Ornithosis

Ornithosis: Excerpt from Professional Guide to Diseases (Eighth Edition)

Ornithosis (also called psittacosis or parrot fever) is caused by the gram-negative intracellular parasite Chlamydia psittaci and is transmitted by infected birds. This disease occurs worldwide and is mainly associated with occupational exposure to birds (such as poultry farming). With adequate antimicrobial therapy, ornithosis is fatal in fewer than 4% of patients.

Causes and incidence

Psittacine birds (parrots, parakeets, and cockatoos), pigeons, and turkeys may harbor C. psittaci in their blood, feathers, tissues, nasal secretions, liver, spleen, and feces. Transmission to humans occurs primarily through inhalation of dust containing C. psittaci from bird droppings; less commonly, through direct contact with infected secretions or body tissues, as in laboratory personnel who work with birds. Person-to-person transmission seldom occurs but usually causes severe ornithosis.

Incidence is higher in women and in people ages 20 to 50.

Signs and symptoms

After an incubation period of 4 to 15 days, onset of symptoms may be insidious or sudden. Clinical effects include chills and a low-grade fever that increases to 103° to 105° F (39.4° to 40.6° C) for 7 to 10 days then, with treatment, declines during the second or third week. Other signs and symptoms include headache, myalgia, sore throat, cough (may be dry, hacking, and nonproductive or may produce blood-tinged sputum), abdominal distention and tenderness, nausea, vomiting, photophobia, decreased pulse rate, slightly increased respiratory rate, secondary purulent lung infection, and a faint macular rash. Severe infection also produces delirium, stupor and, in extensive pulmonary infiltration, cyanosis. Ornithosis may recur but is usually milder.

Diagnosis

Characteristic symptoms and a recent history of exposure to birds suggest ornithosis.

CONFIRMING DIAGNOSIS Firm diagnosis requires recovery of C. psittaci from mice, eggs, or tissue culture that has been inoculated with the patient's blood or sputum. Culture of C. psittaci can be dangerous for laboratory personnel, making serology the preferred method of confirming diagnosis.

Comparison of acute and convalescent serum shows a fourfold rise in Chlamydia antibody titers. In addition, a patchy lobar infiltrate appears on chest X-rays during the first week of illness.

Treatment

Ornithosis calls for treatment with tetracycline. If the infection is severe, tetracycline may be given via I.V. infusion until the fever subsides. Fever and other symptoms should begin to subside 48 to 72 hours after antibiotic treatment begins, but treatment must continue for 2 weeks after temperature returns to normal. Other antibiotics used to treat ornithosis include doxycycline, erythromycin, and azithromycin.

Special considerations

❑Monitor the patient's fluid and electrolyte balance. Give I.V. fluids as needed.

❑Carefully monitor the patient's vital signs. Watch for signs of overwhelming infection.

❑Reduce fever with tepid alcohol or sponge baths and a hypothermia blanket.

❑Observe standard precautions. Instruct the patient to use tissues when he coughs and to dispose of them in a closed plastic bag. Also instruct him to wash his hands afterward.

❑To prevent ornithosis, persons who raise birds for sale should feed them tetracycline-treated birdseed and follow regulations on bird importation. However, routine use of antibiotics in animal and bird feed may contribute to antimicrobial resistance. Infected or possibly infected birds should be segregated from healthy birds, and the structures that housed the infected ones should be disinfected.

❑Report all cases of ornithosis to public health authorities.

Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

More About Psittacosis

• Back to disease: Psittacosis: Introduction
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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