Clinical characteristics of 14 cases of severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing: A case series

Abstract

Introduction: The objective of this study was to explore the clinical, laboratory, and imaging features of severe Chlamydia psittaci pneumonia in order to improve early diagnosis and treatment success rates.

Methods: We conducted a retrospective record review of 14 cases of severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing technology in our hospital. We extracted and analyzed data on the clinical symptoms and signs, contact history, laboratory investigations, chest computed tomography, treatment, and clinical outcomes.

Results: Of the 14 patients, 12 (86%) were male and two (14%) were female, with a mean age of 57 years (SD: 7 years). Eleven patients (79%) had a history of poultry contact. The main clinical manifestations were fever (n = 14, 100%), flu-like symptoms (n = 10, 71%), cough, sputum (n = 9, 64%), and dyspnea (n = 5, 36%). Blood tests revealed marked elevation of neutrophil percentage, C-reactive protein, procalcitonin, brain natriuretic peptide, and creatine kinase levels; slight elevation of aspartate aminotransferase, creatinine, urea, fibrinogen, and D-dimer levels; and decreased albumin, sodium, and calcium levels. Chest computed tomography showed bilateral lesions (n = 7, 50%), middle-lower lobe lesions (n = 10, 71%), lesions in multiple lobes (n = 9, 64%), consolidation shadows (n = 11, 79%), and pleural effusions (n = 11, 79%). The median time from disease onset to hospital admission was 4.5 days (interquartile range: 1-17 days); the mean length of hospital stay was 20.9 ± 8.5 days, and the mean time from admission to diagnosis was 5.1 ± 2.6 days. After diagnosis, patients were either treated with doxycycline alone or doxycycline combined with quinolones. All 14 patients developed respiratory failure and received invasive mechanical ventilation; two (14%) received veno-venous extracorporeal membrane oxygenation, four (29%) received continuous renal replacement therapy, and three (21%) died.

Discussion and conclusion: A poultry contact history and typical flu-like symptoms are early indicators of Chlamydia psittaci pneumonia. Substantial elevations in procalcitonin, creatine kinase, and brain natriuretic peptide indicate severe disease. Metagenomic next-generation sequencing is useful for diagnosis. Early empirical antibiotic therapy with quinolones can reduce the mortality in critically ill patients.

Figure 1

Metagenomic next-generation sequencing results and number of Chlamydia psittaci readings obtained for each patient. BALF = bronchoalveolar lavage fluid.

Figure 2

Chest computed tomography of Case 3, a 58-year-old male, showing patchy consolidation of both lungs with blurred edges, and a small right pleural effusion.

Figure 3

Chest computed tomography of Case 4, a 50-year-old male, showing multiple patchy, patchy and nodular consolidation shadows, ground-glass opacity, air-bronchogram, blurred edges, slightly thickened interlobular septa in both lungs, and a small right pleural effusion.

Figure 4

Chest computed tomography of Case 6, a 46-year-old male, showing large consolidation shadows and ground-glass opacity in both lungs, air bronchograms, and a small bilateral pleural effusion.

Figure 5

Chest computed tomography of Case 10, a 70-year-old male, showing consolidation shadows in the right lung, scattered cavities, and a small right pleural effusion.

Figure 6

Chest computed tomography of Case 12, a 45-year-old male, showing patchy increased density shadows and consolidation shadows in the right lower lung, with air bronchograms.