以持续高热为主要临床表现的鹦鹉热衣原体肺炎延误诊治分析及文献复习OA

Objective To investigate the clinical characteristics of chlamydia psittaci pneumonia and the causes of delayed diagnosis and treatment.Methods The clinical data of 6 patients developing chlamydia psittaci pneumonia with per-sistent high fever as the main clinical manifestation from January 2022 to December 2023 were analyzed,and the case charac-teristics,diagnosis and treatment process,causes of misdiagnosis and preventive measures were summarized.Results All the 6 patients had acute onset,mainly manifested as persistent high fever with a maximum body temperature of 42.0℃,including 3 patients who had contact history with birds and poultry,and the remaining patients denied contact history with birds and poultry.There was fatigue and dyspnea in 5 patients,anorexia in 3 patients,dizziness in 3 patients,cough and sputum in 2 patients,nausea and vomiting in 2 patients,headache in 2 patients,and chest pain,dry throat,hyperhidrosis,diarrhea,blood in sputum in 1 patient,respectively.The percentage of neutrophils increased in 4 patients,procalcitonin increased in 2 patients,alanine aminotransferase increased in 2 patients,and creatine kinase increased in 2 patients.All the 6 patients had lung consolidation by imaging examination,which was manifested as unclear flaky exudation shadow,partly unclear edge,and visible air bronchial sign.All 6 patients were misdiagnosed as common community-acquired pneumonia.The misdiagnosis las-ted 5-9 d.All the 6 patients were diagnosed with chlamydia psittaci pneumonia by bronchoalveolar lavage fluid metagenomic next-generation sequencing.After receiving targeted anti-infection treatment,their condition improved and they were dis-charged from hospital.No death was reported.Conclusion For patients with acute onset,high fever accompanied by cough and dyspnea,and large and unclear flaky exudation shadow on imaging,who have failed to respond to empirical anti-infective treatment,especially those with a history of contact with poultry or birds,chlamydia psittaci pneumonia should be highly sus-pected,and bronchoalveolar lavage fluid metagomic next-generation sequencing should be performed when necessary to make early diagnosis,reduce misdiagnosis and mistreatment.Targeted treatment should be given as soon as possible,to prevent the progression of the disease to a critical condition.