| 王沣,郝泰然,杨德湘,等.鹦鹉热衣原体肺炎 7例[J].安徽医药,2023,27(8):1660-1664. |
| 鹦鹉热衣原体肺炎 7例 |
| Analysis of clinical features of 7 cases of chlamydia psittacosis pneumonia |
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| DOI：10.3969/j.issn.1009-6469.2023.08.037 |
| 中文关键词: 鹦鹉热衣原体 肺炎 鹦鹉热 宏基因组学二代测序技术 |
| 英文关键词: Chlamydia psittacosis Pneumonia Psittacosis mNGS |
| 基金项目: |
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| 摘要点击次数: 1570 |
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| 中文摘要: |
| 目的分析鹦鹉热衣原体肺炎病人的临床特征，提高临床医师对鹦鹉热衣原体肺炎诊断及治疗方法的认识。方法回顾分析 2021年 6月至 2022年 2月铜陵市人民医院收治的 7例鹦鹉热衣原体肺炎病人的病例资料，结合近 5年该病的相关文献对比研究。结果 7例病人均为散发病例， 6例在秋冬季节发病， 6例病人在发病前有明确鸟类或家禽接触史。入院时常见症状包括高热( 100%)、咳嗽( 42.9%)、胸闷( 14.3%)、纳差乏力( 57.1%)、肌肉酸痛( 14.3%)和腹泻( 28.6%)。 4例重症鹦鹉热衣原体肺炎病人均出现呼吸衰竭，其中 2例出现急性呼吸窘迫综合征( ARDS)。实验室检查数据显示白细胞正常或略有增加，巴细胞绝对值下降， C-反应蛋白( CRP)明显升高( 100%)降钙素原( PCT)波动较大。多伴有肝功能损害( 85.7%)肌酐( Cr)异淋(57.1%)乳酸脱氢酶( LDH)升高(100%)肌酸激酶( CK升高(57.1%)。多数病例合并低钾血症( 71.4%)、低钠(85.7%)高( 85.7%)。动脉血气分析多数病例存在氧分压( PO2)低( 66.7%)二氧化碳分压( PCO2)低( 83.3%)。入院病人就诊时胸部 CT均显示肺部实变和渗出影，病变多见于肺下叶( 85.7%)部分病及双肺( 57.1%)少数病例可见胸腔积宏基因组学二代测序技mNGS)检测出鹦鹉)，血症，和常D-二聚体升，提示，例累，液(28.6%)。5例病人行电子支气管镜检查镜下见支气管炎改变。所有病例经，术(热衣原体核酸序列确诊。 4例确诊后使用多西环素治疗， 2例使用莫西沙星， 4例使用阿奇霉素，其中有 2例非重症病人使用阿奇霉素单药治疗。所有病例中有 6例治愈出院，1例临床死亡。结论鹦鹉热衣原体肺炎病人发病前常有鸟类或家禽接触史，本地区以秋冬季节发病为主。临床表现和影像学表现不特异， mNGS是快速、精准的诊断方法。四环素类、大环内酯类抗菌素为基础的药物治疗鹦鹉热衣原体肺炎疗效肯定。 |
| 英文摘要: |
| Objective To analyze the clinical characteristics of patients with Chlamydia psittaci pneumonia, and to improve clinicians' awareness of the diagnosis and treatment of Chlamydia psittacosis pneumonia.Methods The case data of 7 patients with Chlamydia psittacosis pneumonia were retrospectively analyzed in the People's Hospital of Tongling from June 2021 to February 2022,combined with the related literatures of the disease in the past five years was compared for a comparative study.Results All 7 patientswere sporadic cases, 6 patients had onset in autumn and winter, and 6 patients had a clear history of contact with birds or poultry beforethe onset. Common symptoms on admission included high fever (100%), cough (42.9%), chest tightness (14.3%), anorexia (57.1%),muscle aches (14.3%), and diarrhea (28.6%). All 4 patients with severe Chlamydia psittaci pneumonia developed respiratory failure,and 2 of them developed acute respiratory distress syndrome (ARDS). Laboratory examination data showed that the white blood cellswere normal or slightly increased, the absolute value of lymphocytes decreased, the CRP was significantly increased (100%), and thePCT level fluctuated greatly. Most of the patients with Chlamydia psittaci pneumonia had liver function damage (85.7%), creatinine (Cr)abnormality (57.1%), elevated lactate dehydrogenase (LDH) (100%), and and creatine kinase (CK) (57.1%). Most patients with Chlamydia psittaci pneumonia were combined with hypokalemia (71.4%), hyponatremia (85.7%), and elevated D-dimer (85.7%). Arterial blood gas analysis showed that most cases had low partial pressure of oxygen (PO2) (66.7%) and low partial pressure of carbon dioxide (PCO2) (83.3%). Chest CT showed that pulmonary consolidation and exudation, the lesions were more common in the lower lobe of thelung (85.7%), and some patients had both lungs involved (57.1%) at the time of treatment, and few cases showed pleural effusion(28.6%). The changes under the electronic bronchoscopy in 5 patients suggested bronchitis. All patients were diagnosed by the nucleicacid sequence of Chlamydia psittaci detected by metagenomics next-generation sequencing (mNGS). After diagnosis, 4 patients weretreated with doxycycline, 2 patients were treated with moxifloxacin, and 4 patients were treated with azithromycin, of which 2 patientswere treated with azithromycin monotherapy. Among all patients, 6 cases were cured and discharged, and 1 case died clinically.Conclu sions Patients with Chlamydia psittaci pneumonia often have a history of contact with birds or poultry before the onset of disease, andthe disease is mainly in autumn and winter in this area. Clinical manifestations and imaging manifestations are not specific, and mNGSis a rapid and accurate diagnostic method. Tetracycline and macrolide antibiotics-based drugs in the treatment of Chlamydia psittacosis pneumonia are effective. |
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