重症社区获得性鹦鹉热肺炎的临床分析  

Clinical analysis of severe community-acquired Chlamydia psittaci pneumonia

作　　者：姚秀娟[1] 卢锋峰[1] 岳文香[1] 谢宝松[1] 陈愉生[1] YAO Xiujuan;LU Fengfeng;YUE Wenxiang;XIE Baosong;CHEN Yusheng(Fujian Provincial Hospital,Fujian Medical University Provincial Clinical Medical College,Fuzhou,Fujian 350001,P.R.China)

机构地区：[1]福建医科大学省立临床医学院福建省立医院,福建福州350001

出　　处：《中国呼吸与危重监护杂志》2022年第1期2-6,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家科技重大专项(2017 ZX10103004)。

摘　　要：目的探讨重症鹦鹉热肺炎的临床特征、影像特点、诊断和治疗方法,以助早期诊断及早期治疗,降低病死率。方法回顾性分析福建省立医院2019年10月—2020年7月确诊的7例重症鹦鹉热肺炎患者的临床资料。结果7例中,男5例,女2例,年龄为59~69岁。主要临床表现为发热、咳嗽、咳痰、呼吸困难,部分出现消化系统和神经系统症状。7例患者白细胞总数正常或稍增高,淋巴细胞绝对值下降,C反应蛋白明显增高,且均出现呼吸衰竭。胸部CT表现为大片状实变影伴有支气管充气征,短期内进展,继发少量胸腔积液。7例患者均通过宏基因组高通量测序检出鹦鹉热衣原体特异性DNA片段得以明确。6例接受多西环素治疗,1例阿奇霉素治疗,7例治疗后症状好转,影像学改善。结论对于中老年患者,急性起病,高热伴咳嗽、呼吸困难,胸部影像提示大片实变渗出影,经验性针对社区获得性肺炎抗生素无效时,尤其有家禽或鸟类接触史,需高度怀疑鹦鹉热肺炎,必要时通过呼吸道分泌物高通量测序检测明确,尽早给予四环素类抗生素治疗。Objective To investigate the clinical features,imaging features,diagnosis and treatment of severe Chlamydia psittaci pneumonia in order to facilitate early diagnosis and treatment and reduce the mortality rate.Methods The clinical data of 7 patients with severe Chlamydia psittaci pneumonia diagnosed in Fujian Provincial Hospital from October 2019 to July 2020 were retrospectively analyzed.Results Among the 7 cases,there were 5 males and 2 females,aged 59 to 69 years.The main clinical manifestations were fever,cough,sputum,dyspnea,and some symptoms of digestive and nervous systems.The total number of white blood cells was normal or slightly higher in7 patients,the absolute value of lymphocytes was decreased,C-reactive protein was significantly increased,and respiratory failure occurred in all 7 patients.Chest CT showed large patchy consolidation shadows accompanied by air bronchogram signs,which progressed in a short period,followed by a small amount of pleural effusion.The specific DNA fragments of Chlamydia psittaci were identified by metagenomic next-generation sequencing in all 7 patients.Six patients were treated with doxycycline,1 with azithromycin,and 7 relieved with improved symptoms and imaging.Conclusions For elderly patients with acute onset,high fever with cough,difficulty breathing,especially with a history of poultry or birds,whose chest images suggest large consolidation effusion shadows,empirical antibiotic for community-acquired pneumonia is invalid,psittacosis chlamydia pneumonia should be highly suspected.Therefore second-generation sequencing of respiratory secretions is necessary so as to determine the pathogens.Tetracycline class antibiotic treatment should be given as soon as possible after the diagnosis of psittacosis chlamydia pneumonia.

关 键 词：重症肺炎 鹦鹉热衣原体 诊断 治疗 

分 类 号：R518.1[医药卫生—内科学] R563.1[医药卫生—临床医学]