Seminar on psittacosis

An infectious disease due to a bacteria (Chlamydia psittaci) contracted from psittacine birds, especially caged birds like parrots, parakeets, and lovebirds and also in turkey processing plants called psittacosis.1879 - The first outbreak of psittacosis linked the disease to pet parrots and finches

1. SEMINAR ON PSITTACOSIS PRESENTED BY P . Asma Afreen

2. DEFINITION Psittacosis (parrot  fever ):  An infectious disease due to a bacteria ( C hlamydia   psittaci ) contracted from psittacine birds, especially caged birds like parrots, parakeets, and lovebirds and also in turkey processing plants . Psittacosis can be mild, moderate or severe; some people may have no symptoms. Older people generally experience more severe reactions.

3. HISTORY 1879 - The first outbreak of psittacosis linked the disease to pet parrots and finches 1929 – 1930 – 750 human cases with 20% mortality. 1935 – wild psittacines in Australia 1980s – 70% of cases due to having caged birds 1988 – 2006 – 923 cases in US 2002 – 2006 – 66 human cases of reported to the CDC 2011 – 2012 – psittacosis outbreak in Tayside,scotland

4. EPIDEMIOLOGY Psittacosis can affect any age group and gender, but incidence tends to peak in middle age, with an age range of 35 to 55 . The number of report cases of psittacosis in the United States has varied, ranging from 50 to 200 per year. The most recent outbreak being 13 confirmed cases in Georgia and Virginia in 2018. The incidence of psittacosis in the United States concluded that during the years of 1999 to 2006, the reported cases of psittacosis varied between 12 and 25 annually, indicating an incidence of 0.01 per 100,000 population.

5. ETIOLOGY Chlamydia psittaci  is a type of bacteria that often infects birds. Less commonly, these bacteria can infect people and cause a disease called psittaAcosis . Psittacosis in people is most commonly associated with pet birds, like parrots and cockatiels, and poultry, like turkeys or ducks . C. psittaci  are gram-negative, obligate intracellular bacteria of both mammals and birds with multiple genotypes which can be sequenced by genotype-specific real-time PCR for identification and epidemiological studies.

6. TRANSMISSION

7. RISK factors: People of all ages can get psittacosis, but it is more commonly reported among adults. Those who have contact with pet birds and poultry, including people who work in bird-related occupations, are at increased risk: Bird owners Aviary and pet shop employees Poultry workers Veterinarians

8. HISTOPATHOLOGY:

9. PATHOPHYSIOLOGY   C. psittaci   enters into host through inhaling dust Initial infection of the alveolar epithelial cells Multiplication of the bacterium within the host’s epithelial cells allowing for its virulence and spread Initiates a complex host response leading to a large influx of neutrophills thought to be mediated through chemokine release, especially interleukin- 8, a pro-inflammatory cytokine, from the infected host.

10. Activation of an inflammatory cascade and reactive oxygen species, which triggers further recruitment and accumulation of phagocytes and immune cells Result in tissue damage and breakdown of the alveolar-capillary membrane enabling the hematogenous spread of  C. psittaci . Hypoxemia as well as limitations in lung compliance and resultant alveolar hypoventilation .

11. SIGNS AND SYMPTOMS In people, psittacosis causes mild illness. The most common symptoms include : F ever and chills N ausea and vomiting M uscle and joint pain Diarrhoea W eakness Fatigue, sweating C ough (typically dry ) Psittacosis can also cause pneumonia, a lung infection.Most people begin developing signs and symptoms within 5 to 14 days. Less commonly , people report symptoms starting after 14 days.

12. DIAGNOSIS LABORATORY lowered white blood cell count initially during the acute phase of the illness with noted leukopenia later in the disease course.  Anemia has also been observed, most commonly attributed to hemolysis .  Liver function testing, specifically aspartate and alanine aminotransferase , as well as gamma- glutamyl transpeptidase (AST, ALT, GGT) have also been shown to be variably elevated in psittacosis. Additionally, C-reactive protein (CRP) is variable elevated . SEROLOGY Complement fixation test Microimmunofluorescence Sputum culture X-ray of the chest - unilateral consolidation to bilateral, miliary , interstitial and nodular infiltrates Complete blood count CT scan of the chest

13. COMPLICATIONS Most people treated properly for psittacosis make a full recovery. However, some people have serious complications and need care in a hospital. Complications include: Serious pneumonia (lung infection) Endocarditis (inflammation of the heart valves) Hepatitis (inflammation of the liver) Inflammation of the nerves or the brain, leading to neurologic problems With appropriate antibiotic treatment, psittacosis rarely (less than 1 in 100 cases) results in death.

14. TREATMENT Antibiotic therapy is the primary treatment for individuals with psittacosis. Tetracycline and doxycycline are usually the first medications used. Most individuals respond within 24 to 72 hours. The treatment with doxycycline uses 100 mg orally or intravenously every 12 hours for 10 to 14 days. Erythromycin may be recommended for children or pregnant women. Third line antibiotics active against  C. psittaci  include fluoroquinolones , which are less effective than tetracyclines and macrolides . In rare cases, individuals have been treated with chloramphenicol . Very young children may be treated with azithromycin ..

15. Chlamydia psittaci are sensitive to both macrolides and tetracyclines . However, tetracyclines are the drugs of choice, unless contraindicated as they are in children, due to reported macrolide failures. In pregnancy and in patients where doxycycline is contraindicated, the infection is best treated with macrolide antibiotics, such as azithromycin and erythromycin for a 7-day course. After diagnosis, antibiotic treatment typically continues for 10 to 14 days after the fever resolves. Most people who are treated for parrot fever make a full recovery. However, recovery may be slow in people who are older, very young, or who have other health issues.

16. PREVENTION Avoid unnecessary handling of sick birds. Avoid breathing in any dust from dried bird droppings, feathers or cage dust. Isolate sick birds from the rest of the flock. Treat infected birds with appropriate antibiotics for at least one month. Clean cages with appropriate disinfectants, since the bacteria can live for several months in shed feathers and droppings. Wear masks and gloves while cleaning the cages to prevent infection Clean the cages regularly, using plenty of water to minimise the risk of floating dander.

17. Always wash hands thoroughly after tending to birds. Buy pet birds from reputable pet shops. Wash your hands regularly after handling birds or bird supplies. Avoid touching a bird’s beak to your mouth or nose. Take birds that look sick to the veterinarian. Keep birds in a well-ventilated area.

18. REFERENCES https://www.medicinenet.com/script/main/art.asp?articlekey https://www.healthline.com/health/psittacosis https://healthjade.net/psittacosis/#Psittacosis_causes https://www.ncbi.nlm.nih.gov/books/NBK526005 https://emedicine.medscape.com/article/227025-overview https://www.cdc.gov/pneumonia/atypical/psittacosis/index.html http://www.antimicrobe.org/new/m03.asp https://www.britannica.com/science/psittacosis