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Morán-Mariños C, Salas López J, Llanos-Tejada F, Casanova-Mendoza R, Villanueva-Villegas R, Chavez-Huamani A, Vargas-Ponce KG, Condori-Zevallos M. Case series of complicated bronchopulmonary lophomoniasis. Differential diagnosis of tuberculosis? Eur Clin Respir J 2024; 11:2325170. [PMID: 38455273 PMCID: PMC10919296 DOI: 10.1080/20018525.2024.2325170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
Pulmonary lophomoniasis is a rare and life-threatening disease, most commonly reported across Asian and Latin American countries. Here, we have reported two cases of pulmonary lophomoniasis presenting with atypical manifestations. Case #1 represents a 19-year-old male patient with clinical characteristics suggestive of tuberculosis, presenting with hemoptysis and receiving antituberculosis treatment. Case #2 represents a 69-year-old man with post-tuberculosis pulmonary disease with cystic bronchiectasis presenting with polymicrobial co-infection. Based on our case experience, lophomoniasis should be considered in patients with pneumonia who do not respond to antibiotic treatment, and the corresponding epidemiological factors should be carefully considered in addition to bronchoscopy for precise diagnosis.
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Affiliation(s)
- Cristian Morán-Mariños
- Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
- Unidad de investigación en Bibliometría, Vicerrectorado de investigación, Universidad San Ignacio de Loyola, Lima, Perú
| | - Juan Salas López
- Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
| | - Felix Llanos-Tejada
- Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
- Instituto de Investigaciones en Ciencias Biomédicas - INICIB, Facultad de Medicina Humana, Universidad Ricardo Palma, Lima, Perú
| | | | - Renzo Villanueva-Villegas
- Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
- Instituto de Investigaciones en Ciencias Biomédicas - INICIB, Facultad de Medicina Humana, Universidad Ricardo Palma, Lima, Perú
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Taheri A, Fakhar M, Sharifpour A, Banimostafavi E, SafaNavaei S, Abedi S, Mehravaran H, Aliyali M, Shafahi A, Delpzir A. Imaging patterns of Lophomonas blattarum infection in the respiratory tract: a registry-based analysis. BMC Infect Dis 2024; 24:267. [PMID: 38424495 PMCID: PMC10903071 DOI: 10.1186/s12879-024-09141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Lophomonas blattarum is an emerging protozoan that mostly infects the lower respiratory tract and causes pulmonary lophomoniasis. Radiologic findings in patients with pulmonary lophomoniasis have yet to be studied. Thus, we conducted a registry-based clinical investigation to evaluate the radiologic findings of lophomoniasis. METHODS In this cross-sectional study, 34 Lophomonas positive patients were enrolled. Demographic data, relevant characteristics, and radiologic findings of the patients were recorded and analyzed. RESULTS Thirty-four (male = 18, female = 16) patients with an average age of 52.21 ± 20.48 years old were examined. Radiological findings such as Alveolar consolidation (26.5%), Ground glass opacity (5.9%), Centrilobular nodules (23.5%), Tree -in- bud (38.2%), Cavitation (23.5%), Pleural effusion (23.5%), Interstitial opacity (8.8%), Lymphadenopathy (23.5%), Bronchocele (5.9%), Bronchiectasis (29.4%), Nodules (8.8%) and Mass (11.8%) were obtained, that the frequency of all radiological findings was less than 50%. CONCLUSION In this study, the most common radiological findings in patients with lophomoniasis were tree-in-bud nodules, alveolar consolidation, bronchiectasis, and centrilobular nodules which were mostly seen in the right lung and its middle and lower lobes. Given that the radiologic findings of this disease are unknown, it can be considered in differential diagnosis.
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Affiliation(s)
- Amirmasoud Taheri
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Farah-Abad Road, Sari, P.O Box: 48471-91971, Iran
| | - Mahdi Fakhar
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Farah-Abad Road, Sari, P.O Box: 48471-91971, Iran.
| | - Ali Sharifpour
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elhamsadat Banimostafavi
- Radiology Department, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
| | - Sepideh SafaNavaei
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavash Abedi
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Mehravaran
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoud Aliyali
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Shafahi
- Department of Internal Medicine, CardiovascularResearch Center, Institute of Basic and ClinicalPhysiology Sciences, Kerman University ofMedical Sciences, Kerman, Iran
| | - Asieh Delpzir
- Radiology Department, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
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Mirbadie SR, Taheri A, Roshanzamir E, Soleymani E, Fakhar M. Severe lophomoniasis in a patient with diabetes and past history of COVID-19 in Central Iran: case report. J Int Med Res 2024; 52:3000605241232917. [PMID: 38410853 PMCID: PMC10898304 DOI: 10.1177/03000605241232917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
In this case report, we address the diagnostic challenges and clinical implications of severe infection with Lophomonas blattarum in a patient initially suspected of experiencing long COVID symptoms. We describe the patient's medical history, initial symptoms, diagnostic tests, and treatment. A female patient with diabetes in her early 60s presented with severe shortness of breath and was initially diagnosed with diabetic ketoacidosis (DKA). After resolution of her DKA symptoms, persistent respiratory issues led to a COVID-19 test, which was negative. A chest computed tomography scan revealed abnormalities, prompting bronchoscopy and bronchoalveolar lavage fluid analysis, which confirmed the presence of L. blattarum. Notably, the protozoan remained mobile and viable even after a 4-day transport at ambient temperature. This case emphasizes the importance of considering alternative diagnoses and improving awareness about L. blattarum infection in patients with respiratory symptoms, for timely and accurate management.
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Affiliation(s)
- Seyed Reza Mirbadie
- School of Medicine, Shahroud University of Medical Sciences, Bahar Hospital, Shahroud, Iran
| | - Amirmasoud Taheri
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis, Mazandaran University of Medical Sciences, Farah-Abad Road, Sari, Iran
| | - Elahe Roshanzamir
- School of Medicine, Shahroud University of Medical Sciences, Bahar Hospital, Shahroud, Iran
| | - Eissa Soleymani
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis, Mazandaran University of Medical Sciences, Farah-Abad Road, Sari, Iran
| | - Mahdi Fakhar
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis, Mazandaran University of Medical Sciences, Farah-Abad Road, Sari, Iran
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Ghatee MA, Nakhaei M, Sharifpour A, Fakhar M, Mohamadi N, Soleymani M, Abedi S, Aliyali M, Mehravaran H. Geospatial Analysis and Molecular Epidemiologic Study of Emerging Pulmonary Lophomoniasis in Iran: A National Registry-Based Study. J Parasitol Res 2023; 2023:1039186. [PMID: 37323296 PMCID: PMC10266910 DOI: 10.1155/2023/1039186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/18/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Bronchopulmonary lophomoniasis (BPL) is a protozoan pulmonary disease that has been reported sporadically, but its incidence has been increasing. However, the epidemiology and risk factors of the disease have not been clearly identified. The current study aims to identify BPL cases molecularly and assess the demographic and some environmental factors for the first time on the prevalence of BPL as a national registry-based study in Iran. Methodology. The study tested 960 patients with lower respiratory tract symptoms whose bronchoalveolar lavage samples were submitted from seven provinces of Iran to the Iranian National Registry Center for Lophomoniasis. They were tested for BPL by a newly developed polymerase chain reaction test. The study assessed the association of Normalized difference vegetation index (NDVI), digital elevation model (DEM), and geographic latitude as environmental factors and sex and age as demographic factors on the prevalence of BPL. Geospatial information systems methods and chi-squared and Pearson's correlation tests were used for the assessment of geographical and environmental factor effects and statistical analysis, respectively. Results Of the 960 patients, 218 (22.7%) tested positive for BPL; the highest and lowest prevalence rates were reported from the south and northeast of Iran, respectively. The study found a correlation between geographic latitude and age with BPL prevalence, but no association was found for gender, NDVI, or DEM. Most patients were over 40 years old, and the rate of disease was higher in southern latitudes. Conclusion Age and geographical latitude were found to be risk factors for BPL. More exposure to dust and/or chronic pulmonary problems may explain the higher prevalence of the disease in older adults. Higher rates of BPL in lower latitudes may be due to warmer weather and longer days, which can confine individual activities indoors and result in more contact with domestic insects and infected dust.
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Affiliation(s)
- Mohammad Amin Ghatee
- Department of Microbiology, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Maryam Nakhaei
- Iranian National Registry Center for Lophomoniasis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Sharifpour
- Iranian National Registry Center for Lophomoniasis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Fakhar
- Iranian National Registry Center for Lophomoniasis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Niloufar Mohamadi
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mostafa Soleymani
- Iranian National Registry Center for Lophomoniasis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Siavash Abedi
- Iranian National Registry Center for Lophomoniasis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoud Aliyali
- Iranian National Registry Center for Lophomoniasis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hossein Mehravaran
- Iranian National Registry Center for Lophomoniasis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
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Shafahi A, Sharifpour A, Ghadirzadeh E, Taheri A, Fakhar M, Soleymani M. Molecular proof for Lophomonas infection in a patient with history of breast cancer. Respirol Case Rep 2022; 10:e01027. [PMID: 36051364 PMCID: PMC9420100 DOI: 10.1002/rcr2.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/14/2022] [Indexed: 12/04/2022] Open
Abstract
We report a 52-year-old patient with a history of breast cancer (BC) referred to the clinic of Afzalipour Hospital, in Kerman, eastern Iran, with a 1-week complaint of restless dyspnea. A chest computed tomography scan revealed consolidations in the upper lobes of both lungs. The patient had no history of smoking or underlying diseases that would predispose her to consolidation, including pneumonia. Then, bronchoscopy was performed for the patient, and bronchoalveolar lavage fluid was sent to the Iranian National Registry Center, where the Lophomonas parasite was detected in the sample and confirmed using a polymerase chain reaction test. Finally, her symptoms improved by receiving oral metronidazole three times a day for 3 weeks.
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Affiliation(s)
- Ahmad Shafahi
- Department of Internal Medicine, Cardiovascular Research Center, Institute of Basic and Clinical Physiology SciencesKerman University of Medical SciencesKermanIran
| | - Ali Sharifpour
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL)Mazandaran University of Medical SciencesSariIran
| | - Erfan Ghadirzadeh
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL)Mazandaran University of Medical SciencesSariIran
| | - Amirmasoud Taheri
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL)Mazandaran University of Medical SciencesSariIran
| | - Mahdi Fakhar
- Iranian National Registry Center for Lophomoniasis (INRCL), Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Mostafa Soleymani
- Iranian National Registry Center for Lophomoniasis (INRCL), Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
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Fiberoptic Bronchoscopic Findings in Patients Suffering from Emerging Pulmonary Lophomoniasis: A First Registry-Based Clinical Study. Interdiscip Perspect Infect Dis 2022; 2022:8034295. [PMID: 35722220 PMCID: PMC9204497 DOI: 10.1155/2022/8034295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Lophomonas blattarum is an emerging protozoan agent that mainly infects the lower respiratory system, causing pulmonary lophomoniasis. The bronchoscopic findings in patients with pulmonary lophomoniasis have not been investigated yet. Accordingly, we assess the bronchoscopic findings of lophomoniasis in patients suffering from pulmonary lophomoniasis through a registry-based clinical study. Methods In this retrospective study, of 480 patient candidates for bronchoscopy, 50 Lophomonas-positive patients were enrolled. Demographic data, relevant characteristics, and bronchoscopy findings of the patients were recorded and analyzed. Results Overall, 50 (male = 32, female = 18) patients with an average age of 61.8 ± 13.3 years were examined. Nineteen patients (38%) had normal bronchoscopic findings, and 31 patients (62%) had abnormal bronchoscopic findings. According to the severity index, most (52%) of patients had mild severity, followed by moderate (30%) and severe (18%) cases. The highest involvement was in the right lung bronchus (46%), and the lowest was in the carina (8%). Furthermore, purulent and mucosal secretions in the right and left lung bronchus were the most abnormalities found in different anatomical locations. Conclusion For the first time, the current study demonstrated that pulmonary lophomoniasis does not have pathognomonic bronchoscopic findings. However, each suspected patient must be checked for lophomoniasis, even with normal bronchoscopic findings, particularly in endemic areas.
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Global Status of Emerging Lophomonas Infection: A Systematic Review of Reported Cases (1993—2020). Interdiscip Perspect Infect Dis 2022; 2022:3155845. [PMID: 35450275 PMCID: PMC9017527 DOI: 10.1155/2022/3155845] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/22/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose. Lophomonas spp., is an emerging protozoan parasite that belongs to the Parabasalids (Parabasalia, lophomonadida) which infects the respiratory tracts of humans. Despite the presence of a few reports of human lophomoniasis, the true burden of Lophomonas infection is unknown. This systematic review aimed to elucidate the latest global status of publications reporting human cases of lophomoniasis as a new emerging protozoal disease. Methods. A comprehensive and systematic search was performed in 10 (five English and five Persian) databases for studies reporting cases of lophomoniasis between 1993 and March 2020 (27 years). Then, the selected articles were carefully reviewed and screened based on the inclusion and exclusion criteria. Results. Overall, 32 eligible publications reporting 307 lophomoniasis cases from around the world are included in this review. The patients were aged between 1 month and 84 (mean age = 23.7 years). The highest number of cases (n = 171; 55.7%,
) significantly belonged to the juvenile age group (aged ≤18 years). The male to female ratio of the cases was almost equal, and no statistically significant difference between them was observed. The maximum number of cases (n = 237) was reported from Iran. Most cases (n = 196; 63.85%) had no history of underlying diseases/organ transplantation
. Moreover, the BAL specimen was the most commonly used clinical sample to diagnose lophomoniasis
. Conclusion. Our findings reveal that the prevalence of lophomoniasis is likely to be markedly underestimated when evaluated based on published case reports. Additionally, our data, at least for the time being, supports the idea that Lophomonas spp. should not be considered as an opportunistic infection. Thus, current work sheds light on some controversial issues regarding the epidemiological aspects of lophomoniasis.
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Taheri A, Fakhar M, Sharifpour A, Banimostafavi ES. Cavitary pulmonary lesions following emerging lophomoniasis: A novel perspective. Respirol Case Rep 2022; 10:e0908. [PMID: 35140977 PMCID: PMC8812051 DOI: 10.1002/rcr2.908] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/19/2022] Open
Abstract
In this article, we report a patient referred to the clinic of Imam Khomeini Hospital in Sari, Mazandaran, northern Iran, with a 3-month complaint of chronic cough and weight loss. According to the chest computed tomography scan, a cavity was detected in the upper lobe of the patient's left lung. The patient had no history of smoking or underlying diseases that predisposed him to cavitation, including tuberculosis. Then, bronchoscopy was performed for the patient, and bronchoalveolar lavage fluid was sent to the Iranian National Registry Center for lophomoniasis, and Lophomonas blattarum was detected in samples. Finally, the patient's symptoms were totally resolved by prescribing third-daily metronidazole for 2 weeks.
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Affiliation(s)
- Amirmasoud Taheri
- Toxoplasmosis Research CenterCommunicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical SciencesSariIran
| | - Mahdi Fakhar
- Toxoplasmosis Research CenterCommunicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical SciencesSariIran
| | - Ali Sharifpour
- Toxoplasmosis Research CenterCommunicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical SciencesSariIran
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research CenterCommunicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical SciencesSariIran
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Fakhar M, Safanavaei S, Nakhaei M, Esmaeili S, Banimostafavi ES, Spahbodi F, Sharifpour A. Molecular evidence of upper and lower respiratory infection due to Lophomonas in a post-kidney transplantation patient. Clin Case Rep 2022; 10:e05492. [PMID: 35369390 PMCID: PMC8859402 DOI: 10.1002/ccr3.5492] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 12/18/2022] Open
Abstract
We report a case of lophomoniasis in a kidney post-transplantation patient. The patient, 46-year-old man, had pneumonia, acute sinusitis, and tonsillitis on admission. We recommend that lophomoniasis should be essentially ruled out in all patients suffering from post-transplantation infection, particularly in those who do not respond to routine antibiotic regimens.
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Affiliation(s)
- Mahdi Fakhar
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis (INRCL)Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Sepideh Safanavaei
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis (INRCL)Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
- Pulmonary and Critical Care DivisionImam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Maryam Nakhaei
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis (INRCL)Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Samira Esmaeili
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis (INRCL)Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis (INRCL)Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
- Department of RadiologyImam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Fatemeh Spahbodi
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis (INRCL)Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
- Department of NephrologyImam Khomeini HospitalMazandaran University of Medical SciencesSariIran
| | - Ali Sharifpour
- Toxoplasmosis Research CenterCommunicable Diseases InstituteIranian National Registry Center for Lophomoniasis (INRCL)Imam Khomeini HospitalMazandaran University of Medical SciencesSariIran
- Pulmonary and Critical Care DivisionImam Khomeini HospitalMazandaran University of Medical SciencesSariIran
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Zakariaei Z, Sharifpour A, Fakhar M, Soleymani M, Banimostafavi ES, Taheri A. Detection of Lophomonas in pericardial effusion sample in a COVID-19 patient with systemic sclerosis: An unusual case report. SAGE Open Med Case Rep 2022; 10:2050313X221102021. [PMID: 35651516 PMCID: PMC9149606 DOI: 10.1177/2050313x221102021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Systemic sclerosis is a connective tissue disorder that involves the skin and
many other organs, such as the heart, skin, and gastrointestinal tract. Cardiac
involvement is in the form of pericarditis, pericardial effusion, and pulmonary
hypertension. Several complications and super infections post-COVID-19 have been
reported, such as fungal, bacterial infections, and Lophomonas
blattarum. Lophomoniasis is an emerging pulmonary infection that
mainly involves the lower respiratory tract. Herein, we present an ectopic
Lophomonas infection in an unusual location (pericardial
effusion) in a COVID-19 patient who had systemic sclerosis.
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Affiliation(s)
- Zakaria Zakariaei
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
- Toxicology and Forensic Medicine Division, Orthopedic Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Sharifpour
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Fakhar
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
| | - Mostafa Soleymani
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
- Department of Radiology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Amirmasoud Taheri
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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11
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Pinos Vélez N, Ordoñez Vintimilla R, Agreda Orellana S. Lung infection caused by Lophomonas blattarum. Arch Bronconeumol 2021; 57:594-596. [PMID: 35702915 DOI: 10.1016/j.arbr.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/01/2020] [Indexed: 06/15/2023]
Affiliation(s)
- Nathalie Pinos Vélez
- Unidad de Pulmonar, Hospital José Carrasco Arteaga, Cuenca, Ecuador; Unidad de Cirugía de Tórax, Hospital Universitario del Río, Cuenca, Ecuador.
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12
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Study of Lophomonas blattarum Infection in Kidney Transplant Patients in Mashhad City, Iran. Interdiscip Perspect Infect Dis 2021; 2020:6631224. [PMID: 33381171 PMCID: PMC7759399 DOI: 10.1155/2020/6631224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Lophomonas blattarum is a flagellate protozoan which is known as an emerging parasite in the human respiratory system. Organ transplant recipients are considered as immunocompromised patients due to prescription of immunosuppressive drugs. This group of patients is susceptible to opportunistic infection as well as lophomoniasis. This study aims to investigate the prevalence and clinical manifestation of pulmonary infections caused by L. blattarum in kidney transplant recipients. Methods This is a case-control study including 50 kidney transplant recipients and 50 controls. The sputum samples were collected from 50 kidney transplant recipients with bronchopulmonary infection signs suspected to lophomoniasis admitted in Montaserieh and Imam Reza hospitals, Mashhad, Iran. 50 healthy individuals as the control group were matched for sex and age with case ones. The consent form, checklist, and required information were provided for each patient. All samples were microscopically examined for the flagellated protozoan, L. blattarum, using direct smear. Results Among 50 kidney transplant recipients suspected to lophomoniasis, L. blattarum was identified in sputum samples of 4 (8%) participants of the case group including one female and three males. None of the samples were positive among the control group. Symptoms in patients of this study were high fever (4 out of 4 patients), cough (3 out of 4 patients), and dyspnea (2 out of 4 patients). Three patients showed a positive response to metronidazole treatment. Conclusion The results of this study suggest that L. blattarum should be considered as a pathogenic agent in kidney transplant recipients. It is necessary to examine sputum samples in posttransplant pneumonia patients, especially in those resistant to antibacterial therapy.
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Pinos Vélez N, Ordoñez Vintimilla R, Agreda Orellana S. Lung Infection Caused by Lophomonas blattarum. Arch Bronconeumol 2020; 57:S0300-2896(20)30544-5. [PMID: 33441237 DOI: 10.1016/j.arbres.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Nathalie Pinos Vélez
- Unidad de Pulmonar, Hospital José Carrasco Arteaga, Cuenca, Ecuador; Unidad de Cirugía de Tórax, Hospital Universitario del Río, Cuenca, Ecuador.
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Saldaña NG, Mendoza FJO, Larrauri FR, Trujillo DMG, Montoya EV, De La Garza EA, Olguín HJ. Bronchopulmonary infection by Lophomonas blattarum in a pediatric patient after hematopoietic progenitor cell transplantation: first report in Mexico. J Thorac Dis 2017; 9:E899-E902. [PMID: 29268431 DOI: 10.21037/jtd.2017.09.19] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Lophomonas blattarum is a multiflagellated protozoon which parasitizes the gut of termites and cockroaches. Although L. blattarum infection is rare, it can affect lung, maxillary sinuses and genitourinary tract. The presentation of bronchopulmonary lophomonas includes nonspecific symptoms such as fever, cough and dyspnea. Diagnosis is based on identification of living protozoan forms in fresh samples from respiratory secretions (bronchoalveolar lavage). We report the case of a 2-year-old male with a history of severe combined immunodeficiency (T-, B-, NK-), post-hematopoietic stem cell transplant and full immune reconstitution 12 months following a successful transplant who thereafter presented lophomonas.
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Affiliation(s)
| | | | | | | | - Edna Venegas Montoya
- Service of Pediatric Immunology, National Institute of Pediatrics (NIP), Mexico City, Mexico
| | | | - Hugo Juárez Olguín
- Laboratory of Pharmacology, NIP and Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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Abstract
BACKGROUND Bronchopulmonary disease caused by flagellated protozoa infection (BPFP) is thought to be rare in children but may be an emerging or underestimated disease, especially in developing countries. METHODS In this study, we retrospectively reviewed records of 15 patients who were presented with a cough, wheezing or bronchopulmonary disease of unknown causes during admission, and patients who were finally diagnosed with BPFP from January 2014 to January 2015 were enrolled. Protozoa were observed in bronchoalveolar lavage fluid by light microscopy. RESULTS A total of 15 pediatric cases (11 male and 4 female individuals, from 1 year 8 months to 12 years 1 month of age) with flagellated protozoa infection diagnosed by light microscopy were recruited. The course of the disease at the time of diagnosis was from 10 days to 11 months. Patients presented with a fever (N = 9), cough (N = 11), wheezing (N = 5) and chest pain (N = 5). Laboratory data showed elevated peripheral blood leucocytes (N = 6), eosinophilic granulocytes (N = 3), C-reactive protein (N = 5) and immunoglobulin E (N = 3). Bronchoscopy revealed a mucus plug (N = 3) and bronchiectasis (N = 1). Lung computed tomography results indicated ground-glass opacification (N = 2), atelectasis (N = 3), bronchiectasis (N = 1), bronchial wall thickening (N = 3) or nodular opacity (N = 6, including 1 case of pulmonary embolism). All children responded to metronidazole for a 2- to 5-week treatment period. CONCLUSIONS Patients with BPFP often have a chronic or recurrent course and present with recurrent fever, cough, wheezing and chest pain. Chest imaging may reveal ground-glass opacification, atelectasis, bronchiectasis or nodular opacity (including pulmonary embolism). BPFP responds favorably to metronidazole treatment.
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Li R, Gao ZC. Lophomonas blattarum Infection or Just the Movement of Ciliated Epithelial Cells? Chin Med J (Engl) 2017; 129:739-42. [PMID: 26960379 PMCID: PMC4804422 DOI: 10.4103/0366-6999.178025] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
| | - Zhan-Cheng Gao
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China
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Alam-Eldin YH, Abdulaziz AM. Identification criteria of the rare multi-flagellate Lophomonas blattarum: comparison of different staining techniques. Parasitol Res 2015; 114:3309-14. [PMID: 26032944 DOI: 10.1007/s00436-015-4554-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 05/25/2015] [Indexed: 11/25/2022]
Abstract
Bronchopulmonary lophomoniasis (BPL) is an emerging disease of potential importance. BPL is presented by non-specific clinical picture and is usually accompanied by immunosuppression. Culture of Lophomonas blattarum is difficult and its molecular diagnosis has not yet been developed. Therefore, microscopic examination of respiratory samples, e.g., bronchoalveolar lavage (BAL) or sputum, is the mainstay of BPL diagnosis. Creola bodies and ciliocytophthoria are two forms of bronchial cells which occur in chest diseases with non-specific clinical picture like that of BPL. Both forms could be misrecognized as multi-flagellates because of their motile cilia in the wet mounts and due to shape variability of L. blattarum in stained smears. The aim of the study is to compare different staining techniques for visualizing L. blattarum to improve the recognition and diagnosis of BPL, to distinguish respiratory epithelial cells from L. blattarum and to decide which stain is recommended in suspected cases of BPL. BAL samples from patients which contain L. blattarum, creola bodies, and ciliocytophthoria were collected then wet mounts were examined. The BAL samples were also stained by Papanicolaou (PAP), Giemsa, hematoxylin and eosin (H & E), trichrome, Gram, and Diff-Quik (DQ) stains. The different staining techniques were compared regarding the stain quality. In wet mounts, the ciliary movement was coordinate and synchronous while the flagellar movement was wavy and leaded to active swimming of L. blattarum. In stained slides, bronchial cells were characterized by the presence of basal nucleus and the terminal bar from which the cilia arise. Trichrome was the best stain in demonstration of cellular details of L. blattarum. H & E, PAP, and Giemsa stains showed good quality of stains. Gram and DQ stains showed only pale hues of L. blattarum. We recommended adding Wheatley's trichrome staining to the differential diagnosis workup of cases of non-specific chest infections, especially when BPL is suspected, to avoid overdiagnosis or underdiagnosis of it.
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Affiliation(s)
- Yosra Hussein Alam-Eldin
- Medical Parasitology Department, Faculty of Medicine, Ain Shams University, Ramses Street, New Faculty Bldg., 4th floor, P.O. #11566, Cairo, Egypt,
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18
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Khemasuwan D, Farver CF, Mehta AC. Response. Chest 2015; 147:e112. [PMID: 25732459 DOI: 10.1378/chest.14-2855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Danai Khemasuwan
- Interventional Pulmonary Medicine, Henry Ford Hospital, Henry Ford Health System, Detroit, MI
| | - Carol F Farver
- Department of Anatomical Pathology, Cleveland Clinic Foundation, Cleveland, OH
| | - Atul C Mehta
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH.
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19
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Xue J, Li YL, Yu XM, Li DK, Liu MF, Qiu JF, Xue JJ. Bronchopulmonary infection of Lophomonas blattarum: a case and literature review. THE KOREAN JOURNAL OF PARASITOLOGY 2014; 52:521-5. [PMID: 25352701 PMCID: PMC4210735 DOI: 10.3347/kjp.2014.52.5.521] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 07/22/2014] [Accepted: 09/06/2014] [Indexed: 01/16/2023]
Abstract
Human infections with Lophomonas blattarum are rare. However, the majority of the infections occurred in China, 94.4% (136 cases) of all cases in the world. This infection is difficult to differentiate from other pulmonary infections with similar symptoms. Here we reported a case of L. blattarum infection confirmed by bronchoalveolar lavage fluid smear on the microscopic observations. The patient was a 21-year-old female college student. The previous case which occurred in Chongqing was 20 years ago. We briefly reviewed on this infection reported in the world during the recent 20 years. The epidemiological characteristics, possible diagnostic basis, and treatment of this disease is discussed in order to provide a better understanding of recognition, diagnosis, and treatment of L. blattarum infection.
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Affiliation(s)
- Jian Xue
- School of Public Health and Management, Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Ying-Li Li
- School of Public Health and Management, Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Xue-Mei Yu
- Department of Inspection, University-Town Hospital of Chongqing Medical University, Shapingba District, Chongqing 400016, China
| | - Dai-Kun Li
- Department of Inspection, University-Town Hospital of Chongqing Medical University, Shapingba District, Chongqing 400016, China
| | - Ming-Fang Liu
- Department of Inspection, University-Town Hospital of Chongqing Medical University, Shapingba District, Chongqing 400016, China
| | - Jing-Fu Qiu
- School of Public Health and Management, Chongqing Medical University, Yuzhong District, Chongqing, China
| | - Jian-Jiang Xue
- Department of Inspection, University-Town Hospital of Chongqing Medical University, Shapingba District, Chongqing 400016, China
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Martinez-Girón R, Cornelis van Woerden H. Lophomonas blattarum and bronchopulmonary disease. J Med Microbiol 2013; 62:1641-1648. [PMID: 23946475 DOI: 10.1099/jmm.0.059311-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The natural habitat of the multiflagellate protozoon Lophomonas blattarum is as an endocommensal in the hindgut of insects such as cockroaches. However, it also causes bronchopulmonary disease in humans. The aim of this paper was to review the literature on this organism in the context of respiratory disease. The biology epidemiology, route of transmission, pathogenic mechanisms and diagnosis methods are also described. A total of 61 cases were identified in the literature. The majority of these reports were from China, with some cases from Peru and Spain. Most cases were adult males, although paediatric cases were reported in Peru. Clinical presentation was non-specific, including symptoms such as fever, cough and breathless. Antiprotozoal therapy was generally effective.
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Affiliation(s)
- Rafael Martinez-Girón
- Protozoal Respiratory Pathology Research Unit. Fundación INCLÍNICA, Calvo Sotelo, 16-3 dcha, 33007-Oviedo, Spain
| | - Hugo Cornelis van Woerden
- Institute of Primary Care & Public Health, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
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