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FINDINGS: A common pattern is mild respiratory symptoms and extensive pneumonia demonstrated by chest x-ray. Coughing may be absent initially, and then a nonproductive cough or cough with minimal sputum production follows. Person-to-person transmission may occur rarely from patients with "paroxysmal coughing." Pulse may be slow relative to temperature elevation. Other symptoms seen in some cases are pleuritic chest pain, splenomegaly, and rash. Possible complications include encephalitis and myocarditis. [CCDM, p. 432-4] C. psittaci can cause conjunctivitis and keratitis. The rash may resemble the rose spots of typhoid fever. Other associated skin manifestations are erythema multiforme and erythema nodosum. [Guerrant, p. 535-7, 1576] In an Australian series of cases, about 50% of patients had elevated liver transaminases. Pleural effusions may occur. P. psittaci is one of the rare causes of endocarditis. Some patients with severe disease have acute renal failure. [ID, p. 534-5] The main syndromes are mononucleosis-like, typhoidal, and atypical pneumonia. Symptoms present in a minority of patients include sweating, ataxia, nausea/vomiting, abdominal pain, diarrhea, constipation, sore throat, dyspnea, hemoptysis, epistaxis, arthralgia, rash, confusion, tachycardia, bradycardia, splenomegaly, and adenopathy. Anemia from hemolysis occurs in some cases. Other occasional findings are hepatitis with jaundice, reactive arthritis, cranial nerve palsies, transverse myelitis, confusion, encephalitis, meningitis, seizures, urticaria, glomerulonephritis, and bleeding diathesis. [PPID, p. 2256-7] EPIDEMIOLOGY: Most often implicated are imported psittacine birds and then turkeys and ducks. Work-related disease in poultry processing plants has been reported. [CCDM, p. 432] About 50 cases per year are reported in the USA, and about 1/2 of the cases are associated with pet birds. Birds may appear either well or ill with diarrhea and loss of appetite. [Lexi-ID, p. 72] |
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