household. Despite treatment with antimicrobial ophthalmic ointment, the conjunctivitis became bilateral and other systemic signs developed. Intracellular inclusions consistent with a Chlamydia psittaci infection were detected in conjunctival epithelial cells stained with a fluorescein-labeled monoclonal antibody. Chlamydia psittaci was isolated from samples obtained by conjunctival scraping. Subsequently, C psittaci was recovered in samples obtained from the feces of the bird. The cat and the bird were successfully treated with doxycycline. Historic and epidemiologic findings supported the theory of orthozoonotic transmission of C psittaci from the bird to the cat.

[Bilateral pneumonia caused by Chlamydia psittaci. Description of a clinical case]. / Polmonite bilaterale da Chlamydia psittaci. Descrizione di un caso clinico.

A mortal case of atypical pneumonia due to Chlamydia psittaci with acute respiratory distress, septic shock and multiple organ failure is described. Infection has been caused by an ill parrot imported clandestinely. Antibody titration with the immunofluorescence technique allowed diagnosis.

[Pigeon coryza--ornithosis--pigeon breeder's lung]. / Taubenschnupfen--Ornithose--Taubenzüchterlunge.

The published informations on the entities pigeon coryza and ornithosis are reviewed. On the basis of own experiences and experimental data obtained in the Landesveterinäruntersuchungsamt Koblenz, pigeon coryza apparently is a symptom rather than a clearly defined disease. Finally pigeon breeder's lung is discussed in front of the background of own observations and recommendations to be of allergic origin.

Immunity to Chlamydia psittaci with particular reference to sheep.

Chlamydia psittaci, a zoonotic bacterium, is the causal agent of enzootic abortion of ewes, an important disease of sheep in many European countries. The major thrust of current chlamydial research is directed towards the human pathogen Chlamydia trachomatis. This review attempts to bring together relevant information concerning the host immune response to all members of the genus Chlamydiae and show how this has led to an increased understanding of the ovine humoral and cell mediated immune responses to C. psittaci while emphasising areas where there is still a lack of knowledge. Specifically the review looks at the common immuno-accessible antigens of the Chlamydiae and the antibody responses produced during infection, as well as covering the role of T cells and cytokines in the protective immune response.