From: Laboratory methods for case finding in human psittacosis outbreaks: a systematic review
Article, publication year[reference] | Outbreak year, country | Population, setting | Laboratory test C. psittaci, numbers positive/numbers tested | Remarks | ||
---|---|---|---|---|---|---|
 | PCR | Serology (name test, numbers) | Culture |  | ||
Huminer et al., 1988 [31] | 1986–1987, Israel | 8 Families in contact with pet birds or domestic fowl | No | IPA 24/36 with 8/36 seroconversion IgM | Throat swab 22/35 | 8 Family outbreaks with exclusion of C. pneumoniae by MIF; 1 case possible person-to-person transmission; 3 outbreaks with sick household birds (parrots) as index case. |
Bourke et al., 1989 [27] | NM, UK | Family with aviary outside house | No | CFT 3/9 and MIF 3/9 | Nasopharyngeal aspirates, after antibiotics 0/3(?) | Serological cross-reactions with C. trachomatis and C. pneumoniae gave difficulties. |
CDC, 1990 [11] | 1989, USA | Workers turkey processing plant | No | CFT 40/60 | BAL specimen, 1 (seropositive) case | 24/40 Hospitalized. |
Samra et al., 1991 [32] | 1987, Israel | Family owning 3 parrots of which 2 recently died | No | IPA (IgM, IgG, IgA,) 4/4 | Saliva, throat, sputum 3/4 | 2/4 Patients developed hepatitis. |
Morrison et al., 1991 [39] | 1989, UK | Employees and visitors pet shop, after delivery new Agapornis birds | No | CFT 7/7 | No | 2 Patients died. |
CDC, 1992 [26] | 1992, USA | 2 Families bought pet birds (parakeet, cockatiel) linked to bird distributor | No | CFT family A 1/1, family B 2/6 | No | Child and mother of family A mucopurulent conjunctivitis. |
Hedberg et al., 1989 [12] | 1986, USA | Workers at turkey farm and processing plants | No | CFT 122/697 workers; 122/186 suspected cases | No | 13 Hospitalized. |
Hinton et al., 1993 [13] | 1989–1990, Australia | Workers duck farm and processing plant | No | CFT 19/25 with 3/19 seroconversion or IgM positive | No | 3 Symptomatic cases; Significant association length of employment and presence of antibodies; Isolation of C. psittaci in birds. |
Schlossberg et al., 1993 [21] | 1991–1992, USA | Contacts private aviary in basement and outdoors with poultry, psittacine birds, canaries and finches | No | CFT 13/24 (1 confirmed, 10 presumptive, 2 suspected cases) | No | Joint swelling 3 cases, 1 case had a rash and 3 seropositive cases without symptoms. |
Davies et al., 1995 [28] | NM, UK | Cases associated with 2 linked aviaries(e.g. parrots, cockatiels, parakeets) | No | CFT 9/12, IF or CFT positives 9/9 | No | Bird contact reported by 5/9 cases. 1 Fatal case. IF to exclude C. pneumoniae. |
Hughes et al., 1997 [42] | 1994, USA | Hospital staff and roommate exposed to pet-shop worker with psittacosis | No | MIF IgM, IgG 5/8 | ? | Person-to-person transmission likely; Cross-reactivity possible as 3 cases were also MIF seropositive for C. pneumoniae. |
Goupil et al., 1998 [14] | 1990, France | Workers poultry slaughterhouse, truck driver, maintenance mechanic | No | CFT or IF seroconversion with 5Â week interval 18/56 | No | Retrospective study symptomatic workers of whom 6 pneumonia and 4 hospitalized. |
Moroney et al., 1998 [22] | 1995, USA | Owners of recently bought birds originating from 1 breeder (parakeets, finches, cockatiels, love birds, conures, canaries, parrots) | No | MIF 10/58 | No | Human outbreak identified after diagnosis of chlamydiosis in birds. Clinical illness did not correspond with serological response. |
Williams et al., 1998 [23] | 1995, Australia | People living close to forest with many native parrots | Post-mortem lung tissue 1/1 | IF screening 16 positive; CFT 14/16 (four-fold rise or seroconversion) | No | Case-control study; < 2% seropositivity among controls; 1 person died possibly infected by person-to-person transmission. Comment in [59, 60]. |
Lederer et al., 1999 [15] | NM, Germany | Comparison of (a) 82 workers chicken, duck, and geese processing plant of whom 8 symptomatic with; (b) 83 workers other chicken processing plant and (c) 82 non-occupationally exposed | No | (a) CFT/IPA 57/82 and MIF 13/25 (b) CFT/IPA 16/83 and MIF 0/8; (c) CFT/IPA 22/82 and MIF 0/17 | No | 10/18 Workers employed < 3 months had serological signs of recent infection. Two cases died of multi-organ failure, 6 others had pneumonia. Also tested for C. pneumoniae and C. trachomatis in MIF. |
Ito et al., 2002 [41] | NM, Japan | Family, index case visited confectionary with parakeets | No | CFT and MIF 2/2 | ? | Possible person-to-person transmission between sisters. Index case rising CFT titer, sister static high CFT titer. C. pneumoniae and C. trachomatis checked by MIF. |
Telfer et al., 2005 [24] | 2002, Australia | Residents with direct or indirect wild bird contact (parrots, doves, currawongs, magpies) | (Only for exclusion C. pneumoniae 0/8) | MIF 59/95 with 35/59 seroconversion or 4-fold titer rise; 33/35 also 4-fold rise CFT; 3 MIF negatives had 4-fold rise in CFT | No | Case-control study. 2 ICU cases. Probable source wild birds in yards; 1 king parrot tested C. psittaci positive. MIF/EIA for exclusion C. trachomatis and MIF C. pneumoniae. No evidence of infection by other respiratory pathogens in probable C. psittaci cases. |
Saito et al., 2005 [40] | NM, Japan | Owner and co-worker of pet shop selling parrots, parakeets and budgerigars | No | CFT 2/2; MIF 2/2 (seroconversion) | ? | Cross-reactivity with ELISA for C. pneumoniae. Infection by Chlamydophilia avium in a couple working in a pet shop. Comment about nomenclature Chlamydophilia avium [61] |
Heddema et al., 2006 [20] | 2004, Netherlands | Students and staff veterinary teaching hospital in contact with cockatiels, Amazon parrots and pigeons | OmpA RT-PCR 6/29 (sputum, throat swabs) | R-ELISA 9/29, CFT on r-ELISA positive sera 6/9 | No | 3 Hospitalized cases including 1 ICU. Not all PCR positives also seropositive or vice versa. Genotype of C. psittaci PCR positive parrots matched with human cases. |
Kaibu et al., 2006 [30] | 2005, Japan | Family; index patient bought cockatiel parakeet from pet shop | Pharyngeal swab, 0/2 | MIF four-fold rise 4/4 | Pharyngeal swab 0/2 | Dead bird C. psittaci PCR positive. C. pneumoniae and C. trachomatis also tested by MIF. |
Harkinezhad et al., 2007 [46] | NM, Belgium | Veterinarian and veterinary assistant, tested after visiting parrot relief/breeding center, and manager of this center | OmpA nested PCR 3/3, genotype-spec RT-PCR 2/3 pharyngeal, nasal swabs | ELISA 2/2 | Pharyngeal, nasal swabs 2/3 | First report of transmission of genotype E/B from African grey parrots to humans. Veterinarian and assistant had only mild or no clinical signs. |
Tiong et al., 2007 [16] | 2003–2004, Australia | Workers duck abattoir and farm with ducks in open sheds in contact with wild birds | No | ELISA 53/97; IF 35/53 | No | 44/53 Cases reported symptoms and 5/12 pneumonia cases hospitalized. IF to exclude C. pneumoniae and other Chlamydiae spp. cross-reactions. 18/53 Significant cross-reaction to C. pneumoniae. |
Berk, 2008 et al., [3] | 2007, Netherlands | Visitors, participants bird show with many different bird species | RT-PCR 3/11 (2/11 throat swab, 1/5 sputum, 0/7 urine, 0/11 serum) | CFT 0/11 initial sample but seroconversion 9/11 | No | 23/> 200 Visitors ill and 11 hospitalized. Many CFT positives were not PCR positive. Bird source was a Siskin (not a psittaciformes). |
Branley et al., 2008 [44] | 2005, Australia | Staff veterinary surgery handling sick, wild psittacine bird | Spp. spec PCR (genus spec PCR) throat swab 1/3 (1/3), blood 1/3 (1/3), urine 0/3 (2/3) | MIF IgG 3/3 | 0/3 | First report of PCR analyses on human blood and urine samples for diagnosing psittacosis and first report of using PCR for comparison organism load in human psittacosis patients compared to that of sick source bird. Wild bird culture positive. MIF and PCR (urine) negative for C. trachomatis (0/3). |
Çiftçi et al., 2008 [29] | NM, Turkey | Family, bought 2 parrots a month ago | No | MIF 2/2 | No? | First report of psittacosis from Turkey. |
Gaede et al., 2008 [17] | 2005, Germany | Veterinary officer, poultry breeders at infected poultry farm | RT-PCR and DNA micro-array assay BAL 2/2 and urine 1/1 | CFT 111 samples of 65 ‘contacts’ – data not clear. 7 hospitalized cases positive. All CFT positive also MIF positive | No | 17/24 Suspected human cases and 7 hospitalized confirmed cases, of whom 3 admitted to ICU; 1 patient died. C. pneumoniae tested by MIF. Birds PCR positive. |
Matsui et al., 2008 [18] | 2001–2002, Japan | Staff, students and visitors of bird park with hothouses | No | CFT 3/3 and MIF 14/14 symptomatic cases; MIF 8/91 non-symptomatic staff members | No | 13/17 Hospitalized cases. Cross-reactions C. pneumoniae and C. trachomatis excluded by MIF. |
Verminnen et al., 2008 [36] | 2005–2006, Belgium | Turkey farmer and 2 scientists at turkey farm | Nested PCR 3/3 (sputum, pharyngeal, nasal swabs) | MIF 0/3 r-ELISA 3/3 | 3/3 | Environmental monitoring study, not strictly an outbreak study. In air samples, chlamydial organisms detected by nested PCR. PCR C. pneumoniae and C. trachomatis negative. |
Laroucau et al., 2009 (1) [37] | 2006, France | Workers at duck farms and wife of worker | PCR 3/4 (1 BAL, 2 tracheal aspirates, 0 throat swab) | MIF 5/5 | Tracheal aspirates 1/4; BAL, throat swab negative | 5 Severe psittacosis cases but avian flu was suspected at first. Ducks and human cases linked by PCR sequencing OmpA gene. Cross-reactions C. pneumoniae and C. trachomatis checked by MIF. |
Belchior et al., 2011 [19] | 2008, France | Participants bird fair organized by breeders of Psittacidae | 2 RT-PCR 2/3 throat swab | MIF 2/29 (probable cases) | No | Retrospective cohort (n = 86) study, AR 33/86, 11/48 suspected cases hospitalized, 29/48 tested by serology. |
Yang et al., 2011 [38] | 2009, China | Peacock farmers of a flock of sick peacocks | Genotyping OmpA on isolate | IF IgG 4/4 20Â days post infection | Throat swab 1/4 | First report of psittacosis in peacocks and peacock farmers. |
McGuigan et al., 2012 [43] | 2011–2012, Scotland (UK) | Outbreak investigation after pneumonia in 4 family members and 1 health care worker | RT-PCR 3/6, spp. specific PCR 3/3 | CFT positive in 3 confirmed cases, 1 probable case and 4 possible cases | No | Person-to-person spread to healthcare worker with same PCR OmpA strain as index case and to 1 possible case staying at ICU with index case. Suspected C. pneumoniae outbreak turned out to be C. psittaci outbreak after PCR specification (spec RT-PCR C. pneumoniae 0/3). |
Williams et al., 2013 [34] | 2008, England (UK) | Poultry (mainly ducks) processing plant production line workers, engineering staff and visiting administrator | DNA microarray genotyping on DIF positive sputum sample 1/1 | (Paired) CFT and WHIF; WHIF 7/9, 5/7 WHIF positive, 4/9 WHIF recent or rising CFT | No | 2/3 Hospitalized cases ICU. AR 4% (9/225); 16/63 Persons some evidence of C. psittaci infection, 9/63 cases met case definition, 6/9 were symptomatic and sputum of 4/9 cases tested by DIF; 4/4 DIF positive. Cases only in plant processing free-range ducks. |
Wallensten et al., 2014 [25] | 2013, Sweden | Hospitalized psittacosis patient who transmitted the bacterium to family, hospital room mate and medical staff | PCR OmpA 3/3 (BAL) | MIF 4/11 IgM, 6/11 IgG, convalescent 1/6 IgM, 3/6 IgG | No | Human-to-human transmission proven and index ICU patient died. His wife and 5 other secondary cases needed hospitalization: 7 confirmed, 3 probable, 1 possible case; MIF negative for C. trachomatis and C. pneumonia |
Laroucau et al., 2015 [35] | 2013, France | Women with chicken gutting activities on a mixed poultry farm | RT-PCR Chlamydiaceae-spec 23SrRna specific IncA 4/5 sputum, 0/4 throat swabs | MIF 2/8 | No | 8 Hospitalized cases; throat swabs taken after start medication, 4 confirmed, 1 probable, 3 possible cases; in chickens C. psittaci and C. gallinacea detected |
De Boeck et al., 2016 [33] | 2013, Belgium | Belgian couple and daughter bought lovebird in pet shop in the Netherlands | Nested PCR OmpA 2/2, genotyping RT-PCR, pharyngeal swab | Indirect IF IgM 1/3, IgG 2/3 | Pharyngeal swab 2/2 | Couple hospitalized; daughter, tested after self-treatment. One patient seronegative but PCR positive. Birds and humans both genotype A |
Chan et al., 2017 [45] | 2014, Australia | People of veterinary school and horse stud farm in contact with fetal membrane of specific mare | No | EIA 3/3, MIF 0/3 4-fould rise, MIF 1/3 single high titer, MIF 2/3 falling titer | No | 2 Hospitalized cases. AR 56%, 3 probable, 2 suspected cases of 9; mare serology EIA positive for Chlamydial spp. and fetal membrane qPCR positive; foal died 1Â week old |