鹦鹉热衣原体肺炎患者临床特点分析

Clinical features of patients with Chlamydia psittaci pneumonia

摘要:

目的 探讨分析鹦鹉热衣原体肺炎患者的临床表现及辅助检查结果特征，以提高对该病的认识。 方法 回顾性分析某医院2019年6月- 2021年8月经宏基因组二代测序（mNGS）诊断鹦鹉热衣原体肺炎的9例患者临床资料。 结果 9例患者中男性7例，女性2例，包含1例妊娠36⁺²周孕妇；年龄25~70岁，中位年龄63岁；临床主要表现为高热（9例）、咳嗽（9例）、咳痰（7例）。白细胞计数正常8例，淋巴细胞计数降低9例，CRP升高9例，ESR升高9例，PCT正常4例，门冬氨酸氨基转移酶和丙氨酸氨基转移酶升高6例。9例患者胸部CT均表现为斑片或斑片实变影。经血及肺泡灌洗液mNGS确诊后使用多西环素、莫西沙星、左氧氟沙星、阿奇霉素单药治疗方案，疗程14~21 d，均好转出院。 结论 鹦鹉热衣原体肺炎临床表现多样、诊断困难，mNGS检测可以快速明确病原学诊断，有助于及时启动特异性抗感染治疗，可减少抗菌药物的使用，改善预后。

Abstract:

Objective To explore and analyze features of clinical manifestations and auxiliary examination results of patients with Chlamydia psittaci (C. psittaci) pneumonia, and improve the understanding of the disease. Methods Clinical data of 9 patients with C. psittaci pneumonia diagnosed by metagenomic next-generation sequencing (mNGS) in a hospital from June 2019 to August 2021 were retrospectively analyzed. Results Among 9 patients, 7 were males and 2 were females, including a pregnant woman who was 36⁺² weeks pregnancy; patients were aged 25-70 years, with a median age of 63 years; the main clinical manifestations were high fever (n=9), cough (n=9) and expectoration (n=7). Eight patients' leukocyte count was normal, 9 patients' lymphocyte count decreased, 9 patients' C-reactive protein (CRP) increased, 9 patients' erythrocyte sedimentation rate (ESR) increased, 4 patients' procalcitonin (PCT) was normal, 6 patients' aspartate aminotransferase (AST) and alanine aminotransferase (ALT) increased. Chest CT of all patients showed patchy or patchy consolidation. After confirmed by mNGS of blood and bronchoalveolar lavage fluid, monotherapy of doxycycline, moxifloxacin, levofloxacin, and azithromycin were administered for 14-21 days, all patients were cured and discharged from hospital. Conclusion C. psittaci pneumonia has a variety of clinical manifestations and is difficult to be diagnosed, mNGS test can quickly identify the etiology, facilitate the timely initiation of specific anti-infective therapy, reduce antimicrobial use, and improve the prognosis.