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Doctoral Thesis
DOI
https://doi.org/10.11606/T.10.2017.tde-12012017-090917
Document
Author
Full name
Vivian Lindmayer Ferreira
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2016
Supervisor
Committee
Raso, Tânia de Freitas (President)
Godoy, Silvia Neri
Matushima, Eliana Reiko
Silva, Adriana Marques Joppert da
Spinosa, Helenice de Souza
Title in English
Epidemiology of Chlamydia psittaci in pet birds associated with psittacosis cases in humans
Keywords in English
Avian chlamydiosis
Epidemiological surveillance
Psittacosis
Zoonosis
Abstract in English
Zoonosis represent the majority of emerging infectious diseases, which have variable occurrence according to biological, environmental, socio-economic and cultural factors. With respect to socio-cultural factors, a growing practice in Brazil is keeping exotic animals as pets. These can have significant role in the spread of pathogens with zoonotic potencial, such as Chlamydia psittaci, etiologic agent of chlamydiosis in birds and psittacosis in humans. The Psittaciformes are the main order of birds affected by C. psittaci and is the most commonly kept as a pet. Avian chlamydiosis is endemic in Brazil; however, few studies have been conducted regarding its zoonotic potential. In human, psittacosis can lead to atypical pneumonia, however, due to difficulties related to laboratory diagnosis and the relative lack of knowledge by health professionals about this disease, its prevalence in the country is still unknown. In this context, this study aimed to determine the occurrence of C. psittaci in patients with psittacosis symptoms attended at the Ambulatory of Tropical Diseases and Zoonosis of the Infectology Institute Emilio Ribas (IIER). In addition, establishing the epidemiological link with birds and evaluate risk factors related to this zoonosis. Therefore, serum samples from eligible patients were collected in order to be tested for C. psittaci IgA, IgM and IgG antibodies. At the same time, biological samples from any species of birds related to suspected cases of psittacosis were collected for molecular analysis of C. psittaci. Among the eligible patients in this study, 27% (10/37) were classified as confirmed cases of psittacosis; 13.5% (5/37) as probable and 59.5% (22/37) as discarded. Pneumonia (p = 0.004), cough (p = 0.002) and chills (p = 0.011) were statistically significant when comparing with those patients in which psittacosis was discarded. With reference to the epidemiological link with birds, 73% (11/15) of the confirmed/probable cases had domiciliary contact with birds and 27% (4/15) had occupational contact. In addition, 47% (7/15) patients had contact with infected birds in which C. psittaci was laboratorial confirmed; from another 47% (7/15) of the cases, biological samples of the birds related to the patient could not be obtained, and in 6% (1/15) of the cases C. psittaci was not detected in the bird hosts evaluated. In addition, several confirmed/probable cases reported having close contact with the birds as handling (100%, 15/15), keeping the bird in the shoulder (67%, 10/15), kissing the bird (40%, 6/15) and sharing the food with the bird (13%, 2/15), practices that facilitate diseases transmission. Human and animal health care providers have an important role to play in identifying specific factors affecting the health of their patients and should work together. Conjointly efforts would increase the understanding on zoonotic disease and would, ultimately, improve prevention and control strategies
Title in Portuguese
Epidemiologia da Chlamydia psittaci em aves de companhia associada aos casos de psitacose em humanos
Keywords in Portuguese
Clamidiose aviária
Psitacose
Vigilância epidemiológica
Zoonose
Abstract in Portuguese
As zoonoses representam a maior parte das doenças infecciosas emergentes, as quais tem ocorrência variável de acordo com fatores biológicos, ambientais e sócio-econômico-culturais. No que tange aos fatores sócio-culturais, uma prática crescente no Brasil é a manutenção de espécies silvestres como animais de estimação. Estes podem ter significante papel na disseminação de agentes patogênicos com potencial zoonótico, tal como Chlamydia psittaci, agente etiológico da clamidiose em aves e da psitacose em seres humanos. Os Psittaciformes representam a principal Ordem de aves acometida pela C. psittaci, sendo também a mais comumente mantida como pet. A clamidiose aviária é endêmica no Brasil, contudo, são raros os estudos direcionados a avaliação do seu potencial zoonótico. Em humanos a psitacose pode desencadear um quadro severo de pneumonia atípica, no entanto, devido à dificuldade relacionada ao diagnóstico laboratorial e pelo relativo desconhecimento da doença pelos profissionais de saúde, sua prevalência no país é ainda desconhecida. Dentro desse contexto, o presente trabalho teve como objetivo determinar a ocorrência da C. psittaci em pacientes suspeitos de psitacose atendidos no Ambulatório de doenças tropicais e zoonoses do Instituto de Infectologia Emílio Ribas (IIER); estabelecer o vínculo epidemiológico com aves realizando o diagnóstico nestas, assim como avaliar os fatores de risco relacionados com essa zoonose. Para tanto, amostras de sangue de pacientes com quadros suspeitos de psitacose foram coletadas para a investigação de anticorpos anti-C. psittaci IgA, IgM e IgG. Paralelamente, amostras biológicas de quaisquer espécies de aves relacionadas com os casos suspeitos de psitacose foram coletadas para a pesquisa molecular de C. psittaci. Entre os pacientes elegíveis deste estudo, 27% (10/37) foram classificados como casos confirmados de psitacose; 13,5% (5/37) como prováveis e 59,5% (22/37) como descartados. Pneumonia (p = 0.004), tosse (p = 0.002) e calafrio (p = 0.011) foram estatisticamente significantes quando comparado com os pacientes nos quais a psitacose foi descartada. Quanto ao vínculo epidemiológico com aves, 73% (11/15) dos casos prováveis e confirmados de psitacose relataram exposição domiciliar com aves e em 27% (4/15) a exposição foi ocupacional. Adicionalmente, 47% (7/15) dos pacientes tiveram contato com aves nas quais a infecção por C. psittaci foi comprovada laboratorialmente. Em 47% (7/15) dos casos não foi possível obter material biológico das aves relacionadas com os casos e em 6% (1/15) dos casos C. psittaci não foi detectada nas aves avaliadas. Ainda, os casos prováveis e confirmados de psitacose relataram manter contato próximo com suas aves, como pega-lás na mão (100%, 15/15), mantê-las no ombro (67%, 10/15), beijá-las (40%, 6/15) e dividir alimento com elas (13%, 2/15). Ressalta-se que essas práticas facilitam a transmissão do patógeno. Profissionais da saúde tanto humana quanto animal têm um papel importante a desempenhar na identificação de fatores que afetam a saúde de seus pacientes e devem, portanto, trabalhar juntos. Esforços mútuos contribuiriam no conhecimento de doenças com potencial zoonótico e certamente contribuiriam para medidas mais eficazes de prevenção e controle
 
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Publishing Date
2017-01-24
 
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