Fulminant psittacosis in a traveller

Pasan Waidyasekara,Kollengode Ramanathan

doi:10.1099/jmmcr.0.000007

Abstract

Introduction: Psittacosis is a rare cause of pneumonia, caused by Chlamydia psittaci. The disease is transmitted to humans via inhalation of dried bird faeces, feather dust, urine or respiratory secretions. The disease can range from a mild form with non‐specific symptoms to severe systemic disease with prominent respiratory symptoms. Psittacosis causing severe respiratory failure requiring mechanical ventilation is uncommon. Case presentation: A 64‐year‐old male tourist from Hong Kong presented to the emergency department with a 5 day history of headache, myalgia and fever. He had a productive cough and was short of breath. The patient developed septic shock with multiorgan failure requiring intensive care support. We received information from the Centre for Health Diseases in Hong Kong about a psittacosis outbreak in an animal management centre where our patient had been working with recent occupational exposure to dead parrots. Despite a significant increased mortality rate associated with respiratory and renal involvement in psittacosis, our patient survived the sepsis and multiorgan failure and was repatriated back for further rehabilitation. Conclusion: The case illustrates the importance of exploring a patient’s occupational history to establish an infection exposure. The respiratory symptoms, myalgia and fever warranted consideration of an atypical pneumonia. The patient had bilateral pulmonary infiltrates contrary to the unilateral involvement in the majority of the patients with chest X‐ray abnormalities. Despite a high mortality rate associated with respiratory and renal involvement, our patient survived the severe sepsis.

Highlights

Psittacosis is a rare cause of pneumonia, caused by Chlamydia psittaci
Psittacosis is a rare cause of pneumonia throughout the world, caused by Chlamydia psittaci
We report an unusual case of fulminant psittacosis with multiorgan failure in a tourist

Summary

Introduction

Psittacosis is a rare cause of pneumonia throughout the world, caused by Chlamydia psittaci. Initial history from family members revealed that there was no recent history of travel elsewhere and there was no exposure to pets or animals at home He was started on ceftriaxone and azithromycin but was intubated soon after admission for worsening respiratory failure and transferred to the intensive care unit for further management. He had bilateral infiltrates on a chest X-ray (Fig. 1) and required lung-protective ventilation with high oxygen and vasopressor requirements. The family were contacted by the Centre for Health Diseases in Hong Kong (CHDHK) to say they were investigating an outbreak of psittacosis in the animal handling centre where the patient was employed. This was performed at the central laboratory in Brisbane using a commercial assay from Medac

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Discussion