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鹦鹉热衣原体肺炎病例报告2例及文献复习

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本文报道2例患者均有鸽子接触史,表现为发热、乏力、呼吸困难,1例患者病情进展较快,于发病第4天出现急性呼吸窘迫综合征,需无创呼吸机辅助通气。2例患者白细胞计数轻度升高,淋巴细胞百分比降低,血小板计数正常,降钙素原升高,C反应蛋白明显升高,丙氨酸氨基转移酶及天门冬氨酸氨基转移酶不同程度升高,血清钠、钾、白蛋白降低,1例红细胞沉降率(ESR)正常,1例轻度升高,血、肺泡灌洗液常规培养及血清学检查未能明确病原体。胸部X射线、计算机断层成像(CT)表现为一侧肺叶大片渗出和实变,严重者进展快,累及双侧肺叶,出现呼吸衰竭,经验性使用抗生素效果不佳。及时采用宏基因组二代测序(mNGS)技术并结合鸟类接触史,最终确诊为鹦鹉热衣原体肺炎,采用喹诺酮类联合四环素类抗生素治疗后,患者症状、体征和影像学异常均明显好转,但1例患者影像学吸收不佳,进一步联合大环内酯类抗生素治疗1周,随访复查胸部CT,病灶基本吸收。通过分析该2例患者的临床特点、诊断及治疗过程,为临床诊治该类疾病提供参考。
Two cases of Chlamydia psittaci pneumonia and literature review
Two patients had a history of pigeon contact and presented with fever,fatigue and dyspnea.One patient devel-oped acute respiratory distress syndrome(ARDS)on the fourth day of the disease and required non-invasive ventilator as-sisted ventilation.Leukocyte count was slightly increased in 2 patients,lymphocyte percentage was decreased,platelet count was normal,procalcitonin was increased,C-reactive protein was significantly increased,alanine aminotransferase and as-partate aminotransferase were increased to varying degrees,serum sodium,potassium and albumin were decreased,erythro-cyte sedimentation rate(ESR)was normal in 1 patient and slightly increased in 1 patient.The pathogen could not be identi-fied by routine culture and serological examination of blood and alveolar lavage fluid.Chest X-ray,computed tomography(CT)showed large exudation and consolidation of one lung lobe,rapid progression in severe cases,involving both lung lobes,respiratory failure,and poor effect of empirical antibiotic use.After timely application of metagenomic next-generation se-quencing(mNGS)technology combined with avian contact history,the patient was finally diagnosed with Chlamydia psittaci pneumonia.After treatment with quinolones combined with tetracycline antibiotics,the symptoms,signs and imaging abnor-malities of the patient were significantly improved,but 1 patient had poor imaging absorption and was further treated with macrolide antibiotics for 1 week.Follow-up examination of chest CT showed that the lesion was basically absorbed.By ana-lyzing the clinical characteristics,diagnosis and treatment process of these two patients,it can provide reference for clinical diagnosis and treatment of these diseases.

Severe pneumoniaChlamydia psittaciMetagenomic next-generation sequencingHepatic damage

李合强、彭秀、王晓红

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宁夏医科大学临床医学院,宁夏银川 750004

宁夏医科大学总医院重症医学科,宁夏银川 750004

重症肺炎 鹦鹉热衣原体 宏基因组二代测序 肝损害

2024

中国当代医药
中国保健协会 当代创新(北京)医药科学研究院

中国当代医药

影响因子:1.215
ISSN:1674-4721
年,卷(期):2024.31(1)
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