eMedicine Specialties > Infectious Diseases > Lower Respiratory Tract Infections

Psittacosis: Follow-up

Author: Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Coauthor(s): Farhad Arjomand, MD, Pulmonary Fellow, Department of Internal Medicine, Division of Pulmonary and Critical Care, Brooklyn Hospital Center, Cornell University School of Medicine
Contributor Information and Disclosures

Updated: Jun 27, 2008

Follow-up

Further Inpatient Care

  • Severe infection requires intravenous antibiotics and hospital admission.
  • Isolation is not indicated during hospital stay.

Further Outpatient Care

  • Instruct patients to see a physician if symptoms recur (ie, relapse).
  • Patients with relapses may need prolonged retreatment (eg, 3-4 wk).

Inpatient & Outpatient Medications

  • Patients may require doxycycline, usually 100 mg IV; alternatively, consider PO administration with the same dose twice a day.
  • Chloramphenicol is the third drug of choice but is rarely used in the United States.
  • Consider changing erythromycin from intravenous to oral administration (eg, 500 mg qid).
  • Chloramphenicol is rarely used in the United States because it may cause agranulocytosis.
  • Consider changing quinolones from intravenous to oral administration.

Transfer

  • Transfer patients with acute respiratory failure to an intensive care unit.

Deterrence/Prevention

  • Instruct high-risk individuals to avoid handling newly imported or sick birds.

Complications

  • Acute respiratory failure
  • Pericarditis
  • Myocarditis
  • Culture-negative endocarditis
  • Renal failure (rare, only a few case reports)
  • Disseminated intravascular coagulation (rare)
  • Arterial embolism (rare, 2 case reports)
  • Pancreatitis
  • Reactive arthritis
  • Transverse myelitis
  • Meningitis or encephalitis

Prognosis

  • With appropriate antibiotic therapy, the mortality rate is less than 1%.
  • Hypoxemia and renal failure portend a poor prognosis.

Patient Education

  • Warn pet owners and pet-shop and poultry workers to be aware of possible respiratory symptoms and fever.
  • For excellent patient education resources, visit eMedicine's Sexually Transmitted Diseases Center. Also, see eMedicine's patient education article Chlamydia.

Miscellaneous

Medicolegal Pitfalls

  • Failure to make the proper diagnosis (Psittacosis may be easily overlooked, but adherence to published guidelines for the management of community-acquired pneumonia covers this pathogen.)
  • Failure to realize that the natural history of the disease carries an approximately 15% mortality rate and the concomitant need for appropriate empiric therapy
  • Failure to maintain a high index of suspicion
  • Failure to inquire about bird exposure and occupational considerations
  • Failure to realize that doxycycline is not recommended in children because it may cause tooth discoloration

Special Concerns

  • Educate high-risk individuals about the symptoms of psittacosis. These individuals include zoo workers and pet-shop owners, among others. Individuals must keep accurate records of all bird transactions.
  • Avoid purchasing or selling birds that have ocular or nasal discharge, diarrhea, or low body weight.
  • Isolate imported and exotic birds for 30-45 days. Test these birds or treat them with prophylaxis.
 


More on Psittacosis

Overview: Psittacosis
Differential Diagnoses & Workup: Psittacosis
Treatment & Medication: Psittacosis
Follow-up: Psittacosis
References
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References

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Further Reading

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Keywords

psittacosis, ornithosis, parrot fever, Chlamydia psittaci, C psittaci, avian-acquired psittacosis

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Contributor Information and Disclosures

Author

Klaus-Dieter Lessnau, MD, FCCP, Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital
Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Farhad Arjomand, MD, Pulmonary Fellow, Department of Internal Medicine, Division of Pulmonary and Critical Care, Brooklyn Hospital Center, Cornell University School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

Kenneth C Earhart, MD, Deputy Head, Disease Surveillance Program, United States Naval Medical Research Unit #3
Kenneth C Earhart, MD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard B Brown, MD, FACP, Chief, Division of Infectious Diseases, Baystate Medical Center; Professor, Department of Internal Medicine, Tufts University School of Medicine
Richard B Brown, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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