Diagnosis of pulmonary lophomoniasis in an elderly anthracosis patient with resistant respiratory symptoms: A literature review and a case report study.

Key Clinical Message: Anthracosis causes chronic lung inflammation and immunodeficiency, which are associated with parasitic conditions like lophomonas. Healthcare providers must consider both anthracosis and pulmonary lophomoniasis when evaluating patients with respiratory symptoms, as early detection and treatment can lead to better outcomes for affected individuals. Proper diagnosis and management of these conditions can help prevent complications and improve overall lung health. Abstract: Anthracosis is a chronic pulmonary disease characterized by black pigmentation of the bronchial mucosa due to carbon accumulation in the lungs. This condition can result in immunosuppression and make patients more susceptible to parasitic diseases. A 77-year-old patient was admitted with fever, dyspnea, and cough with whitish-yellow sputum that began 2 months ago. Symptoms worsened with partial response to outpatient treatment. Bronchoscopy was requested due to abnormal lab tests and CT scan findings. Bronchoscopy sample revealed anthracosis and microscopic analysis of BAL detected live oval flagellated lophomonas protozoa. Treatment consisted of bronchodilators, corticosteroids, and antibiotic therapy. Anthracosis is linked to parasite diseases, such as lophomonas; thus, concurrent pulmonary lophomoniasis should be considered when anthracosis is identified. Healthcare providers must be vigilant in diagnosing and treating both anthracosis and pulmonary lophomoniasis, as the presence of one may indicate the possibility of the other.

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.

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.

Lophomonas blattarum-like organism in bronchoalveolar lavage from a pneumonia patient: current diagnostic scheme and polymerase chain reaction can lead to false-positive results.

Lophomonas blattarum is an anaerobic protozoan living in the intestine of cockroaches and house dust mites, with ultramicroscopic characteristics such as the presence of a parabasal body, axial filament, and absence of mitochondria. More than 200 cases of Lophomonas infection of the respiratory tract have been reported worldwide. However, the current diagnosis of such infection depends only on light microscopic morphological findings from respiratory secretions. In this study, we attempted to provide more robust evidence of protozoal infection in an immunocompromised patient with atypical pneumonia, positive for Lophomonas-like protozoal cell forms. A direct search of bronchoalveolar lavage fluid via polymerase chain reaction (PCR), transmission electron microscopy (TEM), and metagenomic next-generation sequencing did not prove the presence of protozoal infection. PCR results were not validated with sufficient rigor, while de novo assembly and taxonomic classification results did not confirm the presence of an unidentified pathogen. The TEM results implied that such protozoal forms in light microscopy are actually non-detached ciliated epithelial cells. After ruling out infectious causes, the patient's final diagnosis was drug-induced pneumonitis. These findings underscore the lack of validation in the previously utilized diagnostic methods, and more evidence in the presence of L. blattarum is required to further prove its pathogenicity.

A co-infection of Pneumocystis jirovecii and Lophomonas blattarum causing pneumonia in a patient with adenocarcinoma of lung.

Patients with lung cancer suffer frequent infections which not only thwart the effect of oncological treatment but also affect overall survival. We present a fatal case where coinfection of Pneumocystis jirovecii and Lophomonas blattarum caused pneumonia in a patient with advanced and treated metastatic adenocarcinoma of lung. Cytomegalovirus (CMV) PCR was positive for the patient. Newer pathogens are not only emerging but also there is an increase in incidence of coinfections. Pneumonia due to coinfection of Pneumocystis jirovecii and Lophomonas blattarum is rare and unusual and requires high degree of suspicion and skill for the diagnosis.

Two cases of Lophomonas blattarum infection combined with paragonimiasis and literature review / 中国基层医药

Objective:To investigate the clinical manifestations, diagnosis, and treatment methods of Lophomonas blattarum infection combined with paragonimiasis in children, and improve pediatricians' understanding of the disease. Methods:The clinical data of two children with Lophomonas blattarum infection combined with paragonimiasis who received treatment in the Department of Pediatrics of The First People's Hospital of Yunnan Province were retrospectively analyzed. Children's clinical manifestation and diagnosis and treatment were analyzed. Relative literature was reviewed. Results:Case 1 had the onset of gastrointestinal symptoms. Case 2 had the onset of headache and liver dysfunction. Routine blood tests showed elevated eosinophils two cases and sputum examination results revealed the presence of live eggs of Lophomonas blattarum and paragonimiasis in two cases. Fecal roundworm eggs were also detected in case 1. Follow-up results showed that both cases were cured after treatment with metronidazole injection and praziquantel tablets. Conclusion:Lophomonas blattarum infection is a relatively rare opportunistic infection. Paragonimiasis is a natural parasitic disease that affects both humans and animals. Mixed infection of the two pathogens is rare. We hope that the findings from this paper will broaden clinical physicians' thoughts and guide clinical practice.

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.

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.

Detection of Lophomonas blattarum (Order: Hypermastigida) from Iranian Patients with Allergic Rhinitis.

Background: Allergic rhinitis (AR) is one of the most common allergic diseases triggered by indoor and outdoor allergens. Certain arthropods, such as mites and cockroaches, contain protozoa like Lophomonas blattarum in their intestines to help with digestion that may have some role in AR. We aimed to determine the frequency of L. blattarum in nasal smears of patients with AR in comparison with healthy controls. Methods: In this prospective cross-sectional study (March 2015-March 2016), 36 patients with a clinical presentation of AR (with a positive prick test including mites) and 34 normal controls were included at ear, nose, and throat (ENT) clinic at Imam Reza Hospital of Mashhad, Iran. Nasal secretions were evaluated to examine presence of L. blattarum in the patients and control group by direct method. Diagnosis of L. blattarum was based on microscopic observation both on direct smear and Giemsa stained specimens. Results: Patients with AR had a higher frequency of L. blattarum in their nasal smears than the control group (25% vs. 2.9%) (P=0.001). Conclusion: We found L. blattarum more frequently in the nasal secretion of AR patients compared with healthy subjects; this protozoon may have some role in this condition. However, the relationship between L. blattarum and AR requires further studies to allow a greater understanding.

Lophomonas isolation in sputum sample at Peru.

Lophomonas infection is an emerging parasitic disease causing respiratory infections. After China, Peru is the second country with the highest number of cases. In the bright-field microscopy evaluation of fresh samples, most of them are incorrectly estimated. Therefore, correct identification using cytological stains is to be supplemented. We report a case of a 29-year-old male with typical clinical symptoms of pneumonia, marked eosinophilia, and noninfiltrative pattern in chest X-ray, who had bronchopulmonary lophomoniasis.

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 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.

The prevalence of protozoa in the gut of German cockroaches (Blattella germanica) with special reference to Lophomonas blattarum.

The German cockroach (Blattella germanica) is a common domestic pest, which produces allergens that have been associated with broncho-pulmonary disease. Various protozoan species have been identified in the intestine of this cockroach and it has been hypothesised that these protozoa, or their proteases, may contribute to the burden of cockroach-associated allergens and adjuvants present in domestic dust. The aim of this study was therefore to determine the prevalence of protozoan species in the intestine of Blattella germanica. German cockroaches were anesthetised and dissected and gut contents are used to produce wet slides for microscopy. Both, Giemsa and Papanicolaou stains were used to confirm correct identification of Lophomonas blattarum. Representatives of four genera of protozoa were identified in 110 cockroaches: Nyctoterus sp. was observed in 91.8% of cases, Gregarina sp. in 64.5%, Amoeba sp. in 25.4% and Lophomonas blattarum in 13.6%. Nyctoterus and Gregarina were statistically significantly more likely to be found in diseased cockroaches compared to Amoeba or Lophomonas. The prevalence of Lophomonas blattarum was similar to that in published studies of a different species of cockroach, Periplaneta americana. Further work is needed to assess the interplay between protozoa, cockroaches and broncho-pulmonary diseases.

Bronchopulmonary infection of Lophomonas blattarum: a case and literature review.

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.

Lophomonas blattarum infection presented as acute exacerbation of chronic obstructive pulmonary disease.

The present case described a 70-year-old male who was initially diagnosed and treated as acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Ultimately Lophomonas blattarum (L. blattarum), a rare protozoan causing opportunistic infection, was found in suction sputum smear. Bronchoscopy showed a lot of purulent sputum in airways, diffusely swelling and friable mucus on bronchus. After single tinidazole treatment, symptoms and image showed marked improvement. It indicates though in the untraditional immunocompromised case, the suspect of opportunistic diseases is necessary, especially in the cases failed to improvement under empirical treatment. It also supports the tinidazole treatment is efficacy in L. blattarum infection.

Bronchopulmonary Infection of Lophomonas blattarum: A Case and Literature Review

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.

Bronchopulmonary Lophomonas blattarum infection: two cases report and literature review / 中华内科杂志

Objective To improve the recognition and diagnosis of pulmonary Lophomonas blattarum infection. Methods Two cases of bronchopulmonary Lophomonas blattanan diagnosed in this hospital were reported. The clinical features of 13 cases in the literature during the period of 1993 to 2006,1 case with sinus infection and 12 cases with bronchopulmonary infection, were also analyzed. Results For the 2 cases diagnosed in this hospital, severe asthma and bronchiectasis withprolonged infection were the underlying diseases, respectively. The diagnosis of these 2 cases and the 13 cases reported in the literature were all confirmed by the presence of parasites in airway samples. The most common symptoms included fever (64.3% ), cough and expectoration (71.4%). Fifty percent of the patients showed increased eosinophils in peripheral blood. Chest radiograph and CT scan showed changes similar to pneumonia(83.3%). Chronic cases were manifested with asthma attack, branchiectasis or lung abscess. Smear preparations of sputum or specimen by bronchoscopy were direct methods for diagnosis. Conclusion Pulmonary Lophonomas blattarum infection is an emerging infectious disease caused by protozoon of hypermastigote parasitized in the bronchus or the lung. Epidemiological characteristics including host, route of transmission and susceptible population of Lophomonas blattarum infection are not fully understood. The optimal treatment also needs further investigation.

Diagnosis and Treatment of Lophomonas blattarum Infection in 26 Patients with Bacterial Pneumonia / 中国寄生虫学与寄生虫病杂志

The clinical features of Lophomonas blattarum infection in 26 patients with bacterial pneumonia were analyzed.Common manifestation included fever,cough and breathlessness.Computed tomography(CT)showed interstitial change and alveolar exudation.The parasites were found in sputum smear and from the bronchoalveolar lavage fluid(BALF).Metronidazole was effectively used to cure the pulmonary infection of L.blattarum.