eMedicine Specialties > Infectious Diseases > Lower Respiratory Tract Infections

Psittacosis

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
Farhad Arjomand, MD, Pulmonary Fellow, Department of Internal Medicine, Division of Pulmonary and Critical Care, Brooklyn Hospital Center, Cornell University School of Medicine

Updated: Jun 27, 2008

Introduction

Background

Psittacosis is an infection caused by the obligatory intracellular bacterium Chlamydia psittaci. The term psittacosis is derived from the Greek word for parrot, psittakos, and was first used by Morange in 1892.

This bacterium can infect parrots, parakeets, canaries, and other avian species (eg, turkeys, pigeons, ducks). Another term for this infection is ornithosis, which describes the infection caused by nonpsittacine birds.

The largest epidemic occurred in 1930 and affected 750-800 individuals. This epidemic led to the isolation of C psittaci in several laboratories in Europe and the United States.

Psittacosis is an occupational disease of zoo and pet-shop employees, poultry farmers, and ranchers. Human-to-human transmission is rare, but possible. These cases may cause more severe disease than avian-acquired psittacosis.

Psittacosis is probably underdiagnosed.

Pathophysiology

The primary route for infection is through the respiratory system. Infection develops after organisms from aerosolized dried avian excreta or respiratory secretions from sick birds are inhaled. C psittaci attaches to the respiratory epithelial cells. After the initial inoculation, the organism spreads via the blood stream to the reticuloendothelial system. Subsequently, secondary bacteremia causes lung infection.

Humans may acquire disease by handling sick birds. Mouth-to-beak resuscitation has also been implicated in transmission. Transient exposure to infected birds may cause symptomatic infection, even in visitors to pet shops.

Frequency

United States

Reports show up to 200 cases of psittacosis annually. From 1988-97, the US Centers for Disease Control and Prevention (CDC) received 766 reports of psittacosis, which is probably an underestimate of the actual number of cases because psittacosis is difficult to diagnose, is covered by macrolide antimicrobials (which may be used empirically for therapy of community-acquired pneumonia), and often goes reported.

From 1988-2003, 935 human cases of psittacosis were reported to the CDC.¹

International

Psittacosis is found worldwide. The incidence seems to be increasing in developed countries, which is correlated to the import of exotic birds.

Mortality/Morbidity

The mortality rate prior to the advent of antimicrobial treatment was approximately 15-20%. The mortality rate is less than 1% with appropriate antibiotic therapy.

Race

No race predilection is observed.

Sex

No sex predilection is observed.

Age

Psittacosis occurs in all age groups, including children. The infection is more common among individuals in the middle decades of life.

Breed

Certain strains of C psittaci infect sheep, goats, and cows and may cause chronic infection and abortion.

• Wild birds such as falcons have caused disease through nasal or fecal secretions.
• Mowing lawns without a grass catcher has been found to be a risk factor.
• Most diseases resulted from exposure to infected pet birds, usually cockatiels, parakeets, parrots, and macaws.

Clinical

History

The incubation period is generally 5-14 days. The longest observed incubation time was 54 days. The predominant presentation is respiratory tract infection with constitutional symptoms. Clinical findings are variable.

• Constitutional
  • Fever (50-90%)
  • Chills
  • Malaise
• Respiratory
  • Cough (50-90%), usually not productive
  • Pleuritic chest pain (rare)
  • Dyspnea
  • Sore throat and mild pharyngitis (common)
  • Epistaxis (common)
• Gastrointestinal
  • Nausea and vomiting (uncommon)
  • Abdominal pain (uncommon)
  • Diarrhea (rare)
  • Jaundice (rare)
• Neurological
  • Severe headache (common)
  • Photophobia (common)
  • Agitation and lethargy
• Dermatological - Includes facial rash (Horder spots)

Physical

Disease may range from mild insidious presentations to severe pneumonia that requires mechanical ventilation.

• Respiratory
  • Nonspecific auscultatory findings that often underestimate clinical and radiographic findings may develop.
  • Patients may develop fatal pulmonary embolism and pulmonary infarction.
  • Pleural effusion is rare.
• Cardiac
  • Relative bradycardia is common.
  • Physicians may observe pericarditis, culture-negative endocarditis, and myocarditis.
• Gastrointestinal
  • Splenomegaly occurs in 10-70% of patients, depending on the study.
  • When present, this sign suggests psittacosis in patients with pneumonia.
• Neurological
  • Patients may develop meningitis, encephalitis, seizures, and Guillain-Barré syndrome, but these are rare.
  • Cerebrospinal fluid (CSF) findings are usually normal.
• Dermatological
  • Patients may develop Horder spots, which are macular rashes that resemble the rose spots observed in typhoid fever but appearing on the face.
  • Patients may also develop erythema multiforme and erythema nodosum.
• Hematological
  • Patients may develop anemia secondary to hemolysis.
  • Disseminated intravascular coagulation may occur in patients with overwhelming infections.
• Renal symptoms include acute glomerulonephritis and tubulointerstitial nephritis.
• Musculoskeletal symptoms include reactive arthritis that is usually polyarticular. Rarely, rhabdomyolysis has been observed.²
• Stages of disease progression

1.      Flulike syndromes without radiographic abnormalities

2.      Mild-to-moderate pneumonia

3.      Severe pneumonia

4.      Acute respiratory failure, sepsis, and septic shock

Causes

Psittacosis is an infectious disease caused by the obligatory intracellular bacterium C psittaci.

• C psittaci is associated with psittacine birds and poultry.
• Psittacosis is an occupational disease of poultry farmers, pet-shop workers, and veterinarians.
• Relapses may occur.
• Because psittacosis is a bacterial disease, major protective immunity is unlikely to develop after a single episode of disease. The exact risk of recurrence upon reexposure is unknown. It is reasonable to advise avoidance of infected birds.

Differential Diagnoses

Other Problems to Be Considered

Coxiella burnetii infection
Francisella tularensis infection
Atypical pneumonia (all causes)

Workup

Laboratory Studies

• White blood cell counts are normal to mildly decreased.
• Liver function test values are usually mildly increased.
• The erythrocyte sedimentation rate (ESR) may be elevated.
• Urinalysis may show mild proteinuria (<3500 mg/d).
• Culturing of C psittaci is possible, but this practice is avoided because it can be hazardous to laboratory personnel.
• Test acute-phase serum and convalescent-phase serum 2 weeks after onset to confirm a 4-fold or greater rise in the titer. Complement fixation (CF) is not a specific test and may cross-react with other chlamydial species.
• Physicians use microimmunofluorescence (MIF) and polymerase chain reaction (PCR) studies to detect different chlamydial species. PCR may develop into an early and specific detection test.
• Enzyme-linked immunosorbent assay (ELISA) and direct immunofluorescence (DIF) are experimental in this setting, but physicians have used them to help diagnose C psittaci infection.
• Serologic tests are the mainstays of diagnosis; however, because of the delayed appearance of specific antibodies, these tests are not helpful in emergent clinical management.

Imaging Studies

• Chest radiographic findings are abnormal in up to 90% of cases.
• The most common finding is unilateral, lower-lobe dense infiltrate/consolidation. Psittacosis may present in a bilateral, nodular, miliary, or interstitial pattern.
• Rarely, patients develop pleural effusion.
• Chest radiograph abnormalities resolve within an average of 6 weeks (range, 3-20 wk).

Other Tests

• Few patients have CSF abnormalities.
• CDC criteria for C psittaci infection include the following:
  • Confirmed cases produce a positive culture result for C psittaci from respiratory secretions, a 4-fold increase in antibody titer in 2 serum samples obtained via CF or MIF 2 weeks apart, or immunoglobulin M (IgM) antibodies against C psittaci, as detected by MIF to a reciprocal titer of 16.
  • Possible cases show the presence of antibodies against C psittaci with titers of 1:32 by CF or MIF.

Histologic Findings

Findings may include tracheobronchitis and interstitial pneumonitis with air-space involvement and predominant mononuclear cell infiltration. Findings may also include macrophages that contain cytoplasmic inclusion bodies (ie, Levinthal-Coles-Lillie [LCL] bodies), focal necrosis of hepatocytes along with Kupffer cell hyperplasia in the liver, and hepatic noncaseating granulomata.

Treatment

Medical Care

Consider the diagnosis of psittacosis in patients with community-acquired pneumonia who have been exposed to birds. The mainstay of medical care is antibiotic therapy.

Consultations

• Notify public health authorities about cases of psittacosis.
• Obtain a consultation with an infectious disease specialist.

Diet

Patients require no specific diet.

Activity

Patients do not require activity restrictions.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the clinical setting. Tetracycline and doxycycline are the antibiotics of choice. Treating patients for 2-3 weeks usually prevents relapse. Clinical response occurs within 24-72 hours. Use erythromycin in children younger than 9 years and in pregnant women. Chloramphenicol is a third alternative antibiotic.

Doxycycline remains the drug of choice. Macrolide and quinolone failures have been observed.

Azithromycin (Zithromax)

Anecdotal reports suggest that it is effective. Acts by binding to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected.
Concentrates in phagocytes and fibroblasts as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues.
Treats mild-to-moderate microbial infections.

Plasma concentrations are very low, but tissue concentrations are much higher, giving it value in treating intracellular organisms. Has a long tissue half-life.

Dosing

Adult

Day 1: 500 mg PO
Days 2-5: 250 mg PO qd
Community-acquired pneumonia: 500 mg PO/IV qd for 7-10 d

Pediatric

<6 months: Not established
>6 months:
Day 1: 10 mg/kg PO once; not to exceed 500 mg/d
Days 2-5: 5 mg/kg PO qd; not to exceed 250 mg/d

Interactions

May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine

Contraindications

Documented hypersensitivity; hepatic impairment; do not administer with pimozide

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Site reactions can occur with IV route; bacterial or fungal overgrowth may result from prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function or prolonged QT intervals

Doxycycline (Vibramycin)

DOC; inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Continue treatment for at least 2 wk to prevent relapse.

Dosing

Adult

100 mg PO bid
Severe cases: 4.4 mg/kg IV q12h

Pediatric

<8 years: not recommended
>8 years and <100 lb: 2 mg/kg/d in PO/IV in 1-2 divided doses on day 1; then 1-2 mg/kg/d in 1-2 divided doses; not to exceed 200 mg/d
>8 years and >100 lb: Administer as in adults

Interactions

Bioavailability decreases slightly with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity is very rare with prolonged exposure to sunlight; avoid during last half of pregnancy through 8 y

Erythromycin (E-Mycin, Ery-Tab, E.E.S.)

Macrolide antibiotic; second DOC. Inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. For treatment of staphylococcal and streptococcal infections. In children, age, weight, and severity of infection determine proper dosage. When bid dosing is desired, administer half total daily dose q12h. For more severe infections, double the dose.

Dosing

Adult

500 mg erythromycin stearate/base (or 800 mg ethylsuccinate) PO qid 1 h ac for 2-3 wk
Alternatively, use 333 mg q8h; increase up to 4 g/d, depending on severity of infection

Pediatric

30-50 mg/kg/d (15-25 mg/lb/d) PO divided q6-8h; double dose for severe infection

Interactions

Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis

Contraindications

Documented hypersensitivity; hepatic impairment

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI adverse effects are common (administer doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur

Chloramphenicol (Chloromycetin)

Third DOC but rarely used in the US. Binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria.

Dosing

Adult

500 mg IV qid for 2-3 wk

Pediatric

50-100 mg/kg/d IV divided q6h for 2-3 wk

Interactions

Concurrently with barbiturates, chloramphenicol serum levels may decrease while barbiturate levels may increase and cause toxicity; manifestations of hypoglycemia may occur with sulfonylureas; rifampin may reduce serum chloramphenicol levels, presumably through hepatic enzyme induction; may increase effects of anticoagulants; may increase serum hydantoin levels, possibly resulting in toxicity; chloramphenicol levels may be increased or decreased

Contraindications

Documented hypersensitivity

Precautions

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Use only for indicated infections, or as prophylaxis for bacterial infections; serious and fatal blood dyscrasias (ie, aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia) can occur; evaluate baseline and perform periodic blood studies approximately every 2 d while in therapy; discontinue upon appearance of reticulocytopenia, leukopenia, thrombocytopenia, anemia, or findings attributable to chloramphenicol; adjust dose in liver or kidney dysfunction; caution in pregnancy at term or during labor because of potential toxic effects on fetus (ie, gray syndrome)

Moxifloxacin (Avelox)

Inhibits the A subunits of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription. Anecdotal reports suggest that this drug is effective.

Dosing

Adult

400 mg PO/IV qd

Pediatric

<18 years: Not recommended
>18 years: Administer as in adults

Interactions

Antacids and electrolyte supplements reduce absorption; loop diuretics, probenecid, and cimetidine increase serum levels; NSAIDs enhance CNS stimulating effect
May increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT); ferrous sulfate decreases bioavailability (administer moxifloxacin 4 h prior or 8 h following ferrous sulfate); coadministration with drugs that prolong QTc interval (quinidine, procainamide, amiodarone, sotalol, erythromycin, tricyclic antidepressants) increase risk of life-threatening arrhythmia

Contraindications

Documented hypersensitivity; known QT prolongation, concurrent administration of drugs that cause QT prolongation

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); superinfections may occur with prolonged or repeated antibiotic therapy; fluoroquinolones have induced seizures in CNS disorders and caused tendinitis or tendon rupture

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.

References

1. Smith KA, Bradley KK, Stobierski MG, et al. Compendium of measures to control Chlamydophila psittaci (formerly Chlamydia psittaci) infection among humans (psittacosis) and pet birds, 2005. J Am Vet Med Assoc. Feb 15 2005;226(4):532-9. [Medline].

2. Matsushima H, Takayanagi N, Ubukata M, et al. [A case of fulminant psittacosis with rhabdomyolysis]. Nihon Kokyuki Gakkai Zasshi. Jul 2002;40(7):612-6. [Medline].

3. Committee of the National Association of State Public Health Veterinarians. Compendium of measures to control Chlamydia psittaci infection among humans (psittacosis) and pet birds (avian chlamydiosis), 2000. Centers for Disease Control and Prevention. Morbidity Mortality Weekly Reports. 2000;49:3-17. [Medline].

4. Coutts II, Mackenzie S, White RJ. Clinical and radiographic features of psittacosis infection. Thorax. Jul 1985;40(7):530-2. [Medline].

5. Crosse BA. Psittacosis: a clinical review. J Infect. Nov 1990;21(3):251-9. [Medline].

6. Cunha BA. Atypical pneumonias. Clinical diagnosis and empirical treatment. Postgrad Med. Oct 1991;90(5):89-90, 95-8, 101. [Medline].

7. Cunha BA. Atypical pneumonias. In: Conn RB, Borer WZ, Snyder JW, eds. Current Diagnosis. WB Saunders Co; 1996.

8. Cunha BA. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect. May 2006;12 Suppl 3:12-24. [Medline].

9. Cunha BA. The chlamydial pneumonias. Drugs Today (Barc). Dec 1998;34(12):1005-12. [Medline].

10. Cunha BA, Ortega AM. Atypical pneumonia. Extrapulmonary clues guide the way to diagnosis. Postgrad Med. Jan 1996;99(1):123-8, 131-2. [Medline].

11. De Schrijver K. A psittacosis outbreak in Belgian customs officers. Euro Surveillance. 1995;Sep:3. [Medline].

12. Elliott JH. Psittacosis. A flu like syndrome. Aust Fam Physician. Aug 2001;30(8):739-41. [Medline].

13. Entrican G, Brown J, Graham S. Cytokines and the protective host immune response to Chlamydia psittaci. Comp Immunol Microbiol Infect Dis. Jan 1998;21(1):15-26. [Medline].

14. Gherman RB, Leventis LL, Miller RC. Chlamydial psittacosis during pregnancy: a case report. Obstet Gynecol. Oct 1995;86(4 Pt 2):648-50. [Medline].

15. Gregory DW, Schaffner W. Psittacosis. Semin Respir Infect. Mar 1997;12(1):7-11. [Medline].

16. Heddema ER, Kraan MC, Buys-Bergen HE, et al. A woman with a lobar infiltrate due to psittacosis detected by polymerase chain reaction. Scand J Infect Dis. 2003;35(6-7):422-4. [Medline].

17. Hughes P, Chidley K, Cowie J. Neurological complications in psittacosis: a case report and literature review. Respir Med. Oct 1995;89(9):637-8. [Medline].

18. Jaton K, Greub G. [Chlamydia: diagnostic and treatment]. Rev Med Suisse. Mar 30 2005;1(13):895-8, 901-3. [Medline].

19. Johnson DH, Cunha BA. Atypical pneumonias. Clinical and extrapulmonary features of Chlamydia, Mycoplasma, and Legionella infections. Postgrad Med. May 15 1993;93(7):69-72, 75-6, 79-82. [Medline].

20. Kirchner JT. Psittacosis. Is contact with birds causing your patient's pneumonia?. Postgrad Med. Aug 1997;102(2):181-2, 187-8, 193-4. [Medline].

21. MacLaren G, Pellegrino V, Butt W, et al. Successful use of ECMO in adults with life-threatening infections. Anaesth Intensive Care. Oct 2004;32(5):707-10. [Medline].

22. Matsui T, Nakashima K, Ohyama T, et al. An outbreak of psittacosis in a bird park in Japan. Epidemiol Infect. Apr 2008;136(4):492-5. [Medline].

23. Nash TW, Murray HW. The atypical pneumonias. In: Fishman AP, ed. Pulmonary diseases and disorders. Vol 2. 2^nd ed. New York, NY: McGraw-Hill; 1998:1619-24.

24. Oldach DW, Gaydos CA, Mundy LM, et al. Rapid diagnosis of Chlamydia psittaci pneumonia. Clin Infect Dis. Sep 1993;17(3):338-43. [Medline].

25. Raso Tde F, Godoy SN, Milanelo L, et al. An outbreak of chlamydiosis in captive blue-fronted Amazon parrots (Amazona aestiva) in Brazil. J Zoo Wildl Med. Mar 2004;35(1):94-6. [Medline].

26. Schlossberg D. Chlamydia psittaci (psittacosis). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 5^th ed. Philadelphia, Pa: Churchill Livingstone; 2000:2004-6.

27. Schlossberg D, Delgado J, Moore MM, et al. An epidemic of avian and human psittacosis. Arch Intern Med. Nov 22 1993;153(22):2594-6. [Medline].

28. Stamm WE. Chlamydial infection: psittacosis. In: Braunwald E, et al, eds. Harrison's Principles of Internal Medicine. 14^th ed. New York, NY: McGraw Hill; 1998:1055-64.

29. Telfer BL, Moberley SA, Hort KP, et al. Probable psittacosis outbreak linked to wild birds. Emerg Infect Dis. Mar 2005;11(3):391-7. [Medline].

30. The latest from the IVD industry December 2004. Chlamydia--pathogens that are still often underestimated. Clin Lab. 2005;51(3-4):225-9. [Medline].

31. Tong CY, Sillis M. Detection of Chlamydia pneumoniae and Chlamydia psittaci in sputum samples by PCR. J Clin Pathol. Apr 1993;46(4):313-7. [Medline].

32. Verweij PE, Meis JF, Eijk R, et al. Severe human psittacosis requiring artificial ventilation: case report and review. Clin Infect Dis. Feb 1995;20(2):440-2. [Medline].

33. Wong KH, Skelton SK, Daugharty H. Utility of complement fixation and microimmunofluorescence assays for detecting serologic responses in patients with clinically diagnosed psittacosis. J Clin Microbiol. Oct 1994;32(10):2417-21. [Medline].

Keywords

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

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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