C' Psittaci

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C. PsittaciPsittacosis

Rhonda C. Campbell East Tennessee Regional Health
Office P.O. Box 59019 Knoxville, TN
37950-9019 [phone] Rhonda.C.Campbell_at_state.
tn.us
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East Tennessee Region

• 9-28-06 Pet cockatiel (Frankie) diagnosed with
  Chlamydophila psittaci
• What is C. psittaci and why do I need to do
  follow up on a bird?

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Chlamydia or Chlamydophila Genus

• Birds
• Avian chlamydiosis best term to specify
  infection with C. psittaci in birds

• Humans
• Psittacosis originating from parrots or
  psittacine birds (parrot fever)

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What is Psittacosis?

• Psittacosis is an infectious disease transmitted
  to humans from birds in the parrot family,
  turkeys and pigeons
• Caused by bacteria - Chlamydophila psittaci

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Reservoir Hosts

• 130 species of birds worldwide and variety of
  mammals and humans
• Most common source of human infection exposure
  to recently acquired parrot type birds (macaw,
  cockatoo, parakeet, cockatiel, lovebird)

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Life Cycle

• Enters the host via inhalation or ingestion and
  replicates
• Released to the environment via feces, nasal
  secretions, sputum, blood or infected tissues
• May survive in soil 3 months or in bird droppings
  1 month
• Humans acquire by fecal/oral, mouth to beak
  contact, or handling plumage or tissues
• Inhalation of aerosolized organism

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Clinical Signs and Symptoms Human

• Incubation 5-14 days
• Abrupt onset of fever, chills, headache, malaise,
  and myalgia
• Occasional severe pneumonia and non respiratory
  health problems

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Psittacosis Case Definition (CDC)

• Clinical description
• Illness characterized by fever, chills, headache,
  photophobia, cough, and myalgia
• Laboratory
• Isolation of organism from respiratory secretions
  or
• Fourfold or greater increase in antibody titer or
• High antibody titer by MIF (micro-immunofluorescen
  ce)

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Opening Scenario

• Local veterinarian notified Tennessee Department
  of Health of positive c. psittaci for Frankie
  cockatiel
• Time for us to go to work!!!
• Investigation begins.

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Compendium of Measures toControl Chlamydophilia
psittaci Infection Among Humans and Pet Birds,
2006

• National Association of State Public Health
  Veterinarians, Inc.
• http//www.nasphv.org

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Psittacosis Compendium

• Prevention and control
• Testing methods
• Treatment options
• Responsibilities of owners, physicians, and
  veterinarians
• Epi investigations
• Bird quarantine
• Bird importation

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Psittacosis Compendium

• Prevention and control
• Testing methods
• Treatment options
• Responsibilities of owners, physicians, and
  veterinarians
• Epi investigations
• Bird quarantine
• Bird importation

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When to conduct an epidemiological investigation?

• Bird chlamydiosis (confirmed or probable)
  obtained from a pet store, breeder, or purchased
  w/in 60 days of onset of illness
• Person with confirmed or probable psittacosis
• Several avian chlamydiosis cases from same source

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Diagnosis of C. Psittaci

• Frankie lab confirmed illness
• PCR Blood
• PCR Fecal
• IFA Serum
• Frankie was exposed to two recently purchased
  birds that died
• Veterinarian noticed that Frankie's owner had
  classical symptoms of psittacosis

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Investigation

• Bird owner owned Frankie for several years
• Newly purchased cockatiels
• First one died two days after purchase
• Second bird was purchased then died 5 days later
• From same pet store

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Human Patient 1, Bird Owner

• Headache, fever, myalgia, cough for 3 weeks
• PCP confirmed
• Acute URI
• Serology test for psittacosis
• Rx Doxycycline 100 mg bid x 10 days

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Human Patient 2, Store Owner

• Out of work ill visiting doctor
• Headache, cough, chills, fever 101.3, for 2-3
  weeks
• CXR consistent with psittacosis
• Serology for psittacosis
• Rx Doxycycline x 21 days

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Treatment

• Human
• These two were treated with Doxycycline. Other
  treatment choices include
• Erythromycin or
• Azithromycin Z-pack

• Bird
• Oral doxycycline is the treatment of choice

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Human Case Confirmation

• Both patients improved with treatment
• Convalescent serum collected after 10-14 days
• Acute and convalescent serum sent to state lab
  then CDC results pending

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Pet Store Visit

• Questionnaire developed 26
  employees and the distributor interviewed for
  illness
• Provide education and fact sheet
• One employee reported tiredness
• Another employee reported headache, cough,
  tiredness referred to physician but refused

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Veterinary Visit to Store

• State Veterinarian notified (Dept. of
  Agriculture)
• Local Veterinarian visited Pet Store 60 birds
  examined no other illnesses Isolate and treat
  3 birds caged with the 2 birds that died
• Store employees educated on illness in birds,
  cleaning procedures, and preventive measures

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Distributor

• Sick birds traced to an individual distributor
• Raised birds and had a few domestic breeders
• Housed at facility for short time
• Sales records and dates not kept
• Likely delivered the cockatiels one month prior

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Results

• Illness in the 2 people resolved with treatment
• Frankie well and at home
• No other illnesses among staff or animals at store

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Clinical Signs - Birds

• Respiratory signs nasal or ocular discharge,
  difficulty breathing
• Signs of liver disease green urates in
  droppings, inappetance
• Common spleen liver enlarged
• Pigeons passerines exhibit little or no
  symptoms asymptomatic carriers

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Notifiable Disease?

• Human psittaci is a nationally notifiable disease
• Many states, not Tennessee, require avian
  chlamydiosis be reported to State Veterinarian
• Imported birds not routinely tested for psittaci

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Lessons Learned

• First step Consult the Psittacosis Compendium
  (NASPHV)
• Importance of Communication Teamwork
• Store Owner
• Healthcare Providers
• Health Department (Local, Region, State, State
  Lab)
• All of the Above

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QUESTIONS?
QUESTIONS?

• Thank you!
• Rhonda C. Campbell
• East Tennessee Regional Health Office
• P.O. Box 59019
• Knoxville, TN 37920-9019
• [phone]
• Rhonda.C.Campbell_at_state.tn.us

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The End