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中华实验和临床感染病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 176 -181. doi: 10.3877/cma.j.issn.1674-1358.2024.03.008

病例报告

以头痛、乏力首诊于神经科的鹦鹉热衣原体肺炎二例及文献复习
王柳清1, 李萍2, 李小石2, 刘阳2, 吴鹤龄2, 周国平2,†()   
  1. 1. 211300，南京市，南京市高淳人民医院神经内科
    2. 211300，南京市，南京市高淳人民医院重症医学科
  • 收稿日期:2023-11-11 出版日期:2024-06-15
  • 通信作者: 周国平
  • 基金资助:
    江苏省卫生健康委医学科研项目(No. Z2023061)

Two cases of Chlamydia psittaci pneumonia first diagnosed in neurology department with headache and fatigue and literatures review

Liuqing Wang1, Ping Li2, Xiaoshi Li2, Yang Liu2, Heling Wu2, Guoping Zhou2,†()   

  1. 1. Department of Neurology, Nanjing Gaochun People’s Hospital, Nanjing 211300, China
    2. Intensive Care Department, Nanjing Gaochun People’s Hospital, Nanjing 211300, China
  • Received:2023-11-11 Published:2024-06-15
  • Corresponding author: Guoping Zhou
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引用本文：

王柳清, 李萍, 李小石, 刘阳, 吴鹤龄, 周国平. 以头痛、乏力首诊于神经科的鹦鹉热衣原体肺炎二例及文献复习[J]. 中华实验和临床感染病杂志(电子版), 2024, 18(03): 176-181.

Liuqing Wang, Ping Li, Xiaoshi Li, Yang Liu, Heling Wu, Guoping Zhou. Two cases of Chlamydia psittaci pneumonia first diagnosed in neurology department with headache and fatigue and literatures review[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2024, 18(03): 176-181.

目的

探讨鹦鹉热衣原体肺炎的临床特点、神经系统症状、诊断及治疗方法等。

方法

回顾性分析分别于2021年9月和11月首诊于高淳人民医院神经科的2例男性鹦鹉热肺炎患者，均以头痛、乏力首诊，分析患者临床表现、实验室及影像学检查结果及病情转归等。

结果

两例以头痛、乏力首诊于神经科的鹦鹉热衣原体肺炎病例，经肺泡灌洗液宏基因二代测序均检出鹦鹉热衣原体序列。经多西环素（0.1 g/次静脉滴注，2次/d）等抗感染治疗，患者乏力、肌肉酸痛和头痛等症状明显改善，未造成不良后果。

结论

鹦鹉热衣原体肺炎病程初期可表现为乏力、肌肉酸痛和头痛等神经系统症状，发热患者在诊疗过程中需考虑到鹦鹉热衣原体肺炎的可能。

关键词: 鹦鹉热衣原体肺炎, 乏力, 宏基因组二代测序技术, 重症医学, 神经病学
Objective

To investigate the clinical characteristics, nervous system symptoms and diagnostic methods of Chlamydia psittaci pneumonia, retrospectively.

Methods

Data of 2 male cases of Chlamydia psittaci pneumonia first diagnosed in neurology department with headache and asthenia were analyzed, retrospectively, who were respectively admitted in September and November 2021 in the Neurology Department of Gaochun People’s Hospital. The clinical manifestations, laboratory examination results, imaging examination results and prognosis of the patients were analyzed.

Results

Two cases of Chlamydia psittaci pneumonia first diagnosed in neurology department with headache and fatigue were detected by the second generation sequencing of macrogene in alveolar lavage fluid. After anti-infection treatment such as doxycycline injection (0.1 g intravenous drip twice a day), the symptoms of fatigue, muscle soreness, headache and other symptoms of the patients were significantly improved, without obvious adverse consequences.

Conclusions

Chlamydia psittaci pneumonia may present nervous system symptoms such as fatigue, muscle pain, headache, etc. At the initial stage of the disease course, especially for patients with fever, it is necessary to consider the possibility of Chlamydia psittaci pneumonia in the diagnosis and treatment procession.

Key words: Chlamydia pneumonia, Weakness, Metagenomic next-generation sequencing, Critical care medicine, Neurology
图1 鹦鹉热衣原体基因组覆盖图注：左图：病例1鹦鹉热衣原体基因组覆盖图，该物种的基因组总碱基数为1 179 220（bp），测到的该物种序列覆盖的总长度为21 565（bp），覆盖度为1.828751%，平均深度为1.05X。右图：病例2鹦鹉热衣原体基因组覆盖图，该物种的基因组总碱基数为1 179 220（bp），测到的该物种序列覆盖的总长度为142 188（bp），覆盖度为12.0578%，平均深度为1.11 X
表1 病例1肺泡灌洗液mNGS检测
病原体 检出序列 相对丰度（%）
细菌    
肺炎克雷伯菌 50 1.430
真菌    
光滑念珠菌 26 510 97.777
克柔念珠菌 438 1.611
烟曲霉 8 0.045
病毒    
人类疱疹病毒1型 6 85.714
人类疱疹病毒4型 1 14.286
寄生虫 未检出 —
结核分枝杆菌复合群 未检出 —
非结核分枝杆菌 未检出 —
支原体/衣原体    
鹦鹉热衣原体 231 3.403
图2 两例患者胸部CT演变过程注：A：病例1入院当天、入院后3天、入院后1周及出院前的胸部CT。B：病例2入院当天、入院后3天、入院后1周及出院前的胸部CT。提示两例患者肺部炎症逐渐消散
图3 两例患者肌酸激酶水平变化注：A：病例1入院当天、入院后3天、入院后1周及出院前肌酸激酶水平。B：病例2入院当天、入院后3天、入院后1周及出院前的肌酸激酶水平
表2 病例2肺泡灌洗液mNGS检测
病原体 检出序列 相对丰度（%）
细菌    
不动杆菌属 350 13.39
鲍曼不动杆菌 203 13.39
真菌    
未检出    
病毒    
人类疱疹病毒4型 4 83.33
人类疱疹病毒7型 1 16.67
淋巴隐病毒属 5 83.33
玫瑰疹病毒属 1 16.67
寄生虫 未检出 —
结核分枝杆菌复合群 未检出 —
非结核分枝杆菌 未检出 —
支原体/衣原体    
鹦鹉热衣原体 1 530 86.61
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