Jpn. J. Infect. Dis., 59, 2006

Laboratory and Epidemiology Communications

Psittacosis in All Four Members of a Family in Nagasaki, JapanHaruki Kaibu, Kunihiro Iida, Shinsuke Ueki, Hiroko Ehara, Yuko Shimasaki,
Sachiko Watanabe1, Hitoshi Anzai1, Wakako Takebu1, Takaya Muta2,Teruyo Kusaba3, Toshio Kishimoto4 and Shuji Ando4*
1

Nagasaki City Laboratory of Public Health and Environment, Nagasaki 852-8104;
Nagasaki City Public Health Center, Nagasaki 850-8685; 2Matsubara Muta Internal Medicine andPediatrics Clinic, Nagasaki 851-0131; 3Saint Francisco Hospital, Nagasaki 852-8125; and4
National Institute of Infectious Diseases, Tokyo 162-8640, Japan
Communicated by Ichiro Kurane(Accepted September 8, 2006)
were confirmed as Chlamydophila psittaci by BLAST analysis using the GenBank database (data not shown). C. psittaci
was isolated from these samples, and confirmed using acommercial monoclonal antibody (Chlamydia FA; Denka
Seiken Co., Tokyo, Japan) (1). The pharyngeal swabs fromPatients 3 and 4, as well as the parakeet intestinal tract werenegative for Chlamydiae by PCR and isolation.
Acute and convalescent serum samples from the patientswere examined for antibodies shown to be representativeof chlamydial strains, C. psittaci Budgerigar-No.1, C.
pneumoniae AR-39, and Chlamydia trachomatis L2, by amicro-immunofluorescence test (Micro-IF) (1). Antibody
titers to C. psittaci were elevated more than 4-fold in convalescent samples compared with acute ones for all 4 cases(Table 1). The results indicated that these patients wereinfected with C. psittaci. The results of microbiological testsof the bird specimens suggested that these four family members were infected with C. psittaci from the parakeet.
Local government officials found that there were no
incidence among birds borne from January 1, 2005 to March
31, 2005 at the pet shop.
Occurrence of psittacosis in all the members of a family isa rare event. Furthermore, in this case, 2 of the 4 members
did not help in caring for the parakeet. In these cases, it isassumed that the infection was caused by a high dose of C.
psittaci excreted from the dying parakeet. This incidence
indicates the importance of appropriate management ofbird breeding, including regular health checks for all bred

We report the occurrence of 4 cases of psittacosis in a single
family residing in Nagasaki, Japan in 2005. The clinicalfeatures of the 4 cases were as follows.
Patient 1: 42 years old, male. The patient developed generalmalaise, fever (39 - 40°C), severe cough and sore throat onMarch 25, 2005. Chest X-ray examinations performed onMarch 27 showed signs compatible with pneumonia.
Patient 2: 34 years old, female. The patient developed fever(38 - 39°C) and headache, but no cough, on March 25. Chest
X-ray examinations performed on March 27 showed signs
compatible with pneumonia.
Patient 3: 72 years old, male. The patient developed fever(39°C) and cough on April 1. Chest X-ray examination showedsigns compatible with pneumonia.
Patients 1, 2 and 3 recovered from the symptoms after
intravenous or oral administration of minocycline for 2 weeks
at the outpatient clinic.
Patient 4: 66 years old, female. The patient developed
fever and cough on April 1, and was hospitalized. Chest Xray examination showed signs compatible with pneumonia.
She received infusion of hydrochloric acid cefotiam andclarithromycin, recovered and left the hospital on April 11.
Further study revealed the time course of these cases. Patient 1 purchased a Cockatiel parakeet (Nymphicus hollandicus)
from a pet shop on March 4, 2005. The parakeet was mainly
cared for by Patient 1, but also sometimes by Patient 2, who
was the younger sister of Patient 1. The parakeet died on
March 31. Because of the clinical symptoms in the family
members, the corpse of the parakeet was dispatched to theDepartment of Virology 1, National Institute of Infectious
Diseases, Tokyo, for laboratory examinations.
The corpse was dissected, and cloaca swabs and tissue
samples from the liver, spleen, lung and intestinal tract wereused for microbiological examinations. The feces collectedfrom the bird cage, and the pharyngeal swab fluids fromPatients 3 and 4 were used for further analyses. Specimensfrom Patients 1 and 2 were not available. PCR revealed thepresence of the chlamydial gene in the cloaca swabs and thetissue samples from the liver, spleen, lung and feces of theparakeet (Cai Y., Kishimoto T. et al., in preparation). The
PCR products were directly sequenced, and their sequences

Table 1. Serological results against Chlamydophila psittaci
by Micro-IF*Corresponding author: Mailing address: Department of Virology
I, National Institute of Infectious Diseases, 1-23-1 Toyama,Shinjuku, Tokyo 162-8640, Japan. Tel: +81-3-5285-1111, Fax:
+81-3-5285-1208, E-mail: shuando@nih.go.jp

Time of blood sampling
1st2nd3rd

Patient No.

Immunoglobulin
class

1IgG
IgM

<16<8256
161,024
162IgG
IgM<16<8128
8128
32

3IgG
IgM

<16<864
16128
32

4IgG
IgM

16<864<8NTNTThe second and third samples were collected about 2 weeks andabout 1 month after the onset of symptoms, respectively.
NT, not tested.

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birds. In order to prevent infection from breeding birds, it isimportant to maintain a clean environment and appropriate
hygiene. This includes (i) hygienic disposal of bird feces,(ii) enforcement of hand-washing and gargling rules, (iii)
adequate room ventilation, (iv) prevention of mouth-to-mouth
feeding between birds and their pet owners, (v) medical
examination of all pet owners who develop flu-like symptoms, and (vi) breeding in the outside of the room. We alsoneed to maintain a system of administrative and laboratory
correspondence for outbreaks, because it is predicted that
health hazards by zoonotic pathogens will be increasing.

This article appeared in the Infectious Agents Surveillance
Report (IASR), vol. 26, p. 211-212, 2005 in Japanese.
REFERENCE
1. National Institute of Infectious Diseases and the Association of Public Health Laboratories for MicrobiologicalTechnology, Japan (2000): The Diagnostic Manual ofChlamydial Infection (in Japanese).

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