介绍发热门诊临床医生对轻症鹦鹉热衣原体肺炎的早期识别的临床经验。

回顾性分析2021年6月至2022年8月就诊于北京大学第三医院发热门诊并于入院后采用宏基因组高通量测序（mNGS）确诊的13例轻症鹦鹉热衣原体肺炎患者的临床资料。收集患者禽类接触史、发热及伴随症状、血常规和胸部CT影像。

13例（100%）患者均有明确的鹦鹉或鸽子接触史。患者除了发热症状之外，6例（46.2%）伴干咳，8例（61.5%）伴明显头痛，从出现症状到就诊的中位数时间为3 d。血常规白细胞计数为6.92×10⁹/L（5.04×10⁹/L~8.42×10⁹/L），中性粒细胞比例为76.4%（71.2%~84.8%）。胸部CT显示肺炎均位于一侧肺，绝大多数（12例，92.3%）只累及一个肺叶，以肺下叶更常见（10例，76.9%），肺外带比内带分布更为多见（76.9%比23.1%）。肺部实变最多见（7例，53.8%），其次为结节（4例，30.8%）和肿块（2例，15.4%），常同时伴周围磨玻璃影（11例，84.6%）和内部支气管充气征（11例，84.6%）。而支气管壁增厚（1例，7.7%）、小叶中心结节（1例，7.7%）和胸腔积液（1例，7.7%）为少见影像。

发热门诊临床医生接诊患者符合发热伴干咳或明显的头痛、外周血象正常、胸部CT表现为单侧肺下叶外周实变等临床特征者，应询问鹦鹉或鸽子接触史，考虑到鹦鹉热衣原体肺炎。

To report our experience with early recognition of mild Chlamydia psittaci pneumonia in fever clinic.

Clinical data of 13 cases of mild Chlamydia psittaci pneumonia who visited the Fever Clinic of Peking University Third Hospital from June 2021 to August 2022 were retrospectively analyzed. The diagnosis was confirmed by metagenomic next generation sequencing (mNGS) after admission. Clinical data collected included history of exposure to poultry and birds, clinical symptoms, routine blood tests, and chest CT images.

All the patients (100%) had a history of direct exposure to parrots or pigeons and fever, with 6 cases (46.2%) complicated with dry cough and 8 (61.5%) with obvious headache. The median time from symptoms to the visit of fever clinic was 3 days. The median white blood cell count was 6.92×10⁹/L (range, 5.04×10⁹/L-8.42×10⁹/L), and the median percentage of neutrophils was 76.4% (range, 71.2%-84.8%). Chest CT findings consisted of consolidation (7 cases, 53.8%), nodules (4 cases, 30.8%), and mass (2 cases, 15.4%), which were mainly found in the periphery (10 cases, 76.9%) of one lobe (12 cases, 92.3%) in a single lung (100%) and were often accompanied by surrounding ground glass shadows (11 cases, 84.6%) and internal air bronchogram (11 cases, 84.6%). Bronchial wall thickening (1 case, 7.7%), centrilobular nodules (1 case, 7.7%), and pleural fluid (1 case, 7.7%) was infrequently observed.

Chlamydia psittaci pneumonia should be considered when patients visit fever clinic with a history of exposure to parrots or pigeons, fever with nonproductive cough or prominent headache, normal white blood cell count, and consolidation in the periphery of the lower lobe of a single lung on chest CT images.