Table 2.

Case reports of severe psittacosis and use of corticosteroids.

Age/Sex	Risk factors	Clinical features	Diagnosis	Treatment	MV	Year/Ref
53 F	Eviscerated 4 ducks 10 days before admission	Dyspnea	Serology	Initially ampicillin, cloxacillin, gentamicin	Yes	1982 [14]
		Night sweats	4 weeks after admission	Oxytetracycline started day 26 of admission as not improving
				Prednisone started day 33 for suspicion of post-infective alveolitis – tapered over 4.5 months
65 M	No contact history with birds	Shock	Positive sputum PCR and serology day 6 of admission	Initially flomoxef, followed by imipenem/cilastatin	Yes	2004 [18]
		Altered consciousness		After diagnosis, IV erythromycin
		Hypothermia		High-dose methylprednisolone started day 39 of admission for ARDS
		Multiple organ dysfunction
40 F	Cared for 2 budgerigars which died 1 week before admission	Severe dyspnea	Serology day 10 of admission	IV minocycline day 1 admission due to high clinical suspicion of psittacosis and corticosteroids for ARDS – weaned after 2 weeks	Yes	1989 [15]
		Cough	Confirmed with isolation of C. psittaci from throat swab
		Fever
52 F	Parakeet recent died at patient's home	High fever	Serology, diagnosed after bird history known	Initially cefpirom, followed by methylprednisolone and then prednisolone for suspicion of COP	Yes	2007 [17]
		Non-productive cough		Minocycline commenced later after bird history obtained
		General fatigue
47 F	Hundreds of parrots and budgerigars at home	Fever	Serology day 17 of admission	Commenced on methylprednisolone and minocycline day 2 of admission	Yes	1988 [16]
		Non-productive cough

F: female, M: male, PCR: polymerase chain reaction, ARDS: acute respiratory distress syndrome, COP: cryptogenic organizing pneumonia, MV: mechanical ventilation.