Ornithosis - Symptoms

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

• Manifest forms:
  • acute:
    • pneumonic,
    • flu-like,
    • typhoid-like;
  • subacute:
    • with lung damage,
    • without lung damage;
  • chronic:
    • with lung damage,
    • without lung damage.
• Asymptomatic (inapparent) infection.

According to severity, mild, moderate and severe forms of the disease are distinguished. The acute form lasts up 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 days, most often 8-12 days. In the pneumonic form, the disease usually begins acutely: with chills, an increase in body temperature to 38-40 C, severe weakness, headache, muscle and joint pain. The temperature reaches its maximum on the 2nd-4th day of the disease. The fever is remittent in nature, and without treatment, the temperature lytically decreases on the 2nd-4th week of the disease. In severe cases, a constant fever is possible. From the 2nd-3rd day of the disease, a dry, sometimes paroxysmal cough appears. On the 3rd-4th day, the cough becomes productive. The sputum is mucopurulent, sometimes with streaks of blood. Pain when breathing, shortness of breath are possible. The main symptoms during this period are laryngotracheitis and tracheobronchitis. On the 5th-7th day, physical signs of lung damage are determined: shortening of the percussion sound, weakened or harsh breathing, scant crepitation or fine bubbling rales in the lower parts of the lungs. In some patients, pleural friction rub is heard by the end of the first week of the disease. Exudative pleurisy, as a rule, does not occur. X-ray examination reveals unilateral, more often on the right, lower lobe pneumonia, less often bilateral pneumonia. Four types of pneumonia in ornithosis are distinguished: interstitial (in half of the patients), small focal, large focal and lobar. All types of pneumonia are characterized by dilation of the lung roots, increased bronchovascular pattern and enlargement of the bifurcation lymph nodes. By the end of the febrile period, pneumonia resolves. In some patients, increased pulmonary pattern may persist for many years. From the cardiovascular system - a tendency to bradycardia, moderate hypotension and pulse lability. In severe cases of the disease, muffled heart sounds, systolic murmur and ECG signs of diffuse myocardial damage are detected. Appetite is reduced, nausea, vomiting may occur, and stool retention is more common. The tongue is coated. In half of the patients, the liver enlarges from the 3rd-4th day of the disease, signs of dysfunction are determined, hepatitis is possible. In a third of patients, the spleen enlarges during the same period. All patients develop signs of neurotoxicosis: headache, insomnia, lethargy, adynamia. In severe cases - depression, delirium, confusion with psychomotor agitation, euphoria. Signs of meningism may be determined, in rare cases - serous meningitis. Usually, the pneumonic variant of ornithosis is characterized by a moderate to severe course.

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

The typhus-like form develops with alimentary infection and is characterized by severe fever of a constant or remittent type, relative bradycardia, hepatosplenomegaly, severe non-toxicosis and absence of damage to the respiratory organs.

Ornithosis meningitis is detected 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 often 6-8 days) meningeal syndrome is determined. During a spinal puncture, the fluid flows out under increased pressure. Moderate lymphocytic cytosis (up to 300-500 cells in 1 μl) and a moderate increase in protein are noted in the cerebrospinal fluid. The disease is long-term. Fever has a wave-like course and persists for 3-4 weeks. Sanitation of the cerebrospinal fluid occurs after 5-6 weeks and later. As a rule, there are no persistent residual phenomena from the central nervous system after ornithosis meningitis.

In all patients, regardless of the form of ornithosis, asthenia persists for a long time (up to 2-3 months or more) during the recovery period, with a sharp decrease in working capacity, rapid fatigue, hypotension, and vegetative-vascular changes (acrocyanosis, cold extremities, hyperhidrosis of the palms, tremor of the eyelids and fingers).

The process becomes chronic in 5-10% of patients and is caused by the development of chronic pneumonia, less often endocarditis (in people suffering from heart defects). In most cases, chronic pneumonia is caused not only by chlamydophila, but also by coccal flora, which must be taken into account during treatment.

All forms of acute ornithosis are characterized by a tendency towards leukopenia and lymphocytosis, a significant increase in ESR, up to 40-60 mm/h, even in mild cases.

Complications

Complications of ornithosis include meningitis, thrombophlebitis, hepatitis, myocarditis, iridocyclitis, thyroiditis, and pancreatitis. They may also occur during early convalescence. In modern forms of ornithosis, complications are rare, and relapses are more common (especially with irrational treatment). Relapses occur 1-2 weeks after normalization of body temperature and last 5-7 days.

[ 1 ], [ 2 ]