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Europe has experienced a worrisome increase in psittacosis cases, also referred to as parrot fever, in recent months.

The bacterium Chlamydia psittaci is the cause of the zoonotic infectious disease psittacosis, which is mainly spread from sick birds to people.

Although there have been isolated cases of psittacosis documented all over the world, public health officials and medical professionals are concerned about the current outbreak in Europe.

An Introspective Look Back:

The earliest known case of parrot fever was in the late 1800s, when some German troops who had come into contact with diseased parrots began to exhibit symptoms resembling pneumonia.

It was not until 1907 that a scientist by the name of Robert Koch identified the germ causing the illness.

Parrot fever remained to be a concern to people and birds during the 20th century.

Following an outbreak in the US in the 1930s, laws requiring pet bird owners to quarantine their birds before trading or selling them were passed.

Developments in antibiotic therapy contributed to a decrease in the death rate of human cases of parrot fever in the 1940s and 1950s.

But the illness still poses a threat, particularly to people who work closely with birds in pet stores or aviaries.

Because parrot fever is frequently underreported and misdiagnosed, there is a dearth of information on instances.

Nonetheless, the Centers for Disease Control and Prevention (CDC) states that there are roughly 100 cases of psittacosis documented in the US annually.

A global pooled prevalence of 19.5% was reported for chlamydial infections in birds.

The Psittacosis Outbreak in Europe

Psittacosis outbreaks in Europe have been connected to the growing commerce in exotic birds and the popularity of pet birds, especially parrots and parakeets.

Humans can contract Chlamydia psittaci by close contact with diseased birds, contact with contaminated feathers, droppings, or respiratory secretions, and poor hygiene practices.

Furthermore, there is a high risk of developing the disease from work exposure among veterinarians, pet store personnel, and handlers of birds.

Clinical Presentation and Diagnosis

Clinical symptoms of psittacosis can range widely, from minor respiratory symptoms to severe pneumonia and systemic consequences.

• Fever

• chills

• headache

• coughing

• myalgia

• dyspnea and

• exhaustion

These are typical symptoms. Patients may experience multi-organ failure, pneumonia, respiratory distress, and septicemia in extreme circumstances.

Less commonly, patients may appear with rash, splenomegaly, and pulse-temperature dissociation (fever without elevated pulse rate).

Usually, the incubation period lasts between 5 and 14 days. Less frequently, after exposure, symptoms could start more than 14 days later.

Above image shows an electron micrograph of cells from Chlamydia psittaci. The little arrow points to an elementary body.

The large arrow points to a reticulate body, and the arrow head suggests an intermediate form. The length of the bar is one micron.

A robust index of concern is necessary when diagnosing psittacosis, especially in individuals who have a history of bird exposure or occupational risk factors.

Diagnostic confirmation can be aided by laboratory testing such as polymerase chain reaction (PCR), culture of respiratory specimens, and serological assays.

Computed tomography (CT) scans and chest X-rays are two types of radiological imaging that can show consistent pulmonary infiltrates.

Psittacosis prognosis is influenced by the clinical disease severity of the patient, other disorders, and therapy timing.

15% to 20% of humans with a Chlamydial respiratory infection died before antimicrobial drugs were developed, however it's unclear how many of the deaths were related to psittacosis.

Since the discovery of antibiotics, psittacosis-related mortality has been extremely rare. There is a 94.23% documented cure rate for psittacosis when the right antibiotic therapy is administered.

On the other hand, in the present period, an estimated 1% or less of cases are reported to die from fulminant diseases.

Although uncommon, gestational psittacosis can cause maternal and fetal death.

Options for Treatment

Doxycycline and tetracycline work well to treat human psittacosis for 10–14 days, and even up to 21 days.

According to case studies, most infected people will experience a 48-hour improvement in fever and clinical symptoms after receiving therapy.

The recommended treatment for psittacosis is 100 mg of doxycycline given orally or intravenously every 12 hours for a period of 7 to 10 days. 

Psittacosis cannot be treated with beta-lactam antibiotics.

For individuals for whom tetracycline is not recommended (children under the age of eight and pregnant women) both erythromycin and azithromycin are frequently used.

Although not as effective as tetracyclines and macrolides, fluoroquinolones can still treat C. psittaci infections.

After 24 to 48 hours of medication, symptoms start to get better. There have been cases of relapses. Patients who are extremely sick need to receive doxycycline hyclate intravenously.

In children with mild to severe infections, macrolides continue to be the preferred treatment option.

Control and Preventive Actions¹

• Raising healthcare professional's understanding of the importance of using RT-PCR to diagnose suspected cases of C. psittaci.

• Raising the alertness of owners of domestic or caged birds, particularly psittacines, about the possibility of the disease being carried without obvious symptoms of sickness.

• Putting newly obtained birds in quarantine. Get in touch with the veterinarian for a checkup and treatment if any of your birds are sick.

• Monitoring C. psittaci in wild birds, possibly utilizing specimens that have already been gathered for other purposes.

• Advising owners of pet birds to avoid overcrowding their cages, maintain clean cages, and arrange their cages so that droppings cannot go between them.

• Encouraging the use of clean hands and excellent hygiene when working with birds, their droppings, and their surroundings.

• For hospitalized patients, normal infection-control procedures as well as precautions against droplet transmission should be used.

Conclusion

The recent parrot fever outbreak in Europe serves as a reminder of how crucial it is to control zoonotic infectious illnesses by vigilant monitoring, early discovery, and swift action.

We can slow the development of psittacosis and protect human and animal health by strengthening surveillance efforts, raising public awareness, and putting into place practical preventive measures.

To address this new threat and stop future epidemics, cooperation between public health officials, medical professionals, veterinarians, and bird owners is crucial.

1  Prevention