Ornithosis: Causes, Symptoms & Treatment

Ornithosis is one of the so-called zoonoses – disease transmission between animals and humans is possible. However, humans fall ill comparatively rarely.

What is ornithosis?

Ornithosis is an infectious disease that occurs very rarely in humans. Caused ornithosis in many cases by the so-called bacterium Chlamydia psittaci. The disease owes its alternative name ‘psittacosis’ to this bacterial species. In addition, ornithosis is sometimes also called bird breeder’s lung or parrot disease. As an animal disease, ornithosis is subject to compulsory notification within Germany. Pathogens responsible for the disease initially settle in organs such as the spleen and liver. Occasionally, mild symptoms of jaundice may occur due to this fact, but usually go unnoticed by the patient. The first noticeable symptoms of ornithosis are then usually similar to the complaints caused by an influenza illness; these include, for example, headache and sore throat, cold and/or fever. In addition, ornithosis often leads to symptoms typically associated with pneumonia; such as, most notably, a dry cough.

Causes

In most cases, birds are responsible for transmitting the pathogen that leads to ornithosis. Therefore, people who are in frequent contact with birds (such as animal caretakers or pet shop workers) are most at risk. Infection with germs responsible for ornithosis is possible both by direct contact and by droplet transmission (such as during mucking out of bird cages). Infectious germs enter the body of an affected person through the respiratory tract. Once the germs have penetrated the patient’s organism, they multiply in the patient’s cells. The incubation period (the time between infection with germs and the onset of the disease) of ornithosis in this case is about 10 – 20 days.

Symptoms, complaints and signs

Ornithosis caused by the pathogen Chlamydia psitacci usually shows a sudden onset with high fever, headache, aching limbs and chills. Muscle pain is also part of the flu-like symptom complex. In the majority of infected persons, an uncharacteristic rash develops on the body during the first days of the illness. Some patients recover after this flu-like illness episode. If this is not the case, interstitial pneumonia develops. In this case, it is not the functional tissue of the lung that is affected by the inflammation, but the tissue between the alveoli. This is also referred to as atypical pneumonia. Those affected suffer from a dry and persistent irritating cough, which is occasionally accompanied by chest pain. In the further course, pneumonia can lead to hemoptysis, in which patients cough up secretions containing blood. Many patients further complain of severe headache as an accompanying symptom. In more than half of all patients with ornithosis, the spleen is swollen (splenomegaly), whereas liver swelling occurs only in exceptional cases. Another sign of disease suggestive of ornithosis is MALT lymphoma in the area of the lacrimal ducts. This is a malignant disease of the lymphatic system.

Diagnosis and course

If symptoms are present, the fact that an affected person has frequent contact with birds may already provide initial evidence of the presence of ornithosis. However, the disease can also occur in people in whom a corresponding connection cannot be drawn immediately. Further diagnostics in cases of suspected ornithosis include X-rays of the patient’s chest; if ornithosis is present, this can be detected by looking at the structures of the lungs, for example. Laboratory values that indicate ornithosis include, for example, a slight increase in white blood cells. The course of the disease varies from patient to patient and depends, for example, on age and the integrity of the immune system of the affected person. On average, a gradual decrease in fever occurs around the fourth week of the disease. The period until final recovery is influenced, among other things, by the severity of the symptoms and the start of treatment. If left untreated, especially severe forms of ornithosis can lead to the death of the affected person.

Complications

In so-called parrot disease, the course of the underlying disease is already very stressful for those affected and is regularly accompanied by severe flu-like symptoms. Sometimes there are also disturbances of consciousness and severe gastrointestinal complaints. It is not uncommon for patients to develop pneumonia. Beyond that, however, further complications only occur in particularly severe courses. In these cases, the pathogens spread throughout the body and also affect other organs. There is then a risk of myocarditis (inflammation of the heart muscle) and in particularly severe cases, if the pericardium is also inflamed, perimyocarditis. In these diseases, the patient suffers from shortness of breath, pain and feelings of pressure in the chest, especially behind the breastbone, as well as palpitations and cardiac arrhythmias. Due to the lack of oxygen, the lips, and sometimes the entire facial skin, turn bluish. There may also be enlargement of the liver and spleen. Another rare complication is endocarditis. In this disease, the inner lining of the heart becomes inflamed, usually along with the heart valves. Affected individuals develop high fever, chills and joint pain. The doctor may also often notice altered heart murmurs. In addition, there is often a disturbance in kidney function. Occasionally, the pathogens of ornithosis also affect the central nervous system and cause meningitis (meningitis). However, such severe complications are generally only to be expected if ornithosis is not treated in time or the patient suffers from a severely weakened immune system.

When should you go to the doctor?

If symptoms such as limb pain, greenish diarrhea, and fever occur, there may be underlying ornithosis. A doctor should be consulted if the symptoms persist over a long period of time, rapidly become more severe, or significantly affect the well-being of the sufferer. If there is already a concrete suspicion, for example if the complaints occur after contact with a possibly infected animal, it is best to consult the general practitioner immediately. It is possible that the symptoms are based on an animal disease, which can be fatal if left untreated. Therefore, a doctor must diagnose ornithosis and refer the patient to a specialist if necessary. He or she will prescribe antibiotics, which should cause the symptoms to subside within two to three weeks. If the medication does not show any effect, another visit to the doctor is recommended. More in-depth clarification is necessary, especially if there are signs of hepatitis or cardiac rhythm disturbances. These symptoms indicate a severe course of the disease, which may lead to cardiac arrest and death. Early treatment by the family doctor or a specialist in infectious diseases prevents a serious course. With children, the pediatrician should be consulted first.

Treatment and therapy

Therapeutic treatment of ornithosis usually involves antibiotic administration as early as possible (antibiotics are used to target bacteria). The type of antibiotic that an attending physician prescribes for a given case of ornithosis depends, among other things, on factors such as the patient’s constitution. In the case of ornithosis caused by the bacterium Chlamydia psittaci, physicians often advise taking antibiotics in the form of so-called macrolides or tetracyclines. These types of antibiotics are usually particularly effective in combating the bacterium responsible for ornithosis, which is characterized by growing and living inside a patient’s cells. Macrolides and tetracyclines disrupt the protein balance of the Chlamydia psittaci bacterium, which subsequently cannot continue to grow and dies. Depending on the symptoms, the administration of antibiotics may be supplemented in individual cases, for example, by measures to relieve acute symptoms (such as severe headaches).

Outlook and prognosis

With timely and also adapted therapy with the use of antibiotics, the prognosis of ornithosis is very good. Before the use of antibiotic drugs in this disease, the rate of mortality was 15 to 20 percent. Since then, this has declined and is now less than one percent.Mild infections are often asymptomatic and heal well, but due to the persistence of pathogens in certain retreat sites, the disease can last for varying lengths of time. Fatal are usually severe infections, which also require hospitalization. It is important and necessary in case of ornithosis to carry out the treatment with antibiotics until the end. Premature discontinuation of therapy, which many patients tend to do when symptoms improve, can promote relapse. Treatment can only lead to a successful prognosis if it is carried out consistently. Typically, medication is taken for a period of two to three weeks. The possible symptoms associated with the disease, such as gastrointestinal complaints with abdominal cramps as well as diarrhea and vomiting, or atypical pneumonia, occur depending on the immune status and age of the patient and can also be well controlled with appropriate medication. Here, too, the timely start of therapy is crucial for the prognosis.

Prevention

In particular, individuals who are frequently exposed to birds and/or bird droppings in their leisure time or occupation are recommended by physicians to wear respiratory protection in case of known infected animals to prevent ornithosis. Despite respiratory protection, avoiding direct contact with feces from infected birds can also help prevent ornithosis.

Follow-up

Among other things, aftercare aims to provide daily support and long-term treatment of symptoms. However, both aspects have no relevance after a treated ornithosis. Affected persons are completely cured. They return to their everyday lives. Statistically, less than one percent of patients die from ornithosis within a short period of time. Optionally, doctors near the end of life can offer palliative aftercare. Within this, sufferers are given painkillers to enable a symptom-free period. Elementary life questions can be discussed with a pastoral counselor or psychotherapist. In addition, progress monitoring plays an important role in preventing a recurrence. This is familiar from tumor diseases, for example. Patients present themselves in a certain rhythm in which doctors look for new cancer cases. They hope that a diagnosis at an early stage will provide them with the best possible options for action. Such a form of medical follow-up also does not play a role in ornithosis. Rather, however, those affected can prevent a renewed infection themselves. The physician provides information on suitable preventive measures, which the patient is responsible for implementing. Direct contact with bird feces should be avoided. Careful personal hygiene is generally recommended whenever handling birds.

What you can do yourself

The antibiotic treatment necessary for ornithosis can be supported by various measures, but not replaced by them. The antibiotic should therefore be taken according to instructions for successful treatment and, moreover, should not be dosed or discontinued independently. However, the symptoms of the respiratory disease that has developed can be counteracted with simple means, just as with a cold or flu. These include, above all, keeping the mucous membranes regularly moist by inhalation with salt water, warm foot baths to boost the patient’s own immune system, and cold calf compresses or poultices when a high fever occurs. Likewise, it is necessary to drink enough and to make the diet particularly rich in vitamins and low in calories and fat, especially in the severe phase of the disease. For example, hot ginger tea with honey, small fruit snacks and hot vegetable soups are ideal. Chicken soup, which is often recommended, is also useful, although there is as yet no reliable evidence of its immune-enhancing effect. The immune system can also be supported by sleep or rest. Persistent movements as well as physical and psychological stress are to be avoided. Short walks in the fresh air, on the other hand, are beneficial in the absence of fever. The patient’s room should also be ventilated regularly and, if necessary, the humidity increased with humidifiers or water bowls.