1. C. Psittaci & Psittacosis
Rhonda C. Campbell
East Tennessee Regional Health Office
P.O. Box
Knoxville, TN
(865)

2. East Tennessee Region
– Pet cockatiel (Frankie) diagnosed with Chlamydophila psittaci
What is C. psittaci and why do I need to do follow up on a bird?

3. 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)

4. 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

5. 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)

6. 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

7. 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

8. 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-immunofluorescence)

9. 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….

10. National Association of State Public Health Veterinarians, Inc.
Compendium of Measures to Control Chlamydophilia psittaci Infection Among Humans and Pet Birds, 2006
National Association of State Public Health Veterinarians, Inc.

11. Psittacosis Compendium
Prevention and control
Testing methods
Treatment options
Responsibilities of owners, physicians, and veterinarians
Epi investigations
Bird quarantine
Bird importation

12. Psittacosis Compendium
Prevention and control
Testing methods
Treatment options
Responsibilities of owners, physicians, and veterinarians
Epi investigations
Bird quarantine
Bird importation

13. 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

14. 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”

15. 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

16. 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

17. 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

18. 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

19. Human Case Confirmation
Both patients improved with treatment
Convalescent serum collected after days
Acute and convalescent serum sent to state lab then CDC – results pending

20. Pet Store Visit
Questionnaire developed; 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

21. 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

22. 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

23. Results Illness in the 2 people resolved with treatment
“Frankie” well and at home
No other illnesses among staff or animals at store

24. 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”

25. 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

26. 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

27. East Tennessee Regional Health Office
QUESTIONS?
QUESTIONS?
Thank you!
Rhonda C. Campbell
East Tennessee Regional Health Office
P.O. Box 59019
Knoxville, TN
(865)

28. The End