Psittacosis
Psittacosis: Excerpt from The 5-Minute Pediatric Consult
Nicholas Tsarouhas, MD
Psittacosis - BASICS
Psittacosis - description
- An acute febrile disease characterized by pneumonitis and other systemic symptoms. The name is derived from the Greek for parrot, psittakos.
- Also known as “ornithosis.”
Psittacosis - general prevention
- Epidemiologic investigation is indicated in all suspected cases.
- Birds suspected to be infected should be killed, transported, and analyzed by qualified experts.
- Potentially contaminated living areas where bird was kept should be disinfected and aired.
- Chlamydophila psittaci is susceptible to most household disinfectants (rubbing alcohol, Lysol, bleach).
Psittacosis - epidemiology
- Birds (e.g., pigeons, parrots, parakeets, turkeys, chickens, ducks) are the major reservoir.
- Infecting agent present in bird nasal secretions, urine, feces, feathers, viscera, and carcasses.
- Although inhalation is the most common route of infection, bird bites and mouth-to-beak contact also spread infection.
- Birds may be healthy or sick.
- Most reported cases (70%) are the result of exposure to pet caged birds (especially parrots, parakeets).
- Most common mammalian source of infection is sheep.
- Occupational hazard of workers in poultry plants, pet shops, zoos, farms
- Rarely transmitted person to person
Psittacosis - incidence
- Only 100–200 total cases reported in US each year
- Very rare disease in young children
Psittacosis - risk factors
Close human contact with birds, and in some cases, sheep
Psittacosis - pathophysiology
- Inhalation of aerosolized organisms into the respiratory tract
- Incubation period 5–21 days
- Spreads via bloodstream to lungs, liver, and spleen
- Lymphocytic inflammatory alveolar response
Psittacosis - etiology
- Infection produced by Chlamydophila psittaci, an obligate intracellular parasitic bacterium
- Antigenically and genetically different from Chlamydia species
Psittacosis - associated conditions
Pneumonitis (with a severe headache) is a common presentation.
Psittacosis - DIAGNOSIS
Psittacosis - signs & symptoms
- Abrupt onset of symptoms
- Fever, headache, cough, weakness, chills, muscle aches, and joint pain
- Nonproductive cough
- Vomiting, confusion, and photophobia are less common findings.
Psittacosis - history
Mandatory to question parents about exposure of the patient to any type of bird—wild or domestic
Psittacosis - physical exam
- Ill-appearance, tachypnea, rales, and splenomegaly are common.
- A related bradycardia is found in some cases.
- Rash, meningismus, pharyngeal injection, cervical adenopathy, hepatomegaly, and mental status changes are less common findings.
Psittacosis - tests
Psittacosis - lab
- Routine laboratory studies are rarely helpful.
- Complement fixation titers (see “FAQ”)
- Microimmunofluorescence studies and polymerase chain reaction assays are more specific than complement fixation studies.
- Isolation of the organism is diagnostic.
- Complement fixation titers do not, however, distinguish between chlamydial infections (C. trachomatis), and the various chlamydophilal infections (C. psittaci, C. pneumoniae, and C. pecorum.)
Psittacosis - imaging
Chest x-ray demonstrates diffuse interstitial infiltrates.
Psittacosis - differencial diagnosis
- Psittacosis should be considered in all fevers of unknown origin or atypical pneumonitis.
- Mycoplasma and Chlamydophila pneumoniae, Legionella spp., Coxiella burnetii (i.e., Q fever), tuberculosis, viral and fungal pneumonitis, as well as pneumococcal pneumonia
Psittacosis - TREATMENT
Psittacosis - medication
Psittacosis - first line
- Tetracycline (40 mg/kg/d) or doxycycline (100 mg b.i.d.) in children >8 years of age
- Erythromycin (40 mg/kg/d) in children <8 years of age
- Antibiotics should be continued for at least 10–14 days after defervescence.
Psittacosis - second line
Azithromycin, clarithromycin, and chloramphenicol are additional options.
Psittacosis - FOLLOW UP
Psittacosis - prognosis
- While complete recovery is the rule (even without antibiotic use), a case-fatility rate of 15–20% is reported.
- Resolution of fever and most other systemic symptoms can be expected within 48 hours of antibiotic therapy.
- Untreated patients may have severe pulmonary symptoms for 1–3 weeks.
Psittacosis - complications
- Hepatitis
- Anemia
- Thrombophlebitis
- Pulmonary embolus
- Arthritis
- Keratoconjunctivitis
- Endocarditis
- Myocarditis
- Pericarditis
- Encephalitis: Attendant agitation, delirium, confusion, stupor
Psittacosis - bibliography
American Academy of Pediatrics. Chlamydophila (formerly Chlamydia) psittaci. In Pickering LK, ed. 2006 Red Book: Report of the Committee on Infectious Diseases. 27th ed. Elk Grove Village, IL: American Academy of Pediatrics, 2006:251–252.
Butler JC, Whitney CG. Compendium of measures to control Chlamydia psittaci infection among humans (psittacosis) and pet birds (avian chlamydiosis), 1998. MMWR Morb Mortal Wkly Rep. 1998;47(RR-10):1–14.
Cotton MM, Partridge MR. Infection with feline Chlamydia psittaci. Thorax. 1998;53:75–76.
Cunha BA. The atypical pneumonias: Clinical diagnosis and importance. Clinical Microbiology & Infection. 2006;12(Suppl 3):12–24.
Gregory DW, Schaffner W. Psittacosis. Semin Respir Infect. 1997;12:7–11.
Scully RE. Weekly clinicopathological exercises: Psittacosis causing acute respiratory distress syndrome. N Engl J Med. 1998;338:1527–1535.
Telfer BL, Moberley SA, Hort KP, et al. Probable psittacosis outbreak linked to wild birds. Emerg Infect Dis. 2005;11(3):391–397.
Psittacosis - CODES
Psittacosis - icd9
073.9 Psittacosis
Psittacosis - FAQ
- Q: In children with pneumonia who have a pet bird, how is the diagnosis confirmed?
- A: A 4-fold rise in antibody titers by complement fixation or microimmunofluorescence (acute and convalescent specimens; 2–3 weeks apart); a single titer of 1:32 or higher (highly suggestive); culture (done through the US Centers for Disease Control and Prevention or other national or governmental equivalent)
- Q: Does the source bird usually exhibit signs of disease?
- A: No. The bird is often asymptomatic; it may, however, show some signs of illness (e.g., anorexia, ruffled feathers, depression, or watery green dropping.)
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Book Source Details
- Book Title: The 5-Minute Pediatric Consult
- Author(s): M. William Schwartz MD; et al.
- Year of Publication: 2008
- Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: The 5-Minute Pediatric Consult
Authors: M. William Schwartz MD; et al.
Publisher: Lippincott Williams & Wilkins
Copyright: 2008
ISBN: 0-7817-7577-9
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