MEDizzy - A 44-year-old woman presents to your clinic for evaluation

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Infections due to Neisseria and others

A 44-year-old woman presents to your clinic for evaluation of fever, chills, and malaise; she has had these symptoms for 4 days. In addition, she complains of a severe headache and a dry, nonproductive cough. Results of physical examination are as follows: temperature, 101.6° F (38.7° C); pulse, 62 beats/min, respiratory rate, 16 breaths/min; blood pressure, 136/82 mm Hg. HEENT, pulmonary, and cardiac examination results are within normal limits. Abdominal examination is significant for mild splenomegaly; but the abdomen is nontender and nondistended, and bowel sounds are normal. Upon further questioning, the patient reports that she visited her daughter 2 weeks earlier and that her daughter has a parrot. You suspect psittacosis. Which of the following statements regarding diagnostic tests for psittacosis is false?

ExplanationChlamydia psittaci has been isolated from the secretions, excretions, tissue, and feathers of both symptomatic and asymptomatic birds. In humans, the bacteria are inhaled and are then disseminated hematogenously; they primarily localize in the alveolar macrophages and the endothelial cells of the liver and spleen. The incubation period is from 7 to 14 days. At presentation, the disease can vary in severity from mild to life threatening. On rare occasions, psittacosis can be fatal. Common symptoms are fever, chills, malaise, headache, and nonproductive cough. Other features include an absence of consolidation and pleural effusion, relative bradycardia, splenomegaly, and a rash resembling the rose spots of typhoid fever. Diagnosis is made clinically. Treatment with tetracycline should be initiated while awaiting laboratory results. Abnormal results on liver function testing are commonly seen; the ESR is normal; and the chest x-ray shows a nonspecific pattern. The white cell count is usually normal or decreased. The diagnosis is confirmed by a fourfold increase in acute and convalescent antibody titers.