Gestational psittacosis: an emerging infection

Human psittacosis is a rare infection caused by Chlamydia psittaci that is transmitted through close contact with birds or poultry. However, Zhenjie Zhang and colleagues1Zhang Z Zhou H Cao H et al.Human-to-human transmission of Chlamydia psittaci in China, 2020: an epidemiological and aetiological investigation.Lancet Microbe. 2022; (published online May 23.)https://doi.org/10.1016/S2666-5247(22)00064-7Summary Full Text Full Text PDF Scopus (4) Google Scholar recently reported human-to-human transmission of C psittaci in China, where C psittaci was detected in patients with community-acquired pneumonia. Half of these patients were workers at a duck-meat processing plant, whereas others had no exposure to birds or farm animals. Close contacts of these patients, including health-care workers and family members, also developed respiratory symptoms and tested positive for C psittaci.1Zhang Z Zhou H Cao H et al.Human-to-human transmission of Chlamydia psittaci in China, 2020: an epidemiological and aetiological investigation.Lancet Microbe. 2022; (published online May 23.)https://doi.org/10.1016/S2666-5247(22)00064-7Summary Full Text Full Text PDF Scopus (4) Google ScholarHuman-to-human transmission of psittacosis is an emerging public health risk to medical workers and other close contacts, including pregnant women. Psittacosis during pregnancy is rare, but can cause substantial maternal and fetal morbidity and mortality.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar The infection usually presents with fever persisting for more than 2 days, influenza-like illness, normal or moderately decreased leucocyte count, and thrombocytopenia.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar Psittacosis can promote maternal morbidities, including atypical pneumonia, sepsis, diffuse intravascular coagulation, and hepatic and renal dysfunction.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar, 3McKinlay AW White N Buxton D et al.Severe Chlamydia psittaci sepsis in pregnancy.Q J Med. 1985; 57: 689-696PubMed Google Scholar, 4Gherman RB Leventis LL Miller RC Chlamydial psittacosis during pregnancy: a case report.Obstet Gynecol. 1995; 86: 648-650Crossref PubMed Scopus (30) Google Scholar Previous studies showed an 82·6% fetal mortality and an 8·7% maternal mortality due to gestational psittacosis.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google ScholarDelays in the diagnosis of gestational psittacosis can lead to the abovementioned severe consequences. However, diagnostic tests for C psittaci (such as isolation of C psittaci, serological tests, and detection of C psittaci DNA)5Nieuwenhuizen AA Dijkstra F Notermans DW van der Hoek W Laboratory methods for case finding in human psittacosis outbreaks: a systematic review.BMC Infect Dis. 2018; 18: 442Crossref PubMed Scopus (33) Google Scholar are not routinely available in most hospitals, especially in low-income countries. Timely diagnosis is essential so that adequate treatment can be given to pregnant patients. The recommended antibiotic therapy for gestational psittacosis is erythromycin;2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar, 6Hyde SR Benirschke K Gestational psittacosis: case report and literature review.Mod Pathol. 1997; 10: 602-607PubMed Google Scholar, 7Janssen MJ van de Wetering K Arabin B Sepsis due to gestational psittacosis: a multidisciplinary approach within a perinatological center—review of reported cases.Int J Fertil Womens Med. 2006; 51: 17-20PubMed Google Scholar however, a previous report showed that macrolides are also an effective treatment prenatally.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google ScholarThe epidemiology of gestational psittacosis is still only partly understood. The nonspecific symptoms and absence of routinely available tests pose a diagnostic conundrum.Thus, the prevention of transmission and outbreaks of this disease is of paramount importance. Pregnant women should avoid contact with birds and livestock, farmers who have direct contact with these animals, and any other people who are possibly infected with psittacosis. Health-care professionals caring for pregnant women should also be aware of this emerging infection. Proper history, early recognition, and appropriate antibiotic management are required to save both mother and child. Despite its low incidence, psittacosis remains an important emerging infection associated with perinatal morbidity and mortality. Hence, more research is needed to understand the epidemiology and to develop evidence-based diagnosis and treatment of this disease during pregnancy. Human psittacosis is a rare infection caused by Chlamydia psittaci that is transmitted through close contact with birds or poultry. However, Zhenjie Zhang and colleagues1Zhang Z Zhou H Cao H et al.Human-to-human transmission of Chlamydia psittaci in China, 2020: an epidemiological and aetiological investigation.Lancet Microbe. 2022; (published online May 23.)https://doi.org/10.1016/S2666-5247(22)00064-7Summary Full Text Full Text PDF Scopus (4) Google Scholar recently reported human-to-human transmission of C psittaci in China, where C psittaci was detected in patients with community-acquired pneumonia. Half of these patients were workers at a duck-meat processing plant, whereas others had no exposure to birds or farm animals. Close contacts of these patients, including health-care workers and family members, also developed respiratory symptoms and tested positive for C psittaci.1Zhang Z Zhou H Cao H et al.Human-to-human transmission of Chlamydia psittaci in China, 2020: an epidemiological and aetiological investigation.Lancet Microbe. 2022; (published online May 23.)https://doi.org/10.1016/S2666-5247(22)00064-7Summary Full Text Full Text PDF Scopus (4) Google Scholar Human-to-human transmission of psittacosis is an emerging public health risk to medical workers and other close contacts, including pregnant women. Psittacosis during pregnancy is rare, but can cause substantial maternal and fetal morbidity and mortality.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar The infection usually presents with fever persisting for more than 2 days, influenza-like illness, normal or moderately decreased leucocyte count, and thrombocytopenia.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar Psittacosis can promote maternal morbidities, including atypical pneumonia, sepsis, diffuse intravascular coagulation, and hepatic and renal dysfunction.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar, 3McKinlay AW White N Buxton D et al.Severe Chlamydia psittaci sepsis in pregnancy.Q J Med. 1985; 57: 689-696PubMed Google Scholar, 4Gherman RB Leventis LL Miller RC Chlamydial psittacosis during pregnancy: a case report.Obstet Gynecol. 1995; 86: 648-650Crossref PubMed Scopus (30) Google Scholar Previous studies showed an 82·6% fetal mortality and an 8·7% maternal mortality due to gestational psittacosis.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar Delays in the diagnosis of gestational psittacosis can lead to the abovementioned severe consequences. However, diagnostic tests for C psittaci (such as isolation of C psittaci, serological tests, and detection of C psittaci DNA)5Nieuwenhuizen AA Dijkstra F Notermans DW van der Hoek W Laboratory methods for case finding in human psittacosis outbreaks: a systematic review.BMC Infect Dis. 2018; 18: 442Crossref PubMed Scopus (33) Google Scholar are not routinely available in most hospitals, especially in low-income countries. Timely diagnosis is essential so that adequate treatment can be given to pregnant patients. The recommended antibiotic therapy for gestational psittacosis is erythromycin;2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar, 6Hyde SR Benirschke K Gestational psittacosis: case report and literature review.Mod Pathol. 1997; 10: 602-607PubMed Google Scholar, 7Janssen MJ van de Wetering K Arabin B Sepsis due to gestational psittacosis: a multidisciplinary approach within a perinatological center—review of reported cases.Int J Fertil Womens Med. 2006; 51: 17-20PubMed Google Scholar however, a previous report showed that macrolides are also an effective treatment prenatally.2Katsura D Tsuji S Kimura F Tanaka T Eguchi Y Murakami T Gestational psittacosis: a case report and literature review.J Obstet Gynaecol Res. 2020; 46: 673-677Crossref PubMed Scopus (8) Google Scholar The epidemiology of gestational psittacosis is still only partly understood. The nonspecific symptoms and absence of routinely available tests pose a diagnostic conundrum. Thus, the prevention of transmission and outbreaks of this disease is of paramount importance. Pregnant women should avoid contact with birds and livestock, farmers who have direct contact with these animals, and any other people who are possibly infected with psittacosis. Health-care professionals caring for pregnant women should also be aware of this emerging infection. Proper history, early recognition, and appropriate antibiotic management are required to save both mother and child. Despite its low incidence, psittacosis remains an important emerging infection associated with perinatal morbidity and mortality. Hence, more research is needed to understand the epidemiology and to develop evidence-based diagnosis and treatment of this disease during pregnancy. I declare no competing interests. Human-to-human transmission of Chlamydia psittaci in China, 2020: an epidemiological and aetiological investigationOur study data might represent the first documented report of human-to-human transmission of C psittaci in China. Therefore, C psittaci has the potential to evolve human-to-human transmission via various routes, should be considered an elevated biosecurity and emergent risk, and be included as part of the routine diagnosis globally, especially for high-risk populations. Full-Text PDF Open Access