The diagnosis of psittacosis can be delayed for a number of reasons.
Reasons for a delay in diagnosis:
(1) no or delayed onset of pulmonary symptoms
(2) clear initial chest X-ray
(3) presentation with an intra-abdominal or gastrointestinal complaint
(4) lack of history of exposure to birds (budgerigars, other psittacine birds)
(5) absence of or failure to recognize diagnostic clues
(6) delay in ordering laboratory tests for psittacosis
Diagnostic clues:
(1) hyponatremia
(2) relative bradycardia
(3) absence of leukocytosis (WBC count < 11,100 per µL)
Intra-abdominal or gastrointestinal complaints may include:
(1) nausea and/or vomiting
(2) diarrhea or constipation
(3) hepatomegaly and/or splenomegaly
(4) pancreatitis
(5) abdominal pain
(6) hepatitis
