Prevalence of Chlamydophila psittaci infections in a human population in contact with domestic and companion birds.
TL;DR: Results confirmed the suspicion about the underestimation of psittacosis in Belgium and showed women with excessive alcohol intake defined as a mean intake of >2 units daily were more frequently infected than men.
Abstract: Chlamydophila psittaci infections in humans are underestimated. We investigated the occurrence of C. psittaci in a Belgian population of 540 individuals. Data were from a population survey (n=2524) of apparently healthy community-dwelling subjects aged 35-55 years. Pharyngeal swabs and blood were taken. Individuals completed a questionnaire on professional and nonprofessional activities, smoking habits, medical history and contact frequency with different bird species. Swabs were analysed by a C. psittaci-specific and a Chlamydophila pneumoniae-specific PCR. Sera were tested by a recombinant C. psittaci major outer-membrane protein-based ELISA, a C. psittaci whole organism-based ELISA (Serion) and a micro-immunofluorescence test (Focus Diagnostics). Results confirmed our suspicion about the underestimation of psittacosis in Belgium. Psittaciformes and racing pigeons were the main infection source. Women with excessive alcohol intake defined as a mean intake of >2 units daily were more frequently infected than men. We analysed the effect of seropositivity and/or PCR positivity on inflammation (white blood cell count, high-sensitivity C-reactive protein, fibrinogen). In general, seropositivity showed a trend to slightly higher levels of inflammatory variables (all non-significant), whilst PCR positivity showed a trend to no effect or even lower inflammatory levels.
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TL;DR: This compendium provides information about psittacosis and avian chlamydiosis to public health officials, physicians, veterinarians, the pet bird industry, and others concerned with controlling these diseases and protecting public health.
Abstract: Psittacosis, also known as parrot fever and ornithosis, is a bacterial infection that can cause severe pneumonia and other serious health problems in humans. It is caused by Chlamydia psittaci. Reclassification of the order Chlamydiales in 1999 into 2 genera (Chlamydia and Chlamydophila) was not wholly accepted or adopted. This resulted in a reversion to the single, original genus Chlamydia, which now encompasses all 9 species including Chlamydia psittaci. During 2003–2014, 112 human cases of psittacosis were reported to the Centers for Disease Control and Prevention through the Nationally Notifiable Diseases Surveillance System. While many types of birds can be infected by C psittaci, in general, the literature suggests that human cases can most often occur after exposure to infected parrot-type birds kept as pets, especially cockatiels, parakeets, and conures. In birds, C psittaci infection is referred to as avian chlamydiosis. Infected birds shed the bacteria through feces and nasal discharges, and humans become infected from exposure to these materials. This compendium provides information about psittacosis and avian chlamydiosis to public health officials, physicians, veterinarians, the pet bird industry, and others concerned with controlling these diseases and protecting public health. The recommendations in this compendium provide standardized procedures to control C psittaci infections. This document will be reviewed and revised as necessary, and the most current version replaces all previous versions. This document was last revised in 2010. Major changes in this version include a recommendation for a shorter treatment time for birds with avian chlamydiosis, additional information about diagnostic testing, including genotyping, clearer language associated with personal protective equipment recommended for those caring for confirmed or exposed birds, and incorporating a grading scale with recommendations generally based on the United States Preventive Services Task Force's methods.
146 citations
TL;DR: The major findings of a national research network that focused on the elucidation of host-pathogen interactions in vitro and in animal models of C. psittaci infection are explained and summarized, with the objective of improving the understanding of genomics, pathology, pathophysiology, molecular pathogenesis and immunology.
60 citations
TL;DR: Clinical characteristics of endemic and outbreak-associated cases were similar, and the nature of exposure, risk factors and reasons for the occurrence of outbreaks of psittacosis require further investigation.
Abstract: Following a large outbreak of community-acquired psittacosis in 2002 in residents of the Blue Mountains, New South Wales, Australia, we reviewed new cases in this area over a 7-year period from 2003 to 2009. Using the 2010 criteria from the Centers for Disease Control National Notifiable Diseases Surveillance System, 85 patients with possible psittacosis were identified, of which 48 were identified as definite or probable infection. Clinical features of these cases are summarized. In addition to Chlamydia-specific serology, specimens, where available, underwent nucleic acid testing for chlamydial DNA using real-time PCR. Chlamydophila psittaci DNA was detected in samples from 23 patients. Four of 18 specimens were culture positive. This is the first description of endemic psittacosis, and is characterized in this location by community-acquired psittacosis resulting from inadvertent exposure to birds. The disease is likely to be under-diagnosed, and may often be mistaken for gastroenteritis or meningitis given the frequency of non-respiratory symptoms, particularly without a history of contact with birds. Clinical characteristics of endemic and outbreak-associated cases were similar. The nature of exposure, risk factors and reasons for the occurrence of outbreaks of psittacosis require further investigation.
53 citations
Cites background from "Prevalence of Chlamydophila psittac..."
...This zoonotic infection most commonly occurs in people with a history of exposure to birds in either the setting of occupational or companion animal exposure [3, 4]....
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TL;DR: This study is believed to be the first to detect C. psittaci in Belgian feral pigeons and the prevalence rate in the city of Ghent was extremely low, which is beneficial for public health.
Abstract: Chlamydiosis is a zoonotic disease in birds caused by Chlamydophila psittaci, an obligate intracellular bacterium. There are seven known avian outer-membrane protein A genotypes, A–F and E/B. The importance of genotyping lies in the fact that certain genotypes tend to be associated with certain hosts and a difference in virulence. Genotype B is the most prevalent in pigeons, but the more virulent genotypes A and D have also been discovered. The current study assessed the prevalence of C. psittaci in 32 Belgian homing-pigeon facilities and in 61 feral pigeons captured in the city of Ghent, Belgium. Additionally, zoonotic transmission of C. psittaci was investigated in the homing-pigeon facilities. Homing pigeons were often infected, as at least one of the lofts was positive in 13 of the 32 (40.6 %) pigeon breeding facilities. Genotypes B, C and D were detected. Zoonotic transmission was discovered in 4 of the 32 (12.5 %) pigeon fanciers, revealing genotype D in two of them, whilst genotyping was unsuccessful for the other two human pharyngeal swabs. This study clearly demonstrates the possible risk of C. psittaci zoonotic transmission from homing pigeons. Pigeon fanciers often (37.5 %) used antibiotics for prevention of respiratory disease. Because of the risk of developing drug-resistant strains, regular use of antimicrobial drugs must be avoided. This study is believed to be the first to detect C. psittaci in Belgian feral pigeons. The prevalence rate in the city of Ghent was extremely low, which is beneficial for public health.
53 citations
Cites background or methods from "Prevalence of Chlamydophila psittac..."
...Whilst this makes comparison with the pigeon breeder study less easy, this technique does not have the disadvantage of intermittent shedding (Harkinezhad et al., 2009a)....
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...Once infected, the infectious agent can easily spread in the loft through contaminated dust and aerosols or during transport of pigeons to the release location (Harkinezhad et al., 2009a)....
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...This pigeon fancier was also infected with genotype D. Harkinezhad et al. (2009b) showed that 7 % of apparently healthy people having daily contact with homing pigeons were positive by PCR and/or by a recombinant major outer-membrane protein antibody ELISA....
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...Respiratory disease in pigeons most often reflects an acute infection accompanied by excretion of a higher amount of infectious C. psittaci than in birds without respiratory symptoms, which most often have intermittent shedding (Harkinezhad et al., 2009a)....
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TL;DR: Strong evidence exists for zoonotic transmission from turkeys, chickens and ducks, in addition to the more traditionally reported parrot-like animal sources, and clinicians and public health officials should include poultry and birds species other than parrots in medical history and source tracing.
Abstract: Human psittacosis, caused by Chlamydia (C.) psittaci, is likely underdiagnosed and underreported, since tests for C. psittaci are often not included in routine microbiological diagnostics. Source tracing traditionally focuses on psittacine pet birds, but recently other animal species have been gaining more attention as possible sources for human psittacosis. This review aims to provide an overview of all suspected animal sources of human psittacosis cases reported in the international literature. In addition, for each animal species the strength of evidence for zoonotic transmission was estimated. A systematic literature search was conducted using four databases (Pubmed, Embase, Scopus and Proquest). Articles were included when there was mention of at least one human case of psittacosis and a possible animal source. Investigators independently extracted data from the included articles and estimated strength of evidence for zoonotic transmission, based on a self-developed scoring system taking into account number of human cases, epidemiological evidence and laboratory test results in human, animals, and the environment. Eighty articles were included, which provided information on 136 different situations of possible zoonotic transmission. The maximum score for zoonotic transmission was highest for turkeys, followed by ducks, owls, and the category ‘other poultry’. Articles reporting about zoonotic transmission from unspecified birds, psittaciformes and columbiformes provided a relatively low strength of evidence. A genotypical match between human and animal samples was reported twenty-eight times, including transmission from chickens, turkeys, guinea fowl, peafowl, pigeons, ducks, geese, songbirds, parrot-like birds and owls. Strong evidence exists for zoonotic transmission from turkeys, chickens and ducks, in addition to the more traditionally reported parrot-like animal sources. Based on our scoring system, the evidence was generally stronger for poultry than for parrot-like birds. Psittaciformes should not be disregarded as an important source of human psittacosis, still clinicians and public health officials should include poultry and birds species other than parrots in medical history and source tracing.
42 citations
Cites background from "Prevalence of Chlamydophila psittac..."
..., 2009 [63] psittaciformes 2002–2003 Belgium PCR & serology 8 no 10...
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...…et al., 2007 [61] ducks 2007 Germany PCR 1 no 5 Harkinezhad et al., 2007 [62] psittaciformes unknown Belgium PCR, culture & serology 3 PCR & culture 22 Harkinezhad et al., 2009 [63] psittaciformes 2002–2003 Belgium PCR & serology 8 no 10 columbiformes 2002–2003 Belgium PCR & serology 8 no…...
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...for example occupationally exposed individuals or people living in areas with high animal or bird density [25, 28, 29, 34, 44, 45, 63, 68, 73, 76, 77, 88, 90]....
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References
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Centers for Disease Control and Prevention1, University of Washington2, University of Milan3, Umeå University4, University of Freiburg5, Johns Hopkins University6, National Institutes of Health7, Indiana University8, University of Picardie Jules Verne9, Lund University10, University of Helsinki11, University of California, San Francisco12
TL;DR: There was extensive variation in the numeric titer values of microimmunofluorescence test results for the serodiagnosis of Chlamydia pneumoniae infections, and the overall percentage agreement with the reference standard titers from the University of Washington was 80%.
Abstract: The lack of standardization in chlamydia serology has made interpretation of published data difficult. This study was initiated to determine the extent of interlaboratory variation of microimmunofluorescence (MIF) test results for the serodiagnosis of Chlamydia pneumoniae infections. Identical panels of 22 sera were sent to 14 laboratories in eight countries for the determination of IgG and IgM antibodies by MIF. Although there was extensive variation in the numeric titer values, the overall percentage agreement with the reference standard titers from the University of Washington was 80%. For results by serodiagnostic category, the best agreement was for four-fold rise in IgG titers, while the lowest agreement was for negative or low IgG titers. Agreement for IgM titers was 50%-95%. Four laboratories failed to discern false-positive IgM titers possibly because of the presence of rheumatoid factor. Further studies are underway to determine the source of interlaboratory variation for the MIF test.
133 citations
"Prevalence of Chlamydophila psittac..." refers background in this paper
...Additionally, the MIF test is subjective and time-consuming, only semiquantitative and has poor reproducibility (Peeling et al., 2000)....
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TL;DR: This compendium provides standardized procedures for controlling avian chlamydiosis in birds and public health officials, physicians, veterinarians, the pet bird industry, and others concerned with controlling these diseases and protecting public health.
Abstract: Psittacosis, also known as parrot fever and ornithosis, is a bacterial infection of humans that can cause severe pneumonia and other serious health problems. It is caused by Chlamydophila psittaci, formerly known as Chlamydia psittaci. From 1988 through 2003, 935 human cases of psittacosis were reported to the CDC and most resulted from exposure to infected pet birds, usually cockatiels, parakeets, parrots, and macaws. In birds, C. psittaci infection is referred to as avian chlamydiosis. Infected birds shed the bacteria through feces and nasal discharges, and humans become infected from exposure to these materials. This compendium provides information about psittacosis and avian chlamydiosis to public health officials, physicians, veterinarians, the pet bird industry, and others concerned with controlling these diseases and protecting public health. The recommendations in this compendium provide standardized procedures for controlling avian chlamydiosis in birds, a vital step to protecting human health. This document will be reviewed and revised as necessary.
127 citations
"Prevalence of Chlamydophila psittac..." refers result in this paper
...This is in accordance with the literature, ascribing most psittacosis cases to contact with Psittaciformes (Heddema et al., 2006a; Kaibu et al., 2006; Smith et al., 2005)....
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TL;DR: A nested, multiplex PCR for simultaneous detection of three species of chlamydiae in human and avian specimens was developed and used to infer that C. psittaci had been transmitted from birds purchased in pet stores to humans.
Abstract: We developed a nested, multiplex PCR for simultaneous detection of three species of chlamydiae in human and avian specimens. The PCR was designed to increase sensitivity and to circumvent inhibitors of PCR present in clinical specimens. The target sequence was the 16S rRNA gene. The first-step PCR was genus specific, and the second-step PCR was multiplexed (i.e., had multiple primer sets in the same tube) and could discriminate among Chlamydia pneumoniae, Chlamydia psittaci, and Chlamydia trachomatis on the basis of the molecular weight of the amplicon. The limit of detection of each of the two PCR steps was 5 inclusion-forming units. We used PCR and serologic evidence during outbreaks of psittacosis to infer that C. psittaci had been transmitted from birds purchased in pet stores to humans. We also used this method to test both live and dead birds from pet stores for infection with C. psittaci. Compared with culture, the application of PCR to avian specimens increased the rate of C. psittaci detection.
109 citations
TL;DR: The use of a panel of serovar-specific monoclonal antibodies in the immunofluorescence test provides a reliable method for serotyping avian isolates and shows that similar serovars are prevalent in avian species in Europe and the United States.
Abstract: A panel of five serovar-specific monoclonal antibodies which distinguish the five known avian serovars of Chlamydia psittaci was used to serotype 45 European avian Chlamydia psittaci isolates. Chlamydial antigen was grown in Buffalo green monkey (BGM) cells or in embryonated chicken eggs and was then inoculated into BGM cells. Serotyping was performed in an indirect immunofluorescence test. The 45 European isolates included 22 isolates from the order Psittaciformes, 9 isolates from the order Columbiformes, 6 isolates from the order Galliformes, 5 isolates from the order Passeriformes, and 3 isolates from the order Anseriformes. All of these were successfully serotyped. No additional serovars were found. One isolate from a duck and two isolates from psittacine birds gave positive immunofluorescences with two monoclonal antibodies considered to be specific for two different serovars. These three isolates were cloned by an agar overlay method. Serotyping of the clones demonstrated that the duck and one psittacine bird each were infected with two different serovars. After cloning, one isolate from a psittacine bird reacted only with serovar A. From these results it was concluded that this serotyping system allows the classification of all isolates tested so far. The results show that similar serovars are prevalent in avian species in Europe and the United States. The results also indicate that birds from a certain order are more susceptible to a distinct serovar. The use of a panel of serovar-specific monoclonal antibodies in the immunofluorescence test provides a reliable method for serotyping avian isolates. Monoclonal antibodies to new avian isolate serovars can easily be added to the panel, which makes the system useful for epidemiological studies.
108 citations
"Prevalence of Chlamydophila psittac..." refers background in this paper
...The disease occurs more often in Psittaciformes and the infection is more severe, often leading to bird mortality, as illustrated by Vanrompay et al. (1993) isolating 45 C. psittaci strains from 264 dead birds, among them only four (8.8...
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TL;DR: Residence in the upper Blue Mountains, age of 50–64 years, direct contact with wild birds, and lawn mowing without a grass catcher were associated with psittacosis.
Abstract: In autumn 2002, an outbreak of probable psittacosis occurred among residents of the Blue Mountains district, Australia. We conducted a case-control study to determine independent risk factors for psittacosis by comparing exposures between hospitalized patients and other residents selected randomly from the telephone directory. Of the 59 case-patients with laboratory results supportive of psittacosis, 48 participated in a case-control study with 310 controls. Independent risk factors were residence in the upper Blue Mountains (odds ratio [OR] 15.2, 95% confidence interval [CI] 5.6-41.7), age of 50-64 years (OR 3.9, 95% CI 1.5-10.5), direct contact with wild birds (OR 7.4, 95% CI 2.5-22), and mowing lawns without a grass catcher (OR 3.2, 95% CI 1.3-8.0). Protective equipment is recommended for residents in areas frequented by free-ranging birds if contact with birds and their droppings is likely when performing outdoor activities such as lawn mowing.
86 citations
"Prevalence of Chlamydophila psittac..." refers background in this paper
...Zoonotic risk is not only limited to direct contact with birds but is also associated with a rural environment and outdoor activities such as gardening and mowing lawns (Fenga et al., 2007; Telfer et al., 2005)....
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