以持续高热为主要临床表现的鹦鹉热衣原体肺炎延误诊治分析及文献复习  

Delayed Diagnosis and Treatment of Chlamydia Psittaci Pneumonia with Persistent High Fever as the Main Clinical Manifestation and Literature Review

作　　者：贾卫红 杨雅菲 孟晔 郝娜娜 王丽娜[1] 卜丽娜 刘志燕 唐晶晶 JIA Weihong;YANG Yafei;MENG Ye;HAO Nana;WANG Lina;BU Lina;LIU Zhiyan;TANG Jingjing(Department of Respiratory and Critical Care Medicine,Xi'an No.3 Hospital the Affiliated Hospital of Northwest University,Xi'an 710083,China)

机构地区：[1]西北大学附属医院、西安市第三医院呼吸与危重症医学科,西安710083

出　　处：《临床误诊误治》2025年第1期7-11,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨鹦鹉热衣原体肺炎的临床特点及延误诊治原因。方法分析2022年1月至2023年12月收治的6例以持续高热为主要临床表现鹦鹉热衣原体肺炎患者的临床资料,总结病例特点、诊疗过程、误诊原因及防范措施。结果6例均急性起病,主要表现为持续高热,体温最高42.0℃,有鸟类及家禽接触史3例,其余否认鸟类及家禽接触史。乏力、呼吸困难各5例,食欲减退、头晕各3例,咳嗽咳痰、恶心呕吐、头痛各2例,胸痛、咽干、多汗、腹泻、痰中带血各1例。4例中性粒细胞百分比升高,2例降钙素原升高,2例丙氨酸转氨酶升高,2例肌酸激酶升高。6例影像学检查均有肺实变,表现为片状模糊渗出影,部分边缘不清,内可见支气管充气征。6例均被误诊为普通社区获得性肺炎。误诊时间5~9 d。6例均通过支气管肺泡灌洗液宏基因组二代测序确诊为鹦鹉热衣原体肺炎,予以针对性抗感染治疗后病情好转出院。无死亡病例。结论对于急性起病,高热伴咳嗽、呼吸困难,影像学提示大片状实变渗出影,经过经验性抗感染治疗无效患者,尤其有家禽或鸟类接触史者,需高度怀疑鹦鹉热衣原体肺炎,必要时行支气管肺泡灌洗液宏基因组二代测序,以早期确诊,减少误诊误治,尽早给予针对性治疗,能避免疾病向危重症发展。Objective To investigate the clinical characteristics of chlamydia psittaci pneumonia and the causes of delayed diagnosis and treatment.Methods The clinical data of 6 patients developing chlamydia psittaci pneumonia with persistent high fever as the main clinical manifestation from January 2022 to December 2023 were analyzed,and the case characteristics,diagnosis and treatment process,causes of misdiagnosis and preventive measures were summarized.Results All the 6 patients had acute onset,mainly manifested as persistent high fever with a maximum body temperature of 42.0℃,including 3 patients who had contact history with birds and poultry,and the remaining patients denied contact history with birds and poultry.There was fatigue and dyspnea in 5 patients,anorexia in 3 patients,dizziness in 3 patients,cough and sputum in 2 patients,nausea and vomiting in 2 patients,headache in 2 patients,and chest pain,dry throat,hyperhidrosis,diarrhea,blood in sputum in 1 patient,respectively.The percentage of neutrophils increased in 4 patients,procalcitonin increased in 2 patients,alanine aminotransferase increased in 2 patients,and creatine kinase increased in 2 patients.All the 6 patients had lung consolidation by imaging examination,which was manifested as unclear flaky exudation shadow,partly unclear edge,and visible air bronchial sign.All 6 patients were misdiagnosed as common community-acquired pneumonia.The misdiagnosis lasted 5-9 d.All the 6 patients were diagnosed with chlamydia psittaci pneumonia by bronchoalveolar lavage fluid metagenomic next-generation sequencing.After receiving targeted anti-infection treatment,their condition improved and they were discharged from hospital.No death was reported.Conclusion For patients with acute onset,high fever accompanied by cough and dyspnea,and large and unclear flaky exudation shadow on imaging,who have failed to respond to empirical anti-infective treatment,especially those with a history of contact with poultry or birds,chlamydia psittaci pneumonia should be highly suspect

关 键 词：鹦鹉热衣原体 肺炎 高热 误诊 社区获得性肺炎 支气管镜 肺泡灌洗液 宏基因组二代测序 

分 类 号：R518.1[医药卫生—内科学]