Authenticity of pulmonary Lophomonas blattarum infection: A case report

Abstract

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.

Lophomonas blattarum parásito de cucarachas que causa neumonías infrecuentes en humanos

“…El diagnóstico de laboratorio se basa principalmente en la observación de la morfología parasitaria a través del microscopio de luz. Sin embargo, en algunos estudios se han confundido las células ciliadas del tracto respiratorio de los pacientes con L. blattarum y algunos protozoarios multiflagelados (12). El diagnóstico molecular se lleva a cabo a través de una reacción en cadena de polimerasa específica (PCR) donde se puede observar una banda de 214 pb que confirmaría el género Lophomonas spp (13).…”

“…Como se mencionó anteriormente, se cree que la inhalación de los aerosoles con los ooquistes de Lophomonas infecta a los humanos, pero también se considera la ingestión de comida contaminada con heces de cucarachas. Las condiciones higiénicas deficientes y la presencia de altas poblaciones de cucarachas en hábitats humanos se constituyen en factores de riesgo importantes (12).…”

Case report: pneumonia caused by lophomonas

“…En éstos pacientes no se ha determinado el uso de corticoesteroides, ya que el uso prolongado podría causar inmunosupresión (9). Se sabe que aumenta el riesgo de bacterias, infecciones víricas y fúngicas; en caso que los pacientes hallan estado bajo tratamiento con esteroides incremente el riesgo de infección de tipo oportunista por este protozoario (10). Mujer de 29 años con escolaridad de bachillerato completo, nivel socio económico bajo, estado civil en unión libre, dedicada a labores del hogar, religión católica; con carga genética para diabetes mellitus tipo 2 e hipertensión arterial sistémica línea materna.…”

Lophomoniasis associates with chronic immune compromise and respiratory coinfections: a case report.

“…Its correct diagnosis depends upon the microscopic observation of samples of sputum, bronchial brushings or secretions, tracheal aspirates, or bronchoalveolar lavages. In such tests the protozoon appears as unipolarlly pluriflagellated round, ovoid or piriform cells of 20-60μm in length and 12-20μm in width, that have a highly granular cytoplasm and an inconspicuous nucleus (2,7). In order to avoid the aforementioned diagnostic problems, Fakhar, M et al (2019) proposed a polymerase chain reaction (PCR)-based diagnostic technique (8) that is yet to be widely tested.…”

“…Lophomoniasis usually occurs in patients that have a concomitant RT-disease (10,(13)(14)(15), are immunocompromised because of an underlying disease (16) or receive immunosuppressant drugs as a tolerogenic therapy to organ transplantation (6,17). Nonetheless, although sparse, there are also reports of otherwise healthy individuals with such disease (7). In this way, some authors think that Lophomonas spp may have an opportunistic behavior, rather than a full parasitic ability ( 6), or even that the protozoon is in fact a commensal that can become pathogenic under some unrelated pathological circum-stances (3).…”