Laboratory methods for case finding in human psittacosis outbreaks: a systematic review

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pneumonia 37 infectiousdiseases
trachoma 15 infectiousdiseases

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pneumonia 4123 high seroprevalence was due to cross-reaction with other Chlamydia species, especially with Chlamydia pneumonia e or false positivity of the ELISA test [[2], [4], [5]]. The lack of a C. psittaci-specific antibody
pneumonia 4570 visitors and volunteers working for a bird sanctuary. Three persons were hospitalized and diagnosed with pneumonia (including the index case). For the epidemiologic investigation of this outbreak, a cohort of more than
pneumonia 5312 (micro-immunofluorescence tests (MIF) IgG for C. psittaci) and to exclude other Chlamydia species (MIF IgG for C. pneumonia e, ELISA IgM/A/G for C. pneumoniae and MIF IgG for C. trachomatis). Six patients tested positive for
pneumonia 5345 C. psittaci) and to exclude other Chlamydia species (MIF IgG for C. pneumoniae, ELISA IgM/A/G for C. pneumonia e and MIF IgG for C. trachomatis). Six patients tested positive for C. psittaci with a fourfold rise
pneumonia 5755 sputum sample of an intensive care (ICU) patient, which was taken after 22 days. PCR to exclude C. pneumonia e, Coxiella burnetii, and influenza virus A was performed in nine patients, who all tested negative for
pneumonia 9289 psittacosis outbreaks among humans that took place before 1986 were excluded, because before that time, C. pneumonia e was designated as C. psittaci strain TWAR (Taiwan acute respiratory agent) [[7], [8]] and could not
pneumonia 14000 fowlNoIPA 24/36 with 8/36 seroconversion IgMThroat swab 22/358 Family outbreaks with exclusion of C. pneumonia e by MIF; 1 case possible person-to-person transmission; 3 outbreaks with sick household birds (parrots)
pneumonia 14318 3/9Nasopharyngeal aspirates, after antibiotics 0/3(?)Serological cross-reactions with C. trachomatis and C. pneumonia e gave difficulties.CDC, 1990 [[11]]1989, USAWorkers turkey processing plantNoCFT 40/60BAL specimen,
pneumonia 15879 parakeets)NoCFT 9/12, IF or CFT positives 9/9NoBird contact reported by 5/9 cases. 1 Fatal case. IF to exclude C. pneumonia e.Hughes et al., 1997 [[42]]1994, USAHospital staff and roommate exposed to pet-shop worker with psittacosisNoMIF
pneumonia 16124 5/8?Person-to-person transmission likely; Cross-reactivity possible as 3 cases were also MIF seropositive for C. pneumonia e.Goupil et al., 1998 [[14]]1990, FranceWorkers poultry slaughterhouse, truck driver, maintenance mechanicNoCFT
pneumonia 16345 or IF seroconversion with 5 week interval 18/56NoRetrospective study symptomatic workers of whom 6 pneumonia and 4 hospitalized.Moroney et al., 1998 [[22]]1995, USAOwners of recently bought birds originating from
pneumonia 17478 < 3 months had serological signs of recent infection. Two cases died of multi-organ failure, 6 others had pneumonia . Also tested for C. pneumoniae and C. trachomatis in MIF.Ito et al., 2002 [[41]]NM, JapanFamily, index
pneumonia 17508 recent infection. Two cases died of multi-organ failure, 6 others had pneumonia. Also tested for C. pneumonia e and C. trachomatis in MIF.Ito et al., 2002 [[41]]NM, JapanFamily, index case visited confectionary
pneumonia 17768 person-to-person transmission between sisters. Index case rising CFT titer, sister static high CFT titer. C. pneumonia e and C. trachomatis checked by MIF.Telfer et al., 2005 [[24]]2002, AustraliaResidents with direct or
pneumonia 17966 with direct or indirect wild bird contact (parrots, doves, currawongs, magpies)(Only for exclusion C. pneumonia e 0/8)MIF 59/95 with 35/59 seroconversion or 4-fold titer rise; 33/35 also 4-fold rise CFT; 3 MIF negatives
pneumonia 18268 in yards; 1 king parrot tested C. psittaci positive. MIF/EIA for exclusion C. trachomatis and MIF C. pneumonia e. No evidence of infection by other respiratory pathogens in probable C. psittaci cases.Saito et al.,
pneumonia 18545 parrots, parakeets and budgerigarsNoCFT 2/2; MIF 2/2 (seroconversion)?Cross-reactivity with ELISA for C. pneumonia e. Infection by Chlamydophilia avium in a couple working in a pet shop. Comment about nomenclature Chlamydophilia
pneumonia 19273 shopPharyngeal swab, 0/2MIF four-fold rise 4/4Pharyngeal swab 0/2Dead bird C. psittaci PCR positive. C. pneumonia e and C. trachomatis also tested by MIF.Harkinezhad et al., 2007 [[46]]NM, BelgiumVeterinarian and veterinary
pneumonia 19924 open sheds in contact with wild birdsNoELISA 53/97; IF 35/53No44/53 Cases reported symptoms and 5/12 pneumonia cases hospitalized. IF to exclude C. pneumoniae and other Chlamydiae spp. cross-reactions. 18/53 Significant
pneumonia 19971 53/97; IF 35/53No44/53 Cases reported symptoms and 5/12 pneumonia cases hospitalized. IF to exclude C. pneumonia e and other Chlamydiae spp. cross-reactions. 18/53 Significant cross-reaction to C. pneumoniae.Berk,
pneumonia 20064 exclude C. pneumoniae and other Chlamydiae spp. cross-reactions. 18/53 Significant cross-reaction to C. pneumonia e.Berk, 2008 et al., [[3]]2007, NetherlandsVisitors, participants bird show with many different bird
pneumonia 21443 Suspected human cases and 7 hospitalized confirmed cases, of whom 3 admitted to ICU; 1 patient died. C. pneumonia e tested by MIF. Birds PCR positive.Matsui et al., 2008 [[18]]2001–2002, JapanStaff, students and visitors
pneumonia 21716 symptomatic cases; MIF 8/91 non-symptomatic staff membersNo13/17 Hospitalized cases. Cross-reactions C. pneumonia e and C. trachomatis excluded by MIF.Verminnen et al., 2008 [[36]]2005–2006, BelgiumTurkey farmer and
pneumonia 22058 not strictly an outbreak study. In air samples, chlamydial organisms detected by nested PCR. PCR C. pneumonia e and C. trachomatis negative.Laroucau et al., 2009 (1) [[37]]2006, FranceWorkers at duck farms and wife
pneumonia 22430 was suspected at first. Ducks and human cases linked by PCR sequencing OmpA gene. Cross-reactions C. pneumonia e and C. trachomatis checked by MIF.Belchior et al., 2011 [[19]]2008, FranceParticipants bird fair organized
pneumonia 23033 peacock farmers.McGuigan et al., 2012 [[43]]2011–2012, Scotland (UK)Outbreak investigation after pneumonia in 4 family members and 1 health care workerRT-PCR 3/6, spp. specific PCR 3/3CFT positive in 3 confirmed
pneumonia 23346 same PCR OmpA strain as index case and to 1 possible case staying at ICU with index case. Suspected C. pneumonia e outbreak turned out to be C. psittaci outbreak after PCR specification (spec RT-PCR C. pneumoniae 0/3).Williams
pneumonia 23444 C. pneumoniae outbreak turned out to be C. psittaci outbreak after PCR specification (spec RT-PCR C. pneumonia e 0/3).Williams et al., 2013 [[34]]2008, England (UK)Poultry (mainly ducks) processing plant production
pneumonia 24442 needed hospitalization: 7 confirmed, 3 probable, 1 possible case; MIF negative for C. trachomatis and C. pneumonia Laroucau et al., 2015 [[35]]2013, FranceWomen with chicken gutting activities on a mixed poultry farmRT-PCR
pneumonia 27179 exclude pathogens other than C. psittaci (e.g. Legionella, Mycoplasma) or cross reactivity (e.g., C. pneumonia e, C. trachomatis) (Table 1). Most articles describe combinations of these tests but in seven articles,
pneumonia 28873 human lung tissue postmortem of one single case in 1995 [[20], [23]]. Telfer et al. (2005) used a C. pneumonia e-specific PCR on hospitalized case-patients to exclude C. pneumoniae in an outbreak in Australia in
pneumonia 28941 Telfer et al. (2005) used a C. pneumoniae-specific PCR on hospitalized case-patients to exclude C. pneumonia e in an outbreak in Australia in 2002 [[24]]. From 2006, PCR techniques to identify C. psittaci in human
pneumonia 33067 by a more specific (i.e. species-specific) test to exclude other chlamydial species, especially C. pneumonia e and C. trachomatis. Besides testing strategies to diagnose C. psittaci, many articles describe additional
pneumonia 33333 may cause comparable clinical syndromes, especially influenza like illnesses and community acquired pneumonia (CAP). These tests may act as a first step in multi-stage testing. Testing for C. psittaci will be considered
pneumonia 38797 IF techniques are more reliable when they are performed in 3-spot IF, including C. trachomatis, C. pneumonia e and C. psittaci. Finding a high IgM titer, in combination with clinical symptoms and/or history of
pneumonia 39305 When history is not taken carefully and bird contact unknown, standard diagnostics in patients with pneumonia usually do not include tests for C. psittaci infection [[53]]. Therefore, many psittacosis index patients
pneumonia 43288 history of direct bird contact but indirect contact was universal. Moreover, only a low prevalence of C. pneumonia e was present [[55]]. The systematic review is complicated by the changes in nomenclature over the years,
trachoma 5375 other Chlamydia species (MIF IgG for C. pneumoniae, ELISA IgM/A/G for C. pneumoniae and MIF IgG for C. trachoma tis). Six patients tested positive for C. psittaci with a fourfold rise in IgG titer. PCR for C. psittaci
trachoma 9660 find any human outbreaks when articles mentioned C. psittaci as cause of abortion, ocular lymphoma or trachoma in the pilot search. Articles with these topics were therefore other reasons for exclusion. Full text
trachoma 14299 3/9 and MIF 3/9Nasopharyngeal aspirates, after antibiotics 0/3(?)Serological cross-reactions with C. trachoma tis and C. pneumoniae gave difficulties.CDC, 1990 [[11]]1989, USAWorkers turkey processing plantNoCFT
trachoma 17526 Two cases died of multi-organ failure, 6 others had pneumonia. Also tested for C. pneumoniae and C. trachoma tis in MIF.Ito et al., 2002 [[41]]NM, JapanFamily, index case visited confectionary with parakeetsNoCFT
trachoma 17786 transmission between sisters. Index case rising CFT titer, sister static high CFT titer. C. pneumoniae and C. trachoma tis checked by MIF.Telfer et al., 2005 [[24]]2002, AustraliaResidents with direct or indirect wild bird
trachoma 18245 Probable source wild birds in yards; 1 king parrot tested C. psittaci positive. MIF/EIA for exclusion C. trachoma tis and MIF C. pneumoniae. No evidence of infection by other respiratory pathogens in probable C. psittaci
trachoma 19291 0/2MIF four-fold rise 4/4Pharyngeal swab 0/2Dead bird C. psittaci PCR positive. C. pneumoniae and C. trachoma tis also tested by MIF.Harkinezhad et al., 2007 [[46]]NM, BelgiumVeterinarian and veterinary assistant,
trachoma 20912 compared to that of sick source bird. Wild bird culture positive. MIF and PCR (urine) negative for C. trachoma tis (0/3).Çiftçi et al., 2008 [[29]]NM, TurkeyFamily, bought 2 parrots a month agoNoMIF 2/2No?First
trachoma 21734 8/91 non-symptomatic staff membersNo13/17 Hospitalized cases. Cross-reactions C. pneumoniae and C. trachoma tis excluded by MIF.Verminnen et al., 2008 [[36]]2005–2006, BelgiumTurkey farmer and 2 scientists at
trachoma 22076 outbreak study. In air samples, chlamydial organisms detected by nested PCR. PCR C. pneumoniae and C. trachoma tis negative.Laroucau et al., 2009 (1) [[37]]2006, FranceWorkers at duck farms and wife of workerPCR
trachoma 22448 first. Ducks and human cases linked by PCR sequencing OmpA gene. Cross-reactions C. pneumoniae and C. trachoma tis checked by MIF.Belchior et al., 2011 [[19]]2008, FranceParticipants bird fair organized by breeders
trachoma 24423 secondary cases needed hospitalization: 7 confirmed, 3 probable, 1 possible case; MIF negative for C. trachoma tis and C. pneumoniaLaroucau et al., 2015 [[35]]2013, FranceWomen with chicken gutting activities on
trachoma 27194 pathogens other than C. psittaci (e.g. Legionella, Mycoplasma) or cross reactivity (e.g., C. pneumoniae, C. trachoma tis) (Table 1). Most articles describe combinations of these tests but in seven articles, all published
trachoma 33085 specific (i.e. species-specific) test to exclude other chlamydial species, especially C. pneumoniae and C. trachoma tis. Besides testing strategies to diagnose C. psittaci, many articles describe additional diagnostic
trachoma 38781 specificity and IF techniques are more reliable when they are performed in 3-spot IF, including C. trachoma tis, C. pneumoniae and C. psittaci. Finding a high IgM titer, in combination with clinical symptoms and/or

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