#chlamydia psittaci

[flyonthewallmedstudent]

Psittacosis

Let's open with a case report, like we're on an episode of house.

Case Report

35 yo otherwise well, suddenly presents with 2/52 of high fevers and a headache (usually this means > 39)

a/w chills and rigours, responsive to medication/presumably panadol and intermittent (would resolve then come back)

no respiratory symptoms

She had neutrophilia and intrestingly, a CRP of merely 30.

CXR revealed nonspecific consolidation in 2 lobes, they followed this up with a CT revealing pretty impressive ground glass opacities (or GGOs)

She was empirically treated on IV tazocin only (I'm used to atypical coverage empirically started if there's even a whiff of resp, which she may not have had symptoms but her CXR confirms this)

eventually she was on referred to the authors, who felt her CT findings with consistent with psittacosis and treated her with doxycycline which resolved her symptoms in 48 hrs

on further history, it was revealed that she had parrots at home, one had died 2 days preceding her symptoms and she was sleeping next to its body at night (crazy)

What is it:

psittacosis is a zoonoses (transmitted by animals, animals = reservoirs), in this case, transmitted by birds. Orthinoses if birds in general, but psittacosis if referred to macaws, parrots etc. YOu can also catch it from chickens and turkeys.

Some what related is Bird fancier's lungs. Which just sounds fancy.. I'm sure it's just an old term.

Bird fancier's lung refers to a hypersensitivty pneumonitis (ILD) caused by bird exposure. DIfferent disease process, but birds is the come denominator. INhaled bird particles

Psittacosis specifically refers to the infective disease process caused by a bacteria. It was 'identified" or reported in the 1870s, when a cluster of 7 swiss patients developed the same symptoms and found to have possessed tropical birds.

Similarly, in the 1930s there was an outbreak in the US with a mortality of up to 20% (80% in pregnant women), also attributed to parrots from South America.

Eventually, with further scientific development, the causative pathogen was identified as chlamydia psittaci, an atypical intracellular organism.

Psittacosis is a significant differential to consider in community acquired pneumonia as it has a high mortality if left untreated. But it is rare, and causes about 1% of cases in the US. Part of this is due to improved hygiene practices and strict importation guidelines of tropical birds.

It's spread through the inhalation of dust with either dried faeces or respiratory secretions from infected birds.

Clinical features

Variable! but the key thing on history is birds

incubation time can be anywhere from 2 days to 20

Flu-like (fevers/chills/myalgias/arthralgias/malaise/headache)

high fevers is key

respiratory symptoms - does not always present as per the case report, and can be mild on spectrum (dry cough) to more severe

if systemic, can also get photophobia, deafness and epistaxis

Rare (particularly where doxycycline or azith are prescribed at a low threshold): hepatosplenomegaly (look out for LFTs), GI symptoms (remember CAP can present with diarrhoea, nausea/vomiting --> always do a CXR)

even rarer: endocarditis or myocarditis, encephalitis or hepatitis (usually the complications of untreated disease)

Increased risk groups:

pet shop owners

bird owners

farmers

zoo, lab workers where birds are kept, vets, avian quarantine station workers

poultry handlers/workers

So ask if they live or work with birds, or had recent exposure.

INvestigations

serology is gold standard - so looking for antibodies in blood tests

it's intracellular - so hard to culture if even possible on standard blood cultures

elevated ESR/CRP may see LFT derangement and creatinine rise in systemic illness

CXR- usually lower lobe changes, if CT is done, you can get pulmonary infiltrates with GGOs

Treatment:

usual culprits for atypical coverage: azithromycin 3 days or doxycycline 100 mg BD for 14/7

Differentials

always broad if systemic features only (also consider IE and other causes of sepsis)

with resp symptoms - legionella, Q fever, mycoplasma, tularaemia (except for tularaemia, the rest are also covered by doxycycline)

In clinical practice, I'm so used to just having atypicals on board for any cases of atypical pneumonia. I really take it for granted. But will consider this differential more myself in cases of PUO - but I feel like there should be at least CXR findings regardless.

Anyway, prognosis is very good so long as it is treated.

Sources:

CDC guidelines

Case Report: Importance of Clinical history in Psittacosis

StatPearls

Wiki

[thebesterblog]

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[flock-talk]

What's this I hear about birds carrying chlamydia? From the petco care sheet: "Because all canaries are potential carriers of infectiousdiseases, such as Chlamydiosis, always washyour hands before and after handling your canaryand/or habitat contents to help prevent the potentialspread of diseases." Is there any preventative measures to make sure the bird doesn't have it before purchase? Reputable breeder instead of petco?

The type of Chlamydia referred to here is Chlamydia Psittaci commonly referred to as Psittacosis and it is highly contagious between both avians and people.  There was a recent outbreak of Psittacosis in large chain pet stores which lead to the suffering and death of many pet birds, since most pet store birds come from horrific inbreeding associations and ‘bird mills’ their immune systems were not strong enough to take on the disease and their limited genetic variation made hem highly susceptible to it, which was the cause for many of their quick deaths.

All birds, regardless of where you get them, are at risk of Psittacosis since it is transmitted through the air, even the cleanest of places can be at risk.  But from a rescue or a reputable breeder does increase the odds of them being healthy, good breeders will have enough genetic variation in the birds to have the stronger to fight against diseases and most rescues will already have had the birds tested.

When choosing a bird you want to make sure it looks healthy, signs of sick bird include :

dull plumage

tattered plumage

puffed up

weezing, poor breathing

glazed eyes

nasal discharge

dirty vent

irregular droppings

lethargy

loss of appetite/ underweight (the keel bone should be easily touched but not protruding)

However, it is very easy for a bird to hide Psittacosis for a few days before showing symptoms, at any point that bird could transmit the disease.  The only way to be certain your bird does not have Psittacosis is to take them to the vet for a checkup within the first week of bringing them home and keeping them in QT until the vet has given you the OK.  They will run bloodwork, possibly feather samples, and gram staining to check for most general illness your bird might have.

Once the results are back your vet can then tell you your bird is healthy and can join the rest of your flock or the vet will start up a treatment plan with you.

Until you have a clean bill of health the new bird must remain away from the rest of the flock, you have to wash your hands frequently before and after touching the new bird and it’s generally a good idea to keep them in a different room, if not a different floor to prevent the spread of disease.

If you have birds or brought a new one home and begin feeling ill it’s in your best interest to take yourself to the hospital and tell the doctor that you have a bird so they can test for Psittacosis.

Psittacosis is curable if caught early on with various medications (typically tetracycline derivatives) but can be a really viscous disease for your bird to handle during the curing process and they may require QT in the vets rather than at home treatments in order to have a stable environment during recovery.