seen from United States
seen from China
seen from China
seen from Israel
seen from Israel
seen from China
seen from Italy
seen from United States
seen from United Kingdom
seen from Latvia
seen from China
seen from United States
seen from Singapore
seen from Latvia
seen from Australia
seen from United States
seen from United States
seen from Lithuania
seen from Russia
seen from Mexico
The Science Research Manuscripts of S. Sunkavally, p 548.
Tacos in love
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
"No Parrott (sic) Fever Here"
"Posed for 'Broadway and Hollywood Movies' by Dorothy Mackail (sic), First National Pictures star"
Broadway and Hollywood "Movies" May-Dec 1930
Mackaill's contract with First National would be dropped the following year, her brave dalliance with the parrot notwithstanding. The caption is explained by the following, via the NIH:
"Disease caused by [Chlamydia psittaci, the psittacosis] pathogen was first brought to widespread public attention in the period 1929–30 when the burgeoning global trade in parrots, prized for their colourful plumage for the garment and hat industry and as household pets, was found to cause what is now known as the ‘Great Parrot Fever Pandemic’."
In February 2024, five countries in the WHO European region (Austria, Denmark, Germany, Sweden and The Netherlands) reported an unusual incr
Human infections of the respiratory disease are occurring through exposure to infected birds.
What Is Parrot Fever, The Disease That Has Killed Five People In Europe?
by @GrrlScientist
Severe 'Parrot Fever' Outbreak Claims Lives Across Europe
The World Health Organization (WHO) has raised alarms about a significant outbreak of psittacosis, commonly known as parrot fever, affecting multiple individuals in various European countries. The outbreak, first identified in 2023, has persisted into the current year, resulting in the reported deaths of five individuals, as reported by CNN.
Parrot fever, caused by Chlamydia-family bacteria, is transmitted through contact with both wild and domesticated birds and poultry. Even if infected birds display no symptoms, they can still transmit the bacteria through breathing or excretion.
The US Centers for Disease Control and Prevention (CDC) notes that humans often contract parrot fever by inhaling dust particles contaminated with secretions from infected birds. Additionally, the disease can be transmitted if a person is bitten by a bird or has direct contact between a bird’s beak and their mouth. However, the infection does not spread through the consumption of infected animals.
While rare, human-to-human transmission is possible, as indicated by studies. In most recent cases, individuals had been exposed to infected domesticated or wild birds, according to the World Health Organization.
Typically, individuals who contract parrot fever experience mild symptoms, manifesting five to 14 days after exposure to an infected bird. These symptoms may include headache, muscle pain, dry cough, fever, and chills. Antibiotics are effective in treating the infection, and fatalities among humans are uncommon.
Austria, which typically records two cases of the disease annually, reported 14 confirmed cases in 2023 and an additional four cases in 2024 as of March 4. These cases are unrelated, with no reported travel abroad or encounters with wild birds.
Denmark, usually witnessing 15 to 30 human cases each year, has confirmed 23 cases in this outbreak as of February 27. Public health officials suspect the actual number of cases is higher. Among the Danish cases, 17 individuals have been hospitalized, with 15 diagnosed with pneumonia, resulting in four fatalities.
In Denmark, exposure information indicates that one person contracted parrot fever from a pet bird, while 12 individuals reported contact with wild birds, mainly through bird feeders. Interestingly, three cases had no documented history of contact with any type of birds.
Germany reported 14 confirmed cases of parrot fever in 2023, with an additional five cases in 2024. Nearly all affected individuals experienced pneumonia, and 16 required hospitalization. Five cases in Germany disclosed exposure to ill pet birds or chickens.
Since 2017, Sweden has seen an increase in parrot fever cases, recording 26 cases in late November and early December. However, this year has seen a decrease, with only 13 reported cases. Similarly, the Netherlands reported 21 cases from late December to February 29, double the usual number recorded during the same period in previous years.
The WHO has pledged to monitor the ongoing outbreak closely.
“Montreal Has Three Parrot Fever Cases,” Toronto Star. June 27, 1941. Page 33. ---- Three cases of psittacosis, or parrot fever, in Montreal have been definitely diagnosed by the Ontario department of health special laboratory from specimen of blood sent from Montreal. This was announced today by Dr. B. T. McGhie deputy minister of health.
Dr. McGhie said two more aviaries have voluntarily destroyed all their birds in the interest of the general public. They found some of their birds were infected. This makes five aviaries that have destroyed their birds.
No new cases have occurred in Toronto for several weeks, although a case diagnosed clinically, sent to the Isolation hospital, was scientifically diagnosed as parrot fever a few days ago by blood tests.
