一起家庭聚集性鹦鹉热衣原体肺炎的临床特征分析及诊治  

Clinical features,diagnosis and treatment of a family cluster of Chlamydia psittaci pneumonia

作　　者：谢晓燕 郭玮 曹晶 宋轩 李双双 张兵华 Xie Xiaoyan;Guo Wei;Cao Jing;Song Xuan;Li Shuangshuang;Zhang Binghua(Department of Pulmonary and Critical Care Medicine,the 986th Hospital of Air Force,XVan 710054,China)

机构地区：[1]空军第九八六医院呼吸与危重症医学科,西安710054

出　　处：《国际呼吸杂志》2022年第14期1074-1079,共6页International Journal of Respiration

摘　　要：目的探讨5例家庭聚集性鹦鹉热衣原体肺炎患者的临床特征及诊治,提高对该病的认识。方法收集2021年11月空军第九八六医院集中收治的5例家庭聚集性发病的鹦鹉热衣原体肺炎患者的资料,对其临床特征、实验室检查、影像及治疗用药进行分析。结果5例患者中,男2例,女3例,年龄20~72岁,所有患者均有鹦鹉/鹦鹉粪便接触史。临床表现主要为高热(5例,100%)、咳嗽(5例,100%)、乏力(5例,100%)。实验室检查中白细胞计数正常(4例,80%),淋巴细胞计数降低(4例,80%),C反应蛋白升高(5例,100%),红细胞沉降率升高(5例,100%),肝酶升高(2例,40%),呼吸性碱中毒(5例,100%),PaO2降低(3例,60%)。5例患者均表现为实变影,以外周为主。1例经宏基因二代测序检测出鹦鹉热衣原体核酸序列;2例行反转录-聚合酶链反应检测为阳性;5例鹦鹉热衣原体血清IgM抗体阳性。5例分别经莫西沙星、阿奇霉素治疗14~21 d后,临床完全治愈。结论面对不明原因的聚集病例,应详细询问接触史,宏基因二代测序技术有利于早期确诊病原体,并精准治疗。除外四环素类,大环内酯类、喹诺酮类抗生素在鹦鹉热衣原体肺炎的治疗中表现出较好的疗效。Objective To explore the clinical manifestations,diagnosis,and treatment of five patients in a family cluster of Chlamydia psittaci pneumonia,so as to improve the understanding and clinical treatment of the disease.Methods We collected the clinical data of five patients with Chlamydia psittaci pneumonia in November 2021 in the 986th Air Force Hospital,including clinical features,chest CT scan,and antibiotic use.Results Two males and three females,aged from 20 to 72 years,were included in this study.All patients had a confirmed history of exposure to parrot.All the patients had high fever,cough,and fatigue.Laboratory data showed that white blood cells were mostly normal(four cases,80%).However,we observed decreased lymphocyte count(four cases,80%),increased liver enzyme(two cases,40%),anoxia(three cases,60%),and elevated C-reactive protein,increased erythrocyte sedimentation rate,and respiratory alkalosis in all patients.The chest CT of all patients showed high-density consolidation,mainly in peripheral regions.Chlamydia psittaci nucleic acid was detected in one patient's specimen with metagenomics next-generation sequencing(mNGS).Two patients/reverse transcription-polymerase chain reaction test was positive.Five patients underwent serum antibody test for Chlamydia psittaci,all of which were positive.Moxifloxacin or azithromycin was administered,and the treatment lasted from 14 to 21 days.All patients were cured.Conclusions Patients should be inquired about their contact history in detail when encountering an unexpected clustered outbreak of pneumonia.The mNGS is efficient in identifying the pathogenic bacteria,which contributes to a precise treatment.Besides tetracyclin,azithromycin and quinolones have also shown a good therapeutic effect in the treatment of Chlamydia psittaci pneumonia.

关 键 词：肺炎 鹦鹉衣原体 家庭聚集 临床特征 

分 类 号：R563.1[医药卫生—呼吸系统]