Psittacosis: symptoms

There is no generally accepted classification of ornithosis. The following classification is most rational.

• Manifest forms:
  • sharp:
    • pneumonic,
    • influenza-like,
    • typhoid-like;
  • Subacute:
    • with the defeat of the lungs,
    • without affecting the lungs;
  • chronic:
    • with the defeat of the lungs,
    • without affecting the lungs.
• Asymptomatic (inapparent) infection.

By severity, they release a mild, moderate and severe form of the disease. The acute form lasts to 1.5-2.0 months, subacute - from 2 to 6 months, chronic - from 2 to 8 years.

Influenza-like and pneumonic forms account for up to 85% of all cases of the disease.

The incubation period for ornithosis is from 5 to 30, usually 8-12 days. With the pneumonic form, the disease usually begins acutely: with chills, fever to 38-40 C, severe weakness, headache, pain in the muscles and joints. The temperature reaches a maximum on the 2nd-4th day of the disease. The fever is remittent, and without treatment at 2-4 weeks of the illness, the temperature is lytically reduced. In severe cases, fever of a constant type is possible. From the 2nd to 3rd day of the disease, there is a dry, sometimes paroxysmal cough. On the 3-4th day, cough becomes productive. Sputum is mucopurulent, sometimes with veins of blood. Possible pain in breathing, shortness of breath. The main signs in this period are laryngotracheitis and tracheobronchitis. On the 5th-7th day, physical signs of lung damage are determined: shortening of percussion sound, weakened or hard breathing, uninvited crepitation or small bubbling rales in the lower parts of the lungs. In some patients, by the end of the first week of the illness, pleural friction is heard. Exudative pleurisy, as a rule, does not happen. When X-ray examinations, one-sided, more often right, lower-lobe pneumonia is defined, less often bilateral pneumonia. There are four types of pneumonia in ornithosis: interstitial (in half of patients), small-focal, large-focal and lobar. For all types of pneumonia, the expansion of the roots of the lungs, the enhancement of the bronchoconstrictive pattern and the increase in bifurcation lymph nodes are characteristic. By the end of the febrile period, pneumonia is permitted. In some patients, the enhancement of the pulmonary pattern may persist for many years. From the side of the cardiovascular system - the tendency to bradycardia, moderate hypotension and pulse lability. In severe disease, mute heart sounds, systolic murmur and ECG signs of diffuse myocardial damage are detected. Appetite is reduced, there may be nausea, vomiting, more often there is a delay in the stool. The language is imposed. At half of patients from 3-4 days of illness the liver is enlarged, signs of a violation of its function are determined, hepatitis is possible. At the third of patients in the same period the spleen increases. All patients develop signs of neurotoxicosis: headache, insomnia, lethargy, adynamia. In severe course - depressive state, delirium, confused consciousness with psychomotor agitation, euphoria. May be signs of meningism in rare cases - serous meningitis. Usually the pneumonic variant of ornithosis is characterized by moderate and severe course.

The flu-like form of ornithosis is diagnosed only during outbreaks and is characterized by a sharp onset, a short-term (from 2 to 8 days) fever to 37.5 to 39 ° C, signs of intoxication, dry cough, throat rash, and sometimes hoarseness. The course of the disease is mild or moderate.

Typhoid-like form develops with alimentary infection and is characterized by severe fever of permanent or remitting type, relative bradycardia, hepatosplenomegaly. Pronounced non-toxicity and absence of respiratory damage.

Ornithous meningitis is defined in 1-2% of patients. The disease begins acutely with an increase in body temperature to 39-40 ° C and symptoms of intoxication. Within 2-4 days (less than 6-8 days), meningeal syndrome is determined. When carrying out spinal puncture, fluid flows under increased pressure. In the cerebrospinal fluid, moderate lymphocytic cytosis is noted (up to 300-500 cells per 1 μl), a moderate increase in the protein. The disease proceeds for a long time. The fever has an undulating course and lasts 3-4 weeks. Sanitation of the cerebrospinal fluid comes in 5-6 weeks and later. Persistent residual effects from the central nervous system after the transferred: ornithotic meningitis, as a rule, does not happen.

In all patients, regardless of the form of ornithosis, asthenia persists for a long time (up to 2-3 months or more) with a sharp decrease in work capacity, rapid fatigue, hypotension, vegetative-vascular changes (acrocyanosis, chilliness of limbs, palmar hyperhidrosis, tremor of the eyelids and fingers).

Chronicle of the process occurs in 5-10% of patients and is due to the development of chronic pneumonia, less often endocarditis (in persons suffering from heart defects). In most cases, chronic pneumonia is caused not only by the chlamydophile, but also by the coccal flora, which must be taken into account in the treatment.

For all forms of acute ornithosis, a tendency to leukopenia and lymphocytosis is characteristic, a significant, up to 40-60 mm / h, an increase in ESR even in mild cases.

Complications

Complications of ornithosis - meningitis, thrombophlebitis, hepatitis, myocarditis, iridocyclitis, thyroiditis. Pancreatitis. Their occurrence is possible even in the period of early convalescence. With modern forms of ornithosis complications are rare, more frequent relapses (especially with irrational treatment). Relapses occur 1-2 weeks after the normalization of body temperature and last 5-7 days.

[1], [2]