Wednesday, April 12, 2017

Japan Reports 2 Fatal Cases of Parrot Fever (Psittacosis) In Pregnant Women


Although details are scant, the Japanese language media is reporting overnight on the unusual deaths of two pregnant women from Psittacosis, otherwise known as parrot fever.  One English language report I found from the Japan Times reads:

Two pregnant women die from parrot-borne disease
Kyodo, Staff Report

Two pregnant women have died after they contracted a disease spread through a parrot’s infected feces, health ministry officials said, in what is likely to be the first such cases in Japan.
According to a research team at the Japan Agency for Medical Research and Development, two maternal deaths related to the disease were found in a probe it conducted in fiscal 2016.
The ministry and the national research agency would not say when the two women died.

(Continue . . . )

Parrot fever is a rare, atypical bacterial pneumonia caused by Chlamydia psittaci.  The CDC cites an average of 10 cases of Psittacosis reported each year in the US, although others may go undiagnosed. Treatment is with Tetracyclines, and most people treated recover.

 The CDC's Psittacosis website goes on to say:
Birds are the natural reservoirs of C. psittaci and infection is usually acquired by inhaling dried secretions from infected birds. The incubation period is 5 to 19 days. Although all birds are susceptible, pet birds (parrots, parakeets, macaws, and cockatiels) and poultry (turkeys and ducks) are most frequently involved in transmission to humans. Personal protective equipment (PPE), such as gloves and appropriate masks, should be used when handling birds or cleaning their cages.
Risk Groups
Bird owners, aviary and pet shop employees, poultry workers, and veterinarians. Outbreaks of psittacosis in poultry processing plants have been reported.

Large outbreaks are uncommon, but we've seen some small clusters of cases around the world over the past decade. In 2007 (see To You, My Heart Cries Out Chlamydia) I wrote about a small outbreak that occurred at a Bird lovers Society show in Weurt, Norway.

In November of 2012, in Psittacosis Identified In Hong Kong Respiratory Outbreak, we saw a limited outbreak among personnel at an agricultural station where smuggled birds seized by customs agents had been quarantined. Subsequently 3 parrots died, and 10 were euthanized.

Human infection, at least until relatively recently, has been solely attributed to direct or indirect contact with infected birds. 

But in 2012, the journal Eurosurveillance carried a report called Psittacosis outbreak in Tayside, Scotland, December 2011 to February 2012, involving four family members and a health-care worker, which suggested human-to-human transmission.

The following year, in Sweden Reports Rare Outbreak Of Parrot Fever, we saw a credible report of human transmission of parrot fever, where a 75 year old man who died in Kronoberg appeared to have spread the infection to at least 8 close contacts, including healthcare personnel.

In 2014, the ECDC's Eurosurveillance Journal carried a follow up report called:
Eurosurveillance, Volume 19, Issue 42, 23 October 2014
Surveillance and outbreak reports
Multiple human-to-human transmission from a severe case of psittacosis, Sweden, January–February 2013
Proven transmission of Chlamydia psittaci between humans has been described on only one occasion previously. We describe an outbreak which occurred in Sweden in early 2013, where the epidemiological and serological investigation suggests that one patient, severely ill with psittacosis after exposure to wild bird droppings, transmitted the disease to ten others: Two family members, one hospital roommate and seven hospital caregivers. Three cases also provided respiratory samples that could be analysed by PCR. All the obtained C. psittaci sequences were indistinguishable and clustered within genotype A.
The finding has implications for the management of severely ill patients with atypical pneumonia, because these patients may be more contagious than was previously thought. In order to prevent nosocomial person-to-person transmission of C. psittaci, stricter hygiene measures may need to be applied. 

While H-2-H transmission of C. psittaci now appears possible, contact with birds still appears to be the primary route of transmission (by far).

One of the most fascinating stories regarding Parrot Fever came in 1929, just 10 years after the end of the Spanish Flu Pandemic, when a multi-state outbreak of Parrot Fever briefly stoked pandemic fears once again.
I wrote about It’s surprising long term impact back in 2012 (see How Parrot Fever Changed Public Health In America).

Prior to the development of antibiotics in the middle of last century, the mortality rate from psittacosis pneumonia was on the order of 15% to 20%. The 1929 outbreak would eventually identify 169 cases of parrot fever nationwide, along with 33 deaths (including several members of the public health team investigating the outbreak).

A 2007  EID Journal report Chlamydophila psittaci Transmission from Pet Birds to Humans looked at the use of antibiotics at 39 breeding bird breeding facilities in Belgium, and found that more that 40% had used antibiotics to treat sick birds in the previous 12 months.

More than 10% routinely gave antibiotics to birds prophylactically. The author's warned:

 Because of the risk of developing drug-resistant strains, as described for Chlamydia suis (12,13), regular use of antimicrobial drugs must be avoided.

Just another way that the overuse of antibiotics could eventually return us to the `bad old days'  when relatively minor bacterial infections could prove deadly.

Hopefully we'll get more information out of Japan on these two fatal cases, including when and where they occurred, and if they are epidemiologically linked. A short, English Language media report may be heard at this NTV link:

Two pregnant women die of parrot fever in Japan

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