Next-generation sequencing diagnosis of severe pneumonia from fulminant psittacosis with multiple organ failure: a case report and literature review

Zhang, Heng; Zhan, Danting; Chen, Dandan; Huang, Weibin; Yu, Min; Li, Qiuwen; Marcos, Pedro J.; Tattevin, Pierre; Wu, Di; Wang, Lingwei

doi:10.21037/atm.2020.03.17

Cited by 33 publications

(29 citation statements)

References 26 publications

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“…Transmission to humans often occurs via the inhalation of contaminated aerosols from the excretions of infected birds. The clinical presentation of psittacosis can range from subclinical or an influenza-like illness to fulminant severe pneumonia with multi-organ failure (2)(3)(4)(5)(6)(7). It has been estimated that C. psittaci is the causative organism of approximately 1% of cases of communityacquired pneumonia (CAP), when it is known as C. psittaci pneumonia (8).…”

Section: Introductionmentioning

confidence: 99%

“…With early identification and appropriate antibiotic therapy, the infection is rarely fatal (9). However, in recent years, fulminant severe C. psittaci pneumonia has been described more frequently using metagenomic nextgeneration sequencing (mNGS) in clinical practice (2,3,10), and it is crucial to understand its clinical characteristics and identify its risk factors. There have some case reports or case series reported about clinical manifestations of C. psittaci pneumonia, but the sample sizes are limited (11,12).…”

Section: Introductionmentioning

confidence: 99%

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Severe Chlamydia psittaci pneumonia: clinical characteristics and risk factors

Su¹,

Su²,

Zhou³

et al. 2021

Ann Palliat Med

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Background: Psittacosis ranges from a mild illness to fulminant severe pneumonia with multi-organ failure.It's crucial to understand the clinical characteristics and identify risk factors for a better outcome. Methods:We conducted a retrospective analysis designed to identify risk factors for severe Chlamydia psittaci pneumonia (C. psittaci pneumonia) by comparing the clinical characteristics of patients with severe and less severe forms of the disease. Epidemiological, clinical, laboratory, computed tomography (CT) imaging, and outcome data were collected.Results: We enrolled 27 patients with C. psittaci pneumonia, with a median age of 63 (range, 47-82) years, and 23 of whom (85.2%) had a history of avian exposure. Dyspnea was seen in 15 patients with severe C. psittaci pneumonia (100%), and four in 12 non-severe patients (33.3%) (P<0.01). Compared to nonsevere patients, those with severe C. psittaci pneumonia had significantly higher levels of procalcitonin, urea nitrogen, lactate dehydrogenase, creatine kinase (CK), B natriuretic peptide (BNP), myoglobin, IL-6, and IL-10, as well as lower lymphocyte and CD8+ T cell counts, and P a O 2 /F i O 2 ratio. Among patients with severe infection, CT showed that 46.7% had multi-lobar (more than two lobes) pneumonia, whereas its incidence was 0% in non-severe patients (P=0.01). Multivariate analysis revealed that the independent risk factors associated with severe C.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe Chlamydia psittaci pneumonia: clinical characteristics and risk factors

Su¹,

Su²,

Zhou³

et al. 2021

Ann Palliat Med

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“…SP is a type of pneumonia with severe disease, rapid progress, and poor prognosis. Although there are various treatment measures such as powerful anti-infective treatment and ventilator-assisted ventilation, SP has rapid changes in disease condition, complex inflammatory response, and multiple organ dysfunction syndrome (MODS), which is difficult to treat and expensive, and the prognosis is poor and the mortality rate is high [4,5]. Primary bronchial lung cancer, referred to as lung cancer (LC), is a malignant tumor that occurs in the bronchial mucosal epithelium, which can grow into the bronchial lumen and/or adjacent lung tissue and can pass through lymphatic blood or transbronchial metastasis [6].…”

Section: Introductionmentioning

confidence: 99%

Study on Serum miR-204 Expression Levels in Patients with Severe Pneumonia and Patients with Primary Bronchial Lung Cancer and Its Diagnostic Value

Zheng¹,

Huang

2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To analyze the expression and clinical significance of miR-204 in the serum of patients with severe pneumonia (SP) and primary bronchial lung cancer (LC). Methods. 65 SP patients and 43 primary bronchial LC patients who were treated in the hospital from January 2017 to December 2018 were randomly selected as the SP group and LC group. At the same time, healthy patients from the physical examination department of the hospital were selected. 65 cases were the control group. QRT-PCR detected serum miR-204 expression and compared the differences between groups. The pathological data of patients were collected, and the relationship between serum miR-204 and the patient’s pathological data was compared; the area under the ROC curve and Kaplan–Meier curve were used to evaluate the diagnostic value of serum miR-204 for the two conditions and to explore the relationship between serum miR-204 and prognosis. Results. The serum miR-204 of the SP group was (0.43 ± 0.09), the serum miR-204 of the LC group was (0.40 ± 0.10), the serum miR-204 of the control group was (1.00 ± 0.09), and the miR-204 level of was significantly higher than that of the control group, and the difference between the groups was statistically significant ( P < 0.05). There was no significant difference in serum miR-204 levels between the SP group and the LC group ( P > 0.05). Serum miR-204 levels in SP patients with cumulative organs ≥3 were higher than those with cumulative organs <3, and the difference was statistically significant ( P < 0.001). In the LC group, in patients with stage III to IV and low and undifferentiated patients, the level of miR-204 was higher than that of stage I∼II and high and moderately differentiated patients, and the difference was statistically significant ( P < 0.001). The level of miR-204 in the two groups of patients (0.89 ± 0.10, 0.83 ± 0.13) who died of illness was significantly higher than that of the surviving patients (1.00 ± 0.11, 1.00 ± 0.10), and the difference was statistically significant ( P < 0.05); the survival rate of patients with high expression of miR-204 was higher than that of patients with low expression. The AUC of serum miR-204 level to SP and LC was 0.766 and 0.818, respectively. Conclusion. The level of miR-204 in the serum of SP patients and patients with primary bronchial LC was significantly lower than that of healthy people, and patients who died were lower than those who survived; the miR-204 in serum has a good diagnostic value for SP and LC and is related to the survival and prognosis of patients.

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“…Furthermore, mNGS is less affected by prior antibiotic exposure [12]. Several studies have discussed the potential of mNGS in diagnosing psittacosis or legionnaire's disease [6][7][8]37]. In our study, all 17 psittacosis patients and 9 LP patients were diagnosed with the help of mNGS.…”

Section: Discussionmentioning

confidence: 83%

Comparative analysis of clinical presentation of community-acquired pneumonia induced by Chlamydia psittaci and Legionella Diagnosed through Metagenomic Next-Generation Sequencing

Zeng

et al. 2020

Preprint

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Background Legionella and Chlamydia psittaci cause atypical community-acquired pneumonia, which mimic each other. Our aim was to compare the clinical characteristics of Legionella pneumonia (LP) and psittacosis and assess whether metagenomic next-generation sequencing (mNGS) is an effective method for early diagnosis. Methods We conducted a retrospective study and compared seventeen patients with Chlamydia psittaci pneumonia and nine patients with LP, diagnosed by mNGS. This study was carried out in the First Affiliated Hospital of Wenzhou Medical University, China, from July 2018 to May 2020. mNGS was carried out from bronchial alveolar lavage fluid (BALF) and/or lung tissues. Results 76.5% of psittacosis cases and 0% of legionellosis cases had an avian exposure history (p < 0.001). Compared with LP patients, psittacosis patients had significantly higher hemoglobin (118.9 ± 20.2 vs. 93.2 ± 23.2 g/L, p = 0.007), serum sodium (138.9 ± 5.4 vs. 133.9 ± 6.5 mmol/L, p = 0.047), and higher proportion of elevated aspartate aminotransferase levels (88.2 vs. 44.4%, p = 0.028). Other clinical parameters were similar in psittacosis and LP patients: normal or slightly elevated leucocytes (10.5 vs. 9.5 × 109/L, p > 0.05), neutrophils (9.4 vs. 8.3 × 109/L, p > 0.05), and procalcitonin (0.8 vs 5.1 ng/mL, p > 0.05); highly increased C-reactive protein levels (205.1 vs. 234.9 mg/L, p > 0.05); and decreased lymphocytes (0.7 vs. 0.6 × 109/L, p > 0.05). Extra-pulmonary manifestations and mortality (11.8% in psittacosis vs. 22.2% in LP group, p = 0.591) were also similar in both the groups. mNGS detected Chlamydia psittaci in 17/17 BALF samples, and Legionella in 8/8 BALF samples and 1/1 lung tissue sample. Conclusions Apart from sharing many features with legionellosis, psittacosis is a vital differential diagnosis for LP, especially in patients with avian exposure history. mNGS is a sensitive and promising method for early diagnosis of both psittacosis and LP.

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Next-generation sequencing diagnosis of severe pneumonia from fulminant psittacosis with multiple organ failure: a case report and literature review

Cited by 33 publications

References 26 publications

Severe Chlamydia psittaci pneumonia: clinical characteristics and risk factors

Severe Chlamydia psittaci pneumonia: clinical characteristics and risk factors

Study on Serum miR-204 Expression Levels in Patients with Severe Pneumonia and Patients with Primary Bronchial Lung Cancer and Its Diagnostic Value

Comparative analysis of clinical presentation of community-acquired pneumonia induced by Chlamydia psittaci and Legionella Diagnosed through Metagenomic Next-Generation Sequencing

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