Psittacosis Workup

  • Author: Klaus-Dieter Lessnau, MD, FCCP; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jul 20, 2011
 

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.
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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).
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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.
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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.

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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 Thoracic Society, and Society of Critical Care Medicine

Disclosure: Sepracor None None

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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.

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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