8例鹦鹉热衣原体肺炎患者的临床特征分析及其诊治

Clinical features and treatment of 8 patients with Chlamydia psittaci pneumonia

摘要:

目的 分析鹦鹉热衣原体肺炎患者的临床特征和诊治方法，提高对该病的认识。 方法 回顾性分析某院2019年9月-2021年8月经宏基因组学二代测序技术（mNGS）诊断的鹦鹉热衣原体肺炎患者的临床资料，总结该病的临床特征及诊治要点。 结果 8例患者中男性7例，女性1例，年龄45~83岁。所有患者均以高热起病，可伴有咳嗽、乏力、全身肌肉酸痛等症状，其中6例有明确的禽类接触史。8例患者均出现C反应蛋白、乳酸脱氢酶升高，凝血功能异常；5例患者淋巴细胞计数下降；6例患者表现丙氨酸氨基转移酶、门冬氨酸氨基转移酶升高，血钠下降。胸部影像表现为单侧肺病变多见，主要发生在右肺（5例），双肺发生者较少（1例），5例患者表现为肺实变伴支气管充气征，出现肺实变、磨玻璃影、空洞形成各1例。7例患者支气管镜下主要表现为支气管黏膜充血水肿。8例患者经mNGS明确诊断为鹦鹉热衣原体肺炎，给予多西环素、阿奇霉素、莫西沙星治疗，均好转出院。 结论 鹦鹉热衣原体肺炎通常表现为高热伴肺部斑片实变影，对患者支气管肺泡灌洗液进行mNGS检测能快速准确诊断。早期给予多西环素、阿奇霉素或莫西沙星治疗效果明显。

Abstract:

Objective To analyze the clinical features, diagnosis and treatment methods of Chlamydia psittaci (C. psittaci) pneumonia, and improve the understanding of the disease. Methods Clinical data of patients with C. psittaci pneumonia diagnosed with metagenomic next-generation sequencing (mNGS) in a hospital from September 2019 to August 2021 were retrospectively analyzed, clinical features, diagnosis and treatment of the disease was summarized. Results Among 8 patients, 7 were males and 1 was female, aged 45-83 years. All patients started with high fever, accompanied by cough, fatigue, and general muscle pain, 6 of whom had a definite history of poultry contact. All patients had increased C-reactive protein (CRP) and lactate dehydrogenase (LDH) as well as abnormal coagulation function; 5 patients had decreased lymphocyte count; 6 patients had increased alanine aminotransferase and aspartate aminotransferase as well as decreased blood sodium. Chest imaging showed that manifestation of unilateral lung was more common, lesions mainly occurred in the right lung (n=5), less in both lungs (n=1). Five patients showed lung consolidation with bronchial inflation sign, 1 patient was with lung consolidation, ground-glass opacity and cavity formation respectively. Seven patients showed congestion and edema of bronchial mucosa under bronchoscopy. Eight patients were clearly diagnosed as C. psittaci pneumonia by mNGS, and were treated with doxycycline, azithromycin and moxifloxacin, all patients were cured and discharged from hospital. Conclusion C. psittaci pneumonia is usually characterized by high fever with pulmonary consolidation patches, application of mNGS detection of bronchoalveolar lavage fluid of patient can quickly and accurately diagnose C. psittaci pneumonia. Early treatment with doxycycline, azithromycin or moxifloxacin is effective in C. psittaci pneumonia.