11 April 2012

Bird people: beware parrot fever

Coughing, tight chest, fever, headache, fatigue, muscle aches? If you keep or work with birds, these might be symptoms of a potentially fatal infection: parrot fever.


Karen Cronje and Stefanie Hefer share their home in Tamboerskloof, Cape Town, with Jimmy, Kuifie, Pepito, Piet, Patrys, Simon, Bridget and several others who prefer to remain nameless - an exuberant and beloved collection of parrots, parakeets, cockatiels, budgies and finches, usually only a source of delight and interest to their owners.

A few years ago, however, Stefanie explains that they'd noticed one of their African Greys, Beatrix, had been looking a bit poorly. "We'd been keeping her indoors for a few days to shelter her from the winter weather. She just wasn’t herself. She’d lost weight and eventually stopped eating. Then one evening she literally just keeled over. I tried to breathe air into her mouth, but she was gone. It was a real loss - I sobbed my heart out."

Stefanie took Beatrix to a bird disease specialist to find out what had caused her – very – premature death: African Greys live into their eighties, and Beatrix had only been five or six years old. The post mortem showed that Beatrix's lungs were completely perforated; she had literally suffocated to death. The veterinarian diagnosed avian chlamydiosis, a serious infection in birds, and immediately packed Karen and Stefanie off to their GP to be tested for psittacosis.

What are psittacosis and avian chlamydiosis?
Psittacosis, also known as 'parrot fever' or ornithosis, is a disease humans can contract from birds infected with Chlamydophila psittaci, a bacterial-type organism.

Flu-like symptoms usually appear about five to 14 days after exposure to C. psitaci, and may include fever, chills, headache, tiredness, sore muscles, a dry cough, breathing difficulty and chest tightness. The severity of the disease ranges from no obvious symptoms to severe pneumonia and even death.

Parrot fever may be particularly dangerous for the elderly, immunocompromised people and pregnant women, especially if complicated by other respiratory problems.

In birds, C. psittaci infection is called avian chlamydiosis. Infected birds shed the organism in their faeces and respiratory tract secretions, and humans can become infected from exposure to these. The most usual means of infection is by inhaling microbes that have entered the air from dried faeces or secretions. Other means of exposure include mouth-to-beak contact and handling infected birds.

Watch out for parrot fever in caged birds
C. psittaci occurs most commonly in psittacine (parrot-type) birds, like cockatiels, parakeets, parrots and macaws, although it has been found in many bird species. Among other caged birds, infection occurs most frequently in pigeons and doves.

Andrew Whitelaw, a microbiologist at the University of Cape Town, says that internationally, it is estimated that about 5-8% of caged birds are infected.

Most human cases result from exposure to pet birds. Other people at risk include:

  • bird breeders,
  • workers in poultry plants,
  • veterinarians and veterinary technicians,
  • laboratory workers handling infected birds or tissues
  • farmers
  • zoo workers and animal rehabilitators.

Human infection can sometimes even result from brief exposure to infected birds or materials, in people who don't keep or work with birds.

Person-to-person transmission, although it can't be ruled out completely as a possibility, has never been proven, so it’s not necessary to take elaborate precautions against infecting others if you have the illness.

15-20% fatality rate
Doctors take Psittacosis very seriously - and with good reason. Without treatment, the fatality rate in humans is 15-20%. With timely, appropriate antibiotic treatment, however, risk of death drops to less than 1%. Symptoms usually start to improve after two to three days of treatment, but relapse can occur, and it's very important to complete the full course of antibiotics and report any recurrence of symptoms to your doctor.

It is difficult to grow a culture from C. psittaci in the laboratory, and it can take several days to get a clear result. Karen and Stefanie's GP therefore didn't wait to put them on a 10-day course of doxycycline, the antibiotic of choice for treating this infection. All the surviving birds in the household were put on antibiotics too.

As it turned out, the test came back positive for both Karen and Stefanie. They had been experiencing symptoms even before Beatrix's death, but hadn't thought for a moment that these were connected. Psittacosis is often mistaken for other respiratory conditions like flu or bronchitis, because the symptoms are similar.

Says Karen: "We both had symptoms, but they didn't seem unusual, especially in the middle of the Cape winter. I had bronchitis for which I was taking antibiotics – but then I'd had bronchitis before. The one unusual symptom I'd had was headaches, which I normally never get. I also had a fever and a blocked nose.”

Stefanie had been having breathing difficulty. “I felt like I had a ton of bricks on my chest, which was something I’d never experienced before, and I was struggling to breathe. I’ve also been wheezing, coughing, feeling congested, as well as generally really tired.”

Karen and Stefanie’s symptoms cleared up, and the rest of the flock showed no signs of illness. Despite the experience, they have remained confirmed 'bird people'.

“Lots of people said: ‘So are you going to get rid of your birds now?’ But the answer was: No, of course not! We love our birds dearly, and we didn’t feel any resentment towards them because we got this infection. It wasn't as if it were their fault.”

How to protect yourself and your birds

  • If you buy a bird, do so only from a reputable breeder or pet shop that maintains high standards of cleanliness and doesn't keep birds under crowded conditions.
  • Choose a bird that appears healthy (although this is no guarantee it is free from infection).
  • “Once you’ve bought the bird, take it immediately to a vet (not home first) you trust, for a thorough check-up,” says Dr Anel Coetzee, a veterinarian with Tygerberg Animal Hospital who specialises in birds.
  • Maintain good hygiene. Clean all cages, food bowls, and water bowls at least once a day. Don’t allow litter and faeces to accumulate. Soiled bowls should be emptied, thoroughly cleaned and rinsed before reuse.
  • Between occupancies by different birds, cages should be thoroughly scrubbed with soap and water, disinfected and rinsed.
  • Make sure the space you keep your birds is well-ventilated.
  • As with all pets, wash your hands well after handling them. Kissing your birds and feeding them from your mouth is not a good idea.
  • Protect birds from undue stress (e.g. crowding, relocation and cold) and malnutrition. This lowers their resistance to infection. Dr Coetzee says that incorrect feeding is a major cause and predisposing factor in a number of conditions: “Feed your birds pellets, not seeds; seeds are a ‘death diet’ that leads to malnutrition.”
  • If you’re going away, don’t board your birds where there are others – rather get someone in to look after them. Also, says Dr Coetzee, don’t take in stray birds and house them with your resident birds.
  • Get to know your bird. If you’re familiar with all its quirks and foibles, you’re much more likely to notice a change in behaviour or appearance that could signal disease. Signs of avian chlamydiosis (and of several other bird diseases) include lethargy, appetite loss, weight loss, and ruffled feathers, discharge from the eyes or nostrils area, diarrhoea or unusual faeces e.g. loose green stools.
  • If you or your bird are diagnosed with the infection, inform everyone who has had recent contact with your bird, and suggest they get tested – especially if they’ve been experiencing symptoms.

(- Olivia Rose-Innes, EnviroHealth Editor, Health24, updated April 2009)


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