鹦鹉热衣原体肺炎10例临床特征分析及诊治  

Clinical characteristics and management of 10 cases of Chlamydia psittaci pneumonia

作　　者：郭玲玲[1] 刘娜 周洪[1] 李凡[1] 吴海凤 童波[1] GUO Lingling;LIU Na;ZHOU Hong;LI Fan;WU Haifeng;TONG Bo(Department of Respiratory and Critical Care Medicine,People’s Hospital of Jiangxi Province,Nanchang 330006,China)

机构地区：[1]江西省人民医院呼吸与危重医学科,南昌330006

出　　处：《中国感染与化疗杂志》2022年第5期551-555,共5页Chinese Journal of Infection and Chemotherapy

摘　　要：目的通过分析10例鹦鹉热衣原体肺炎临床特点,以提高临床医师对该病的诊治水平。方法收集2019年1月—2021年7月经肺泡灌洗液宏基因组二代测序(mNGS)确诊的鹦鹉热衣原体肺炎10例患者的临床资料,包括临床症状、体征、实验室检查、肺部影像学资料及治疗、转归情况,对其进行回顾性分析。结果10例患者中男7例、女3例,中位年龄69.5岁。临床主要表现:发热(9/10)、咳嗽(7/10)、咯痰(6/10)、呼吸困难(6/10)、神经系统症状(6/10)、全身酸痛无力(5/10);检验结果多表现为白细胞减少(4/10)或正常(5/10),低蛋白血症(10/10),乳酸脱氢酶升高(9/10);血气分析多表现为低氧血症(9/10);炎症指标多明显升高,C反应蛋白升高(10/10),降钙素原(PCT)升高(8/10);半数患者心电图表现为相对缓脉(5/10);肺部影像学多表现为单侧肺叶受累(8/10),均表现为渗出、实变(10/10)。治疗及预后:多数患者治疗效果良好,其中6例患者经莫西沙星治疗后治愈,2例患者多西环素治疗后治愈,2例重症患者先后给予莫西沙星联合多西环素、替加环素联合莫西沙星治疗,仍治疗失败死亡。结论鹦鹉热衣原体肺炎临床具有一定的特征性,影像学均表现为斑片渗出、实变。大多数患者经四环素类、喹诺酮类药物治疗后治愈。重症患者可合并感染性休克、呼吸衰竭、心肌损害而死亡。临床对于常规抗感染治疗效果不理想的肺部感染患者,行支气管肺泡灌洗液的mNGS检测可明确病原学,为临床治疗指明方向。Objective To summarize the clinical features of 10 cases of Chlamydia psittaci pneumonia for clinicians to better understand this disease and avoid misdiagnosis in clinical practice.Methods The diagnosis of Chlamydia psittaci pneumonia was confirmed in 10 patients by metagenomic next generation sequencing(mNGS)of alveolar lavage fluid from January 2019 to July 2021.The clinical features,laboratory test results,chest CT scan,antimicrobial treatment and outcomes were analyzed retrospectively.Results The 10 patients included 7 males and 3 females(median age of 69.5 years).The main clinical manifestations were fever(9/10),cough(7/10),expectoration(6/10),dyspnea(6/10),nervous system symptoms(6/10),and malaise(5/10).The white blood cell count did not elevate in general.Decreased albumin(10/10),elevated lactate dehydrogenase(9/10),hypoxemia(9/10),elevated serum C-reactive protein(10/10)and procalcitonin(8/10)levels were the prominent laboratory abnormalities.Relatively slow pulse rate was found in half of the patients(5/10).Chest CT scan showed exudation and consolidation in all patients(10/10).Six patients were cured after moxifloxacin treatment,and two patients cured by doxycycline therapy.The remaining two patients died due to severe Chlamydia psittaci pneumonia even after treatment with moxifloxacin plus doxycycline,and tigecycline plus moxifloxacin.Conclusions Chlamydia psittaci pneumonia has some clinical features,including high fever,dyspnea,malaise,and relatively slow pulse rate.The use of mNGS can improve the accuracy of diagnosis and reduce the misdiagnosis of Chlamydia psittaci pneumonia.Most patients can be cured by appropriate antimicrobial therapy.

关 键 词：鹦鹉热衣原体 肺炎 宏基因组二代测序 

分 类 号：R518.1[医药卫生—内科学]