Psittacosis

Psittacosis
Classification and external resources
Direct fluorescent antibody stain of a mouse brain impression smear showing C. psittaci.
ICD-10	A70
ICD-9	073
DiseasesDB	2375
MedlinePlus	000088
eMedicine	med/1951
MeSH	D009956

In medicine (pulmonology), psittacosis — also known as parrot disease, parrot fever, and ornithosis — is a zoonotic infectious disease caused by a bacterium called Chlamydophila psittaci (formerly Chlamydia psittaci) and contracted from parrots, such as macaws, cockatiels and budgerigars, and pigeons, sparrows, ducks, hens, gulls and many other species of bird. The incidence of infection in canaries and finches is believed to be lower than in psittacine birds.

In certain contexts, the word "psittacosis" is used when the disease is carried by any species of bird belonging to the Psittacidae family, whereas "ornithosis" is used when other birds carry the disease.^[1]

In humans

Symptoms

In humans, after an incubation period of 5–14 days, the symptoms of the disease range from inapparent illness to systemic illness with severe pneumonia. It presents chiefly as an atypical pneumonia. In the first week of psittacosis the symptoms mimic typhoid fever: prostrating high fevers, arthralgias, diarrhea, conjunctivitis, epistaxis and leukopenia.^[2] Rose spots can appear and these are called Horder's spots.^[3] Splenomegaly is frequent toward the end of first week. Diagnosis can be suspected in case of respiratory infection associated with splenomegaly and/or epistaxis. Headache can be so severe that suggests meningitis and some nuchal rigidity is not unusual. Towards the end of first week stupor or even coma can result in severe cases.

The second week is more akin to acute bacteraemic pneumococcal pneumonia with continuous high fevers, cough and dyspnoea. X rays show patchy infiltrates or a diffuse whiteout of lung fields.

Complications in the form of endocarditis, hepatitis, myocarditis, arthritis, keratoconjunctivitis, and neurologic complications (encephalitis) may occasionally occur. Severe pneumonia requiring intensive-care support may also occur. Fatal cases have been reported (less than 1% of cases).

Diagnosis

Blood analysis shows leukopenia, thrombocytopenia and moderately elevated liver enzymes. Differential diagnosis must be made with typhus, typhoid and atypical pneumonia by Mycoplasma, Legionella or Q fever. Exposure history is paramount to diagnosis. Diagnosis involves microbiological cultures from respiratory secretions of patients or serologically with a fourfold or greater increase in antibody titers against C. psittaci in blood samples combined with the probable course of the disease. Typical inclusions called "Leventhal-Cole-Lillie bodies"^[4] can be seen within macrophages in BAL (Bronchial Alveolar Lavage) fluid. Culture of Chlamydia psittaci is hazardous and should only be carried out in biosafety laboratories.

Epidemiology

Psittacosis was first reported in Europe in 1879.^[5]

In 1929, a highly publicized outbreak of psittacosis hit the United States. Although not the first report of psittacosis in the United States, it was the largest up to that time. It led to greater controls on the import of pet parrots.^[5] The aftermath of the outbreak and how it was handled led to the establishment of the National Institutes of Health.^[6]

From 2002 through 2009, 66 human cases of psittacosis were reported to the Centers for Disease Control and most resulted from exposure to infected pet birds, usually cockatiels, parakeets, parrots, and macaws. Many more cases may occur that are not correctly diagnosed or reported.

Bird owners, pet shop employees, zookeepers and veterinarians are at risk of the infection. Some outbreaks of psittacosis in poultry processing plants have been reported.

Treatment

The infection is treated with antibiotics. Tetracyclines and chloramphenicol are the drugs of choice for treating patients with psittacosis.^[7] Most persons respond to oral therapy doxycycline, tetracycline hydrochloride, or chloramphenicol palmitate. For initial treatment of severely ill patients, doxycycline hyclate may be administered intravenously. Remission of symptoms usually is evident within 48–72 hours. However, relapse can occur, and treatment must continue for at least 10–14 days after fever abates. Although its in vivo efficacy has not been determined, erythromycin probably is the best alternative agent for persons for whom tetracycline is contraindicated (e.g., children aged less than 9 years and pregnant women).^{[citation needed]}

In birds

An immature blue heron with psittacosis

In birds, Chlamydophila psittaci infection is referred to as avian chlamydiosis (AC). Infected birds shed the bacteria through feces and nasal discharges, which can remain infectious for several months. Many strains remain quiescent in birds until activated under stress. Birds are excellent, highly mobile vectors for the distribution of chlamydial infection because they feed on, and have access to, the detritus of infected animals of all sorts.

Signs

C. psittaci in birds is often systemic and infections can be inapparent, severe, acute or chronic with intermittent shedding. Signs in birds include "inflamed eyes, difficulty in breathing, watery droppings and green urates."^[8]

Diagnosis

Initial diagnosis may be via symptoms, but is usually confirmed via an antigen and antibody test. A PCR-based test is also available. Although any of these tests can confirm psittacosis, false negatives are possible and so a combination of clinical and lab tests is recommended before giving the bird a clean bill of health.^[8] It may die within 3 weeks.

Epidemiology

Infection is usually via the droppings of another infected bird, though it can also be transmitted via feathers and eggs,^[9] and is typically either inhaled or ingested.^[8]

C. psittaci strains in birds infect mucosal epithelial cells and macrophages of the respiratory tract. Septicaemia eventually develops and the bacteria become localized in epithelial cells and macrophages of most organs, conjunctiva, and gastrointestinal tract. It can also be passed in the eggs. Stress will commonly trigger onset of severe symptoms, resulting in rapid deterioration and death. C. psittaci strains are similar in virulence, grow readily in cell culture, have 16S-rRNA genes that differ by <0.8%, and belong to eight known serovars. All should be considered to be readily transmissible to humans.

C. psittaci serovar A is endemic among psittacine birds and has caused sporadic zoonotic disease in humans, other mammals, and tortoises. Serovar B is endemic among pigeons, has been isolated from turkeys, and has also been identified as the cause of abortion in a dairy herd. Serovars C and D are occupational hazards for slaughterhouse workers and for people in contact with birds. Serovar E isolates (known as Cal-10, MP or MN) have been obtained from a variety of avian hosts worldwide and, although they were associated with the 1920s–1930s outbreak in humans, a specific reservoir for serovar E has not been identified. The M56 and WC serovars were isolated during outbreaks in mammals.

Treatment

Treatment is usually via antibiotics, such as doxycycline or tetracycline, and can be administered via drops in the water, or injections.^[9] Many strains of C. psittaci are susceptible to bacteriophage.

Use as a biological weapon

Psittacosis was one of more than a dozen agents that the United States researched as potential biological weapons before the nation suspended its biological weapons program.^[10]

Notable Casualties

The most high-profile death caused by Parrot Fever is that of Thea Selway, mother of singer Philip Selway.^[11]

In Media

In season 4, episode 6 of the TV series The Untouchables titled "Bird In Hand", the 1929 outbreak is used as the background story in the search for a mobster who might have contracted the illness.

Series 6, Episode 5 of the TV series Only fools and Horses, when Del boy is rushed to hospital with mysterious symptoms, Albert recalls how a crew mate suffered from something similar, until a doctor diagnosed green parrot disease, to which Rodney asks "How the hell's Del gonna get green parrots' disease in Peckham?"

Season 2, episode 3 of the TV series House, titled "Humpty Dumpty", features a case of psittacosis.

Season 1, episode 3 of the TV series Route 66, titled "The Swan Bed", features a case of psittacosis.

In Hergé's "The Adventures of Tintin" (Tintin in the Congo), Tintin's dog, Snowy, is bitten in the tail by a parrot and develops psittacosis.

Sources

• The initial content for this article was adapted from sources available at http://www.cdc.gov.

References

External links

• Psittacosis on Birds n Ways
• Psittacosis on East Petaluma Animal Hospital website
• Notes on Avian Chlamydiosis – Psittacosis – Parrot fever