Bronchopulmonary infection of Lophomonas blattarum: a case and literature review

Imaging patterns of Lophomonas blattarum infection in the respiratory tract: a registry-based analysis

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.

Severe lophomoniasis in a patient with diabetes and past history of COVID-19 in Central Iran: case report

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.

Lophomonas as a respiratory pathogen-jumping the gun

Human infections with the protozoan Lophomonas have been increasingly reported in the medical literature over the past three decades. Initial reports were based on microscopic identification of the purported pathogen in respiratory specimens. Later, a polymerase chain reaction (PCR) was developed to detect Lophomonas blattarum, following which there has been a significant increase in reports. In this minireview, we thoroughly examine the published reports of Lophomonas infection to evaluate its potential role as a human pathogen. We examined the published images and videos of purported Lophomonas, compared its morphology and motility characteristics with host bronchial ciliated epithelial cells and true L. blattarum derived from cockroaches, analyzed the published PCR that is being used for its diagnosis, and reviewed the clinical data of patients reported in the English and Chinese literature. From our analysis, we conclude that the images and videos from human specimens do not represent true Lophomonas and are predominantly misidentified ciliated epithelial cells. Additionally, we note that there is insufficient clinical evidence to attribute the cases to Lophomonas infection, as the clinical manifestations are non-specific, possibly caused by other infections and comorbidities, and there is no associated tissue pathology attributable to Lophomonas. Finally, our analysis reveals that the published PCR is not specific to Lophomonas and can amplify DNA from commensal trichomonads. Based on this thorough review, we emphasize the need for rigorous scientific scrutiny before a microorganism is acknowledged as a novel human pathogen and discuss the potential harms of misdiagnoses for patient care and scientific literature.

Geospatial Analysis and Molecular Epidemiologic Study of Emerging Pulmonary Lophomoniasis in Iran: A National Registry-Based Study

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.

High Occurrence of Emerged Lophomonas Infection among Patients Suspected of Having Pulmonary Tuberculosis: In-House PCR-Based Evidence

Objectives

Lophomonas infection is a respiratory disease in humans that is associated with symptoms of cough, sputum, dyspnea, and sometimes hemoptysis, which shows the importance of differentiating this disease from tuberculosis and asthma.

Methods

This study was performed on 216 participants suspected of having tuberculosis who had symptoms of fever, chronic cough, or sputum and were referred to tuberculosis laboratories in three cities in Golestan Province, northeastern Iran, during 2019-2020. A sputum sample was taken from the suspected patients. DNA was extracted from the frozen samples, and an in-house polymerase chain reaction was performed to detect the Lophomonas DNA.

Results

Out of 216 subjects, 47 (21.75%) were infected with Lophomonas spp. Moreover, 9 patients (4.2%) were infected with tuberculosis. Also, 2 patients had a comorbidity of tuberculosis and Lophomonas infection (P=0.63). There was no significant difference in the comparison of symptoms and the rate of Lophomonas infection (P=0.84), but in the comparison of the set of symptoms of cough, sputum, and fever with those of cough and sputum, cough with fever, sputum with fever, and the rate of Lophomonas infection, there was a significant difference (P=0.012).

Conclusions

Lophomonas infection was relatively high in patients suspected of having tuberculosis and due to the similar clinical symptoms of Lophomonas infection and tuberculosis; it is recommended that the sputum samples of subjects suspected of having tuberculosis be examined for this parasite in order to make a correct diagnosis and the patients receive timely treatment and the appropriate medication.

Lophomonas and Mycobacterium co-infection: the first molecular evidence to overcome potential diagnostic pitfalls

Lophomoniasis is an emerging protozoan disease that mostly involves the lungs. Because the disease has similar symptoms to other pulmonary infections such as tuberculosis, most cases are underdiagnosed. Here, we present a patient with co-infection of Lophomonas/Mycobacterium.

Detection of a Lophomonas, a rare pathogen in Bronchoalveolar lavage

Lophomonas infection is an emerging parasitic disease-causing respiratory infection. Although common in immunocompromised patient, it has been observed also in some immunocompetent cases. We report the case of a 45-year-old male who presented with productive cough, fever, and chest pain, with marked eosinophilia and cavitary lesion in the X-ray chest. KOH preparation and acid-fast bacilli microscopy of bronchoalveolar lavage (BAL) were negative. Direct microscopic examination of BAL accidentally showed a large number of living Lophomonas species with the movement of flagella. Methylene blue and Giemsa staining showed the plume of flagella and the nucleus. The patient was managed conservatively with metronidazole and get cured. It was concluded that the patient presented with signs and symptoms of pneumonia must be evaluated for rare events also if the patient was not responding with typical management of pneumonia. We reported the first case of this rare entity in Chhattisgarh state in an immunocompetent young Indian male.

Fiberoptic Bronchoscopic Findings in Patients Suffering from Emerging Pulmonary Lophomoniasis: A First Registry-Based Clinical Study

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.

Molecular Evidence of Emerged Pulmonary Lophomoniasis due to Lophomonas blattarum among Hospitalized Patients in Southwestern Iran: A National Registry-Based Study

Objectives

Lophomonas protozoan is an emerging pathogen transmitted through arthropods such as cockroaches. Lophomoniasis is still a mysterious disease with many unknown epidemiological aspects. The current study aimed to determine the prevalence of lophomoniasis among patients who were hospitalized in Hajar Hospital, Shahrekord, southwestern Iran, using a conventional PCR technique.

Methods

In this retrospective study, 132 frozen bronchoalveolar lavage fluid (BALF) specimens from patients with respiratory disorders hospitalized in Hajar Hospital, Shahrekord district, southwestern Iran, were analyzed during 2020-2021. Samples are referred to the Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran Province, Northern Iran, for detecting Lophomonas spp. infection by a conventionally small subunit ribosomal RNA (SSU rRNA) PCR test.

Results

A total of 132 frozen BALF specimens were examined, 36 (27.3%) tested Lophomonas spp. positive using the conventional PCR technique. Also, based on sequencing data and blast analysis, the presence of L. blattarum species was confirmed. The average age of Lophomonas spp.‐ positive patients was 67.02 ± 15.14 years. Out of the 36 positive subjects, 63.9% were male and 36.1% female. Male and Lophomonas infection had a significant correlation (p=0.001). Our findings revealed that L. blattarum infected nonsmokers more than smokers (p=0.001). The most common underlying disease was also bronchitis

Conclusion

Our results showed, for the first time, that pulmonary lophomoniasis caused by L. blattarum is a common and emerging disease in the study area, southwestern Iran. Furthermore, our findings support the use of the PCR test to detect Lophomonas infection in archived frozen clinical samples.

First molecular approach to diagnose paediatric pulmonary lophomoniasis: A case series

A prospective study was conducted from 2017 to 2021 at Bouali Hospital in Mazandaran province, Sari, Iran. Out of 58 patients who were enrolled in our study, lophomoniasis was diagnosed in bronchoalveolar lavage fluid of nine patients, for the first time, using an in-house polymerase chain reaction technique. All patients were treated with metronidazole at 7.5 mg/kg/day every 12 h for 14 days. After 6 months of follow-up, symptoms were fully resolved.

Global Status of Emerging Lophomonas Infection: A Systematic Review of Reported Cases (1993—2020)

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%, $P<0.04$ ) 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 $\left(P<0.001\right)$ . Moreover, the BAL specimen was the most commonly used clinical sample to diagnose lophomoniasis $\left(P<0.001\right)$ . 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.

Cavitary pulmonary lesions following emerging lophomoniasis: A novel perspective

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.

First Co-morbidity of Lophomonas blattarum and COVID-19 Infections: Confirmed Using Molecular Approach

Introduction

Lophomoniasis is caused by Lophomonas spp., a new emerging protozoan, which commonly affects the human lower respiratory tract. The Lophomonas parasite mostly lives commensally in the hindgut of cockroaches.

Case Presentation

We present the case of a 33-year-old woman, 30 weeks pregnant, who had severe COVID-19. She was intubated upon admission and began the routine COVID-19 treatment. To rule out possible super infection dual with COVID-19, microscopic examination of the patient's mini-bronchoalveolar lavage (mini-BAL) specimen, revealed L. blattarum, which was identified by the SSU rRNA-PCR and sequencing approaches (accession number: MZ093069). According to that, the patient was treated successfully with metronidazole.

Conclusion

To prevent serious complications, lophomoniasis should be listed in co-morbidity cases of COVID-19 infection during the COVID-19 pandemic worldwide. To the best of our knowledge, this is the first co-infection of Lophomonas blattarum and COVID-19 in the world which has been confirmed using a molecular approach.

Molecular evidence of upper and lower respiratory infection due to Lophomonas in a post-kidney transplantation patient

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.

Morphological and Molecular Identification of Emerged Lophomonas blattarum Infection in Mazandaran Province, Northern Iran: First Registry-Based Study

BACKGROUND

In the last decade, several cases of bronchopulmonary lophomoniasis (BPL) have been recorded. Little information is available about epidemiological aspects on Lophomonas infection among BPL patients. The present study was aimed to investigate the prevalence of Lophomonas spp. infection in patients who were referred to the Iranian National Registry Center for Lophomoniasis (INRCL), using morphological and molecular tests.

SUBJECTS AND METHODS

We examined patients enrolled in the INRCL from 2017 to 2019 at the Mazandaran University of Medical Sciences, northern Iran. All bronchoalveolar lavage fluid (BALF) and two nasal discharges of the patients were examined by both microscopic and small-subunit ribosomal RNA (SSU rRNA) PCR methods. To confirm the species of Lophomonas, two positive samples were sequenced.

RESULTS

In this study, 321 specimens (including 319 BALF and 2 nasal discharges) were microscopically examined. Lophomonas spp. was found in 45(14%) (n = 44 BAL; n = 1 nasal discharge). The mean age of infected patients was 54.9 ± 17.1 years. The following morphological characteristics were observed in both fresh and Papanicolaou-stained smears to identify Lophomonas spp. All microscopically positive specimens were confirmed with genus-specific PCR technique. The obtained sequences were deposited in Gen Bank under the accession numbers (MN243135-36). The BLAST analysis of our two sequences with the only available sequence in the Gen Bank of the Thailand strain of L. blattarum, showed identity of 99-100% and 98.51%, respectively.

CONCLUSION

To the best of our knowledge, this is the first registry-based study regarding lophomoniasis worldwide. According to our study, the conventional PCR test is an available and reliable tool for confirming the Lophomonas parasite in clinical samples. Moreover, the results confirmed that L. blattarum is circulating at least in our region.

First report of Lophomonas spp. in German cockroaches (Blattella germanica) trapped in hospitals, northern Iran

Cockroaches are considered to be important reservoirs for protozoan and helminth parasites,particularly an emerging Lophomonas spp., protozoan parasite. German cockroaches, Blattella germanica (B. germanica), are domestic pest distributed worldwide. However, little information is available regarding the burden of Lophomonas spp. infestation among domestic cockroach population worldwide. The present study investigated parasitic agents, emphasizing Lophomonas spp. infestation among B. germanica in northern Iran. During spring and summer 2018, a total of 496 adults B. germanica (265 males and 231 females) were trapped by hand and glass traps from the teaching hospitals in Mazandaran, Sari, northern Iran. All cockroaches were identified using taxonomic keys. Each cockroaches was anesthetized with chloroform and the alimentary tract removed. Each section was smeared onto a glass slide. All the smears were examined under light microscopy to determine the presence of the parasites. Ten genera of parasites were identified from the trapped B. germanica; overall, 233 (47%) were found to be positive for helminths (n = 135) and protozoa (n = 98). The helminths included Aspiculuris tetraptera egg (67/233, 28.7%), Oxiuros sp. (39/233; 16.7%), Dentostomella translucida (17/233; 7.3%), and nematodes Ova (12/233; 5.2%). The protozoan parasites identified Gregarina sp. (61/233; 26.2%), Entamoeba sp. (19/233; 8.2%), Blastocystis sp. (5/233; 2.1%), Lophomonas (4/233; 1.7%), Nyctotherus sp. (4/233; 1.7%), unclassified flagella (5/233; 2.1%). Lophomonas spp. was detected within the gut of B. germanica, for the first time, in Iran. It has previously been identified in the gut of cockroaches a long time ago, however, this is the first attempt to detect Lophomonas in cockroaches housing in hospitals. Thereby, it possibly presenting pose a serious respiratory infection risk for patients and health care personnel.

A Bibliometric Analysis of Global Research on Lophomonas Spp. in Scopus (1933-2019)

BACKGROUND

This study was designed to analyze the global research on Lophomonas spp. using bibliometric techniques.

METHODS

A bibliometric research was carried out using the Scopus database. The analysis unit was the research articles conducted on Lophomonas spp.

RESULTS

A total of 56 articles on Lophomonas spp. were indexed in the Scopus throughout 1933-2019 (87 years) with the following information: (A) The first article was published in 1933; (B) 21 different countries contributed in studies related to Lophomonas spp.; (C) China ranked first with 16 publications about Lophomonas spp.; and (D) "Brugerolle, G" and "Beams, H.W." from France and the US participated in 4 articles respectively, as the highest number of publications in the Lophomonas spp. network.

DISCUSSION

After 87 years, Lophomonas still remains unknown for many researchers and physicians around the world. Further studies with high quality and international collaboration are urgently needed to determine different epidemiological aspects and the real burden of the mysterious parasite worldwide.

Pulmonary Infection with Lophomonas blattarum

OBJECTIVE

To describe the characteristics of Lophomonas blattarum infection in children based on a retrospective review of medical records data from Beijing Children's Hospital, Capital Medical University, China.

METHODS

This study included 53 cases from July 2014 through December 2016. The data were tabulated and statistically analysed in a Microsoft Excel spreadsheet and SPSS 17.0.

RESULTS

The average age of the 53 patients was 7.10 ± 0.56 years, and the male/female ratio was 3:2.3. The most common clinical manifestation was cough, and almost half of the patients had fever. Furthermore, all patients were treated with metronidazole and recovered.

CONCLUSIONS

For children who have had long-term respiratory symptoms, the possibility of Lophomonas blattarum infection should be ruled out. Metronidazole is effective in treating L. blattarum infection in children.

Lophomonas sp. in the upper and lower respiratory tract of patients from a hospital in Lambayeque, Peru: clinical case studies

Infections with protozoans, mainly due to immunodeficiency, are common all over the world. However, pulmonary infections with protozoans are less frequent. Lophomonassp. is a flagellated protozoan that lives in the gastrointestinal tract of some species of cockroaches. Some cases, that show the presence of Lophomonas in populations whose lungs are affected, have been reported. Case report: The medical records of nine patients were studied: seven adult patients and two pediatric patients who were in the Intensive Care Unit (ICU) and in the Neonatal Intensive Care Unit (NICU), respectively. The samples were taken from tracheal aspirations and bronchoalveolar lavages. The patients’ ages were between 9 and 95 years, and 60% of them were male. Some of the patients were healthy, a priori, and others were immunosuppressed. There were found three patients with neoplasia, two patients with diabetes mellitus and four patients with no systemic pathologies. It is concluded that Lophomonas sp. is a protozoa parasite which emerges from the upper and lower respiratory tract of hospitalized patients. However, its pathogenic role is still controversial in all cases, that's why it merits further study for its understanding and possible treatment.

Lophomonas blattarum: A new flagellate causing respiratory tract infections

Lophomonas blattarum is a flagellate protozoan parasite which was originally described as a commensal in the gut of cockroaches. From the 1990s, reports started coming out of peoples Republic of China about its possible role in bronchopulmonary infections, and this was followed by reports from some other parts of the world as well. There had been some skepticism regarding the misidentification of bronchial ciliated epithelial cells as L. blattarum, but recent use of molecular diagnosis has come as an aid in clearing the controversy. This review focuses on the various aspects of the parasite including its biology, epidemiology, clinical manifestations, laboratory diagnosis, and the treatment aspects. Molecular diagnosis has recently been employed and more reports concerning its validation is needed. More basic research concerning the genomic and proteomic analysis is necessary to develop reliable molecular and serological tests for this parasite in future.

Bronchopulmonary lophomoniasis: A rare cause of pneumonia in an immunosuppressed host

Bronchopulmonary lophomoniasis is rare but immunocompromised individual is susceptible to this infection. We reported a case of bronchopulmonary lophomoniasis in a Malaysian female with systemic lupus erythromatosus. She presented with productive cough, shortness of breath and high-grade fever for 2 weeks. Physical examination revealed bronchial sound and crackles over the left lung with, reduced expansion and dull percussion in lower left lobe. Chest radiography showed consolidation of the left lung. Routine laboratory tests revealed general low cell count. Blood and sputum culture were negative. Bronchoalveolar lavage stain and culture for bacterial and fungal were negative. Bronchoalveolar lavage for Lophomonas blattarum was positive. Patient was treated with antiprotozoal drug, metronidazole. All her clinical problems resolved and she was discharged 14 days after admission.

First Molecular Diagnosis of Lophomoniasis: the End of a Controversial Story

INTRODUCTION

We report a case of lophomoniasis in an immunocompetent patient with acute paranasal sinusitis from the north of Iran whose disease was diagnosed by both microscopic and molecular methods.

CASE PRESENTATION

The patient, a 40-year-old woman, suffered from upper respiratory infection, was referred to the Iranian National Registry Center for Lophomoniasis (INRCL) at the Mazandaran University of Medical Sciences, Sari, Iran, for diagnosis. A direct wet mount of nasal discharge revealed the flagellate protozoa morphologically identified Lophomonas blattarum. Moreover, through a specific polymerase chain reaction (PCR) of nasal discharge, a 214-bp band was observed, confirming the genus Lophomonas spp. The patient was treated successfully with metronidazole 500 mg t.i.d for 1 week.

CONCLUSION

To the best of our knowledge, this is the first molecular detection of lophomoniasis in the literature. According to our preliminary study, a reliable PCR test is available now for detecting the Lophomonas parasite.

Authenticity of pulmonary Lophomonas blattarum infection: A case report

Pulmonary protozoal infections are rare. A 28-year-old woman was admitted to hospital with chief complains of cough, sputum, and dyspnea. The clinical laboratory tests for blood revealed an increased eosinophil percentage of 31.3% and significantly elevated total IgE. The chest computed tomography scan revealed that bilateral bronchial walls were thickening, accompanied with patchy spots scattered throughout bilateral lungs. A suspected multiflagellated protozoan was observed under a light microscope. But some different features were observed by electron microscopy, such as the orientation of flagella and nucleus. Besides, both bronchoalveolar lavage fluid and bronchoscopic brush smears underwent Gram staining and Pap staining, which revealed that numerous respiratory ciliated cells were scattered or accumulated in the sample. Finally, she was diagnosed with eosinophil pneumonia. Metronidazole, bronchodilators, and mucolytics were taken for 5 d and symptoms and pulmonary ventilation function improved. We herein report a case of chronic eosinophilic pneumonia, which was misdiagnosed as multiflagellated protozoan infection, and it is suggested that reliable diagnosis approaches are necessary, rather than clinical symptoms and morphological features.

Bronchopulmonary infection by Lophomonas blattarum in a pediatric patient after hematopoietic progenitor cell transplantation: first report in Mexico

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.

Bronchopulmonary Disease Caused by Flagellated Protozoa Infection in 15 Chinese Children

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.

Lophomonas blattarum infection in immunocompetent patient

Lophomonas blattarum (L. blattarum) is a protozoan parasite living in intestinal tracts of termites and cockroaches. Chen and Meng from China repoted first case of pulmonary L. blattarum infection in 1993. 137 cases have only been reported in literature between 1993 to 2013. Majority of these infections occur in immunocompromised patients and have been reported from China. We report a case of this rare entity in an immunocompetent young Indian male.