43例鹦鹉热衣原体肺炎临床特征

Clinical characteristics of 43 cases of Chlamydia psittaci pneumonia

摘要:

目的 探讨鹦鹉热衣原体肺炎的临床特征及治疗方案。 方法 回顾性分析某院2018年3月—2022年3月经宏基因组二代测序(mNGS)确诊的43例鹦鹉热衣原体肺炎患者的临床资料。 结果 43例患者平均年龄为55.80岁，男性23例，女性20例；有明确禽类接触史的18例，发病多见于冬春季。临床表现以发热最常见，可伴有咳嗽、肌肉酸痛、畏寒等症状。28例(65.12%)患者血常规白细胞计数(WBC)正常，21例中性粒细胞计数(N)升高，32例淋巴细胞计数(L)降低；43例患者C反应蛋白(CRP)升高；26例丙氨酸转氨酶(ALT)升高，32例天冬氨酸转氨酶(AST)升高，33例乳酸脱氢酶(LDH)升高。15例患者存在呼吸衰竭，9例患者进展为重症肺炎。胸部高分辨率计算机体层成像(HRCT)主要表现为单侧肺下叶实变影，右肺多见，13例患者合并胸腔积液。气管镜下主要表现为肺泡炎，分泌物少。43例患者mNGS检测出鹦鹉热衣原体序列数范围为1~21 269。40例患者接受了含有喹诺酮类抗菌药物的治疗方案，病原体明确后调整为多西环素、米诺环素及替加环素。43例患者住院时间中位数为13.00 d，均好转出院, 无死亡病例。 结论 鹦鹉热衣原体肺炎患者多以高热起病，累及肺部，有禽类接触史，mNGS检查能够快速准确地检出病原体，治疗首选多西环素，喹诺酮类抗菌药物治疗亦有效，部分患者进展为重症病例，但总体预后良好。

Abstract:

Objective To evaluate the clinical characteristics and treatment of Chlamydia psittaci (C. psittaci) pneumonia. Methods Clinical data of 43 patients with C. psittaci pneumonia confirmed by metagenomic next-genera- tion sequencing (mNGS) in a hospital from March 2018 to March 2022 were retrospectively analyzed. Results The mean age of the 43 patients was 55.80 years, with 23 males and 20 females. 18 patients had a clear history of contacting with birds or poultry. The onset months were mostly winter and spring. The most common clinical manifesta- tion was fever, which can be accompanied by symptoms such as cough, muscle soreness, and chills. Blood routine test showed that 28 (65.12%) patients had normal white blood cell count, 21 had an increase in neutrophil count, and 32 had a decrease in lymphocyte count. 43 patients had elevated C-reactive protein level, 26 had elevated alanine transaminase, 32 had elevated aspartate aminotransferase, and 33 had elevated lactate dehydrogenase. 15 patients had respiratory failure, 9 patients progressed to severe pneumonia. Chest high-resolution computed tomography (HRCT) showed consolidation in the unilateral lower lobe of the lung, more in the right lung, and 13 patients complicated with pleural effusion. The main manifestation under bronchoscope was alveolitis with little secretion. In 43 patients, mNGS detected C. psittaci sequence numbers ranging from 1 to 21 269. Quinolone treatment was applied to 40 patients, which was adjusted to doxycycline, minocycline and tigecycline after the pathogen was identified. The median hospitalization time of 43 patients was 13.00 days. All patients showed improvement and were discharged, without reported cases of mortality. Conclusion Most patients with C. psittaci pneumonia are characte-rized by an onset with high fever, lung involvement, and a history of poultry exposure. mNGS enables rapid and accurate pathogen detection. Doxycycline is the preferred choice for treatment, and quinolones are also effective. Some patients can progress to severe cases, but the overall prognosis is good.