9例重症鹦鹉热衣原体肺炎的临床特点及诊治分析

目的 探讨重症鹦鹉热衣原体肺炎患者的临床特点及宏基因二代测序(mNGS)在其病原学诊断中的应用。 方法 收集2019年11月-2021年2月住院的重症鹦鹉热衣原体肺炎患者9例,男性5例,女性4例,年龄中位数67岁。回顾性分析患者的病历资料,描述其临床表现、实验室检查、影像学特点、mNGS病原学结果及治疗过程。 结果 9例中,4例发病前接触过鸟类或禽类。临床表现主要为高热、咳嗽、呼吸困难、乏力、肌肉酸痛;白细胞计数正常或轻度升高,中性粒细胞比例和降钙素原明显升高,部分患者出现肝、肾功能异常;胸部CT检查主要表现为单侧或双侧肺叶斑片状实变影。所有患者均进行mNGS检测,均检出鹦鹉热衣原体核酸序列,予多西环素单药或联用莫西沙星为基础的治疗,均痊愈。 结论 鹦鹉热衣原体肺炎发病率低,但病情危重,对疑似病例应尽早完善mNGS检测,及时启动以四环素类药物为基础的治疗方案。

Analysis of clinical characteristics, diagnosis and treatment of 9 cases severe pneumonia infected by Chlamydia psittaci

Objective To explore the clinical characteristics of patients with severe pneumonia infected by Chlamydia psittaci and the application of metagenomic next-generation sequencing(mNGS) in pathogenic diagnosis. Methods 9 patients with severe Chlamydia psittaci pneumonia hospitalized in Fujian Provincial Hospital from November 2019 to February 2021 were enrolled, including 5 males, 4 females, with a median age of 67 years. Their medical records were retrospectively analyzed, and their clinical manifestations, laboratory tests, imaging characteristics, mNGS etiology results and treatment process were described. Results Among 9 patients, four had contacted with birds or poultry before the onset of disease. Clinical manifestations were mainly high fever, cough, dyspnea, fatigue and myalgia. The white blood cell count of patients were normal or slightly increased, while the neutrophil proportion and procalcitonin were significantly increased. Some patients had abnormal hepatic functions and renal functions. The main feature of chest CT scan was pathy consolidation of unilateral or bilateral lobes. All patients were tested for mNGS, and the nucleic acid sequence of Chlamydia psittaci were detected. Treatments based on doxycycline monotherapy or doxycycline plus moxifloxacin were initiated, and all patients recovered. Conclusion Chlamydia psittaci pneumonia has a low incidence and is critically ill. mNGS testing should be conducted for suspected cases as soon as possible, and tetracycline-based treatment programs should be initiated in time.