Karen R. Steingart Fran Cappa Robert Williams Thomas Schaumberg

Local Health District Handles Unusual Case of Infection in Pet Store Employees In July 1995, a 47-year old manager of a Vancouver, Wash., pet Store was hospitalized with fever, chills, shortness of breath, headache, diarrhea, and increasing confusion. She was diagnosed With atypical pneumonia, which resolved following treatment with erythromycin. Although her physician considered a diagnosis of psittacosis, the laboratory results were inconclusive, and the local public health agency was not notified. Two months after her hospitalization, the patient consulted another physician, who referred her to the Southwest Washington Health District (SWWHD) as a suspected case of psittacosis. This physician, a bird fancier, noted her history of exposure to birds. According to the patient, many of the birds in the pet store had died, and other employees had complained of respiratory symptoms.

The birds were placed under immediate quarantine by state agriculture officials. The store was one of 200 in a national chain, and the potential for cases in other states led the SWWHD to request assistance with the investigation from the Washington Department of Agriculture, the U.S. Department of Agriculture (USDA), the Washington State Department of Health, and the Centers for Disease Control and Prevention (CDC). Of significance, in February 1995, the CDC had received a report of psittacosis in a Georgia employee of the same pet store chain.

The day after issuing the quarantine, representatives from the SWWHD and USDA visited the pet store to obtain specimens from birds and to interview employees. Since beginning bird sales in May, the pet store had received about 150 birds, including parakeets cockatiels, finches, conures, love birds, and doves. Approximately 20% of the birds had died, which is an unusually large proportion. Birds were inspected for signs of psittacosis, and specifically ruffled feathers, nasal discharge, diarrhea, and lethargy cloacal and tracheal swabs were obtained for culture. Specimens were sent to the National Veterinary Services Laboratory in Ames, Iowa. Chlamydia psittaci isolated from at least two birds.

Five employees (age range 18-48 years) with exposure histories to birds, including the index case, met the laboratory criteria for psittacosis. All reported the presence of fever, chills, headaches, and myalgia. Two reported sore throat or irritation, three cough, and one anorexia and vomiting. Medical evaluation of three of the patients included chest radiographs: two were negative, one showed left lower lobe pneumonia with pleural effusion.

Three of the cases received a course of erythromycin or tetracycline with resolution of symptoms; in one case symptoms improved without treatment. Although the patient with pneumonia improved on erythromycin, she experienced unexplained nonspecific symptoms for at least three months after treatment, despite an additional course of doxycycline.

A licensed veterinarian supervised the quarantine. All birds in the store were treated for 45 days with feed containing chlortetracycline. Letters that described the signs and symptoms of human and avian psittacosis were sent to all persons who had bought birds. Several birds were examined, but cultures for C. psittaci were negative. The corporate office voluntarily placed birds under quarantine at all their pet stores throughout the United States and treated the birds with a 45-day course of chlortetracycline.

Follow-up Investigation The pet store received birds from a broker in California. This broker never had physical possession of the birds, but rather had made arrangements for their transportation from a supplier. The broker kept no health certificates or leg bands to identify the birds as required by Washington law (WAC 246- 1 00201). The supplier bred many of the birds, but sometimes received birds from other breeders. Without identification bands at the initial source, it was impossible to trace birds back to the source of the infection. In the Georgia case of human psittacosis, the birds were traced to a supplier in Oklahoma. This company tested its flock, found no evidence of psittacosis, and concluded that the birds in Georgia were exposed to the disease somewhere during transport, but not in the holding area in Oklahoma. The source of the infection still could not be identified. Valuable Lessons Psittacosis is not among the diseases routinely encountered by local health departments. These cases provided a valuable exercise in epidemiological investigation and an opportunity for close cooperation among local, state, and federal agencies.

The full and prompt support of these agencies contributed significantly to the successful management of this unusual episode. The sidebar summarizes valuable "lessons from the field." We recommend these guidelines to any health jurisdiction that may encounter a similar problem in the future.

Recommended Reading

Kuritsky JN, Schmid GP, et al: Psittacosis: A diagnostic challenge. J Occup Med 1984;26:731 33.

National Association of State Public Health Veterinarians. Compendium of Psittacosis Control,1995.

Schlossberg D: Chlamydia psittaci. In: GL Mandell, GR Douglas Jr, JE Bennett (Eds), Principles and Practice of Infectious Diseases. New York: John Wiley & Sons, 1995.

Wong KH, Skelton SK, Daugharty H: Utility of complement fixation and microimmunofluorescence assays for detecting serological responses in patients with clinically diagnosed psittacosis. J Clin Microbiol 1994;32:2417-2421.

Authors

Karen R. Steingart, M.D., M.PH., is health officer for the Southwest Washington Health District.

Fran Cappa, M.PH., is the epidemiologist for the Southwest Washington Health District.

Robert Williams, D.V.M., is a veterinary medical officer for the U.S. Department of Agriculture.

Thomas Schaumberg, M.D., is a pulmonologist for the Vancouver Clinic, Vancouver, Washington 

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