East Tennessee Region

1. East Tennessee Region • 9-28-06 – Pet cockatiel (Frankie) diagnosed with Chlamydophila psittaci • What is C. psittaci and why do I need to do follow up on a bird?

2. Birds “Avian chlamydiosis” best term to specify infection with C. psittaci in birds Humans “Psittacosis” originating from parrots or psittacine birds (parrot fever) Chlamydia or Chlamydophila Genus

3. What is Psittacosis? • Psittacosis is an infectious disease transmitted to humans from birds in the parrot family, turkeys and pigeons • Caused by bacteria - Chlamydophila psittaci

4. Reservoir & Hosts • 130 species of birds worldwide and variety of mammals and humans • Most common source of human infection: exposure to recently acquired parrot type birds (macaw, cockatoo, parakeet, cockatiel, lovebird)

5. Life Cycle • Enters the host via inhalation or ingestion and replicates • Released to the environment via feces, nasal secretions, sputum, blood or infected tissues • May survive in soil 3 months or in bird droppings 1 month • Humans acquire by fecal/oral, mouth to beak contact, or handling plumage or tissues • Inhalation of aerosolized organism

6. Clinical Signs and Symptoms – Human • Incubation 5-14 days • Abrupt onset of fever, chills, headache, malaise, and myalgia • Occasional severe pneumonia and non respiratory health problems

7. Psittacosis Case Definition (CDC) Clinical description • Illness characterized by fever, chills, headache, photophobia, cough, and myalgia Laboratory • Isolation of organism from respiratory secretions or • Fourfold or greater increase in antibody titer or • High antibody titer by MIF (micro-immunofluorescence)

8. Opening Scenario • Local veterinarian notified Tennessee Department of Health of positive c. psittaci for “Frankie” cockatiel • Time for us to go to work!!! • Investigation begins….

9. Compendium of Measures toControl Chlamydophilia psittaci Infection Among Humans and Pet Birds, 2006 National Association of State Public Health Veterinarians, Inc. http://www.nasphv.org

10. Psittacosis Compendium • Prevention and control • Testing methods • Treatment options • Responsibilities of owners, physicians, and veterinarians • Epi investigations • Bird quarantine • Bird importation

11. Psittacosis Compendium • Prevention and control • Testing methods • Treatment options • Responsibilities of owners, physicians, and veterinarians • Epi investigations • Bird quarantine • Bird importation

12. When to conduct an epidemiological investigation? • Bird chlamydiosis (confirmed or probable) obtained from a pet store, breeder, or purchased w/in 60 days of onset of illness • Person with confirmed or probable psittacosis • Several avian chlamydiosis cases from same source

13. Diagnosis of C. Psittaci • “Frankie” lab confirmed illness • PCR + Blood • PCR + Fecal • IFA + Serum • Frankie was exposed to two recently purchased birds that died • Veterinarian noticed that Frankie's owner had “classical symptoms of psittacosis”

14. Investigation • Bird owner – owned Frankie for several years • Newly purchased cockatiels • First one died two days after purchase • Second bird was purchased then died 5 days later • From same pet store

15. Human Patient #1, Bird Owner • Headache, fever, myalgia, cough for 3 weeks • PCP confirmed: • “Acute URI” • Serology test for psittacosis • Rx: Doxycycline 100 mg bid x 10 days

16. Human Patient # 2, Store Owner • Out of work ill; visiting doctor • Headache, cough, chills, fever 101.3, for 2-3 weeks • CXR: “consistent with psittacosis” • Serology for psittacosis • Rx: Doxycycline x 21 days

17. Human These two were treated with Doxycycline. Other treatment choices include: Erythromycin or Azithromycin “Z-pack” Bird Oral doxycycline is the treatment of choice Treatment

18. Human Case Confirmation • Both patients improved with treatment • Convalescent serum collected after 10-14 days • Acute and convalescent serum sent to state lab then CDC – results pending

19. Pet Store Visit • Questionnaire developed; 26 employees and the distributor interviewed for illness • Provide: education and fact sheet • One employee reported “tiredness” • Another employee reported headache, cough, tiredness; referred to physician but refused

20. Veterinary Visit to Store • State Veterinarian notified (Dept. of Agriculture) • Local Veterinarian visited Pet Store; 60 birds examined – no other illnesses Isolate and treat 3 birds caged with the 2 birds that died • Store employees educated on illness in birds, cleaning procedures, and preventive measures

21. Distributor • Sick birds traced to an individual distributor • Raised birds and had a few domestic breeders • Housed at facility for short time • Sales records and dates not kept • Likely delivered the cockatiels one month prior

22. Results • Illness in the 2 people resolved with treatment • “Frankie” well and at home • No other illnesses among staff or animals at store

23. Clinical Signs - Birds • Respiratory signs: nasal or ocular discharge, difficulty breathing • Signs of liver disease: green urates in droppings, inappetance • Common: spleen & liver enlarged • Pigeons & passerines exhibit little or no symptoms: “asymptomatic carriers”

24. Notifiable Disease? • Human psittaci is a nationally notifiable disease • Many states, not Tennessee, require avian chlamydiosis be reported to State Veterinarian • Imported birds not routinely tested for psittaci

25. Lessons Learned • First step: Consult the Psittacosis Compendium (NASPHV) • Importance of Communication & Teamwork • Store Owner • Healthcare Providers • Health Department (Local, Region, State, & State Lab) • All of the Above

26. Thank you! Rhonda C. Campbell East Tennessee Regional Health Office P.O. Box 59019 Knoxville, TN 37920-9019 (865) 549-5287 Rhonda.C.Campbell@state.tn.us QUESTIONS? QUESTIONS?

27. The End