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.
Subject(s)
COVID-19 , Diabetes Mellitus , Diabetic Ketoacidosis , Lung Diseases, Parasitic , Protozoan Infections , Humans , Female , Protozoan Infections/complications , Protozoan Infections/diagnosis , Lung Diseases, Parasitic/diagnosis , Lung Diseases, Parasitic/drug therapy , Lung Diseases, Parasitic/etiology , Iran , Post-Acute COVID-19 Syndrome , COVID-19/complications , Diabetic Ketoacidosis/complicationsABSTRACT
BACKGROUND Strongyloides stercoralis is an intestinal helminth. Parasitism is caused by penetration of the larvae through the skin. It is endemic in tropical and subtropical regions of the world and in the United States occurs in the southeastern region. It has a tendency to remain dormant or progress to a state of hyper-infection during immunosuppression. CASE REPORT We present the case of a 70-year-old Nigerian who developed fatal ARDS secondary to Strongyloides infection after been treated with steroids for treatment of autoimmune necrotizing myopathy. Despite adequate management with mechanical ventilation and appropriate antifungal therapy, the patient died on day 19 of hospitalization. CONCLUSIONS S. stercoralis is known to affect every organ in the body. ARDS is often an overlooked complication of Strongyloides hyper-infection, which is often deadly. Immediate diagnosis and treatment are important for patient survival.
Subject(s)
Lung Diseases, Parasitic/diagnosis , Respiratory Distress Syndrome/parasitology , Strongyloides stercoralis , Strongyloidiasis/complications , Strongyloidiasis/diagnosis , Aged , Animals , Fatal Outcome , Humans , Lung Diseases, Parasitic/etiology , Lung Diseases, Parasitic/therapy , Male , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/therapy , Strongyloidiasis/therapy , Tomography, X-Ray ComputedABSTRACT
The prognosis of pulmonary toxoplasmosis, including disseminated toxoplasmosis involving the lungs, following hematopoietic stem cell transplantation (HSCT) is extremely poor due to the difficulties associated with early diagnosis and the rapidly progressive deterioration of multiorgan function. In our institution, we identified nine cases of toxoplasmosis, representing incidences of 2.2 and 19.6 % among all HSCT recipients and seropositive HSCT recipients, respectively. Of the patients with toxoplasmosis, six had pulmonary toxoplasmosis. Chest computed tomography (CT) findings revealed centrilobular, patchy ground-glass opacities (n = 3), diffuse ground-glass opacities (n = 2), ground-glass opacities with septal thickening (n = 1), and marked pleural effusion (n = 1). All cases died, except for one with suspected pulmonary toxoplasmosis who was diagnosed by a polymerase chain reaction assay 2 days after the onset of symptoms. In pulmonary toxoplasmosis, CT findings are non-specific and may mimic pulmonary congestion, atypical pneumonia, viral pneumonitis, and bronchopneumonia. Early diagnosis and treatment is crucial for overcoming this serious infectious complication. Pulmonary toxoplasmosis should be considered during differential diagnosis in a recipient with otherwise unexplained signs of infection and CT findings with ground-glass opacities, regardless of the distribution.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Lung Diseases, Parasitic/diagnostic imaging , Lung/diagnostic imaging , Lung/parasitology , Toxoplasma/isolation & purification , Toxoplasmosis/diagnostic imaging , Adult , Aged , Antiparasitic Agents/therapeutic use , Female , Humans , Lung Diseases, Parasitic/blood , Lung Diseases, Parasitic/drug therapy , Lung Diseases, Parasitic/etiology , Male , Middle Aged , Retrospective Studies , Tomography, X-Ray Computed , Toxoplasma/drug effects , Toxoplasmosis/blood , Toxoplasmosis/drug therapy , Toxoplasmosis/etiology , Young AdultABSTRACT
The risk of Toxoplasma gondii infection in solid organ transplant recipients is well known but mainly after heart transplantation. We discuss a case of acute respiratory distress caused by Toxoplasma gondii on Day 32 after liver transplantation. The reported case, which is extremely rare, emphasizes how direct examination and Quantitative Polymerase Chain Reaction (QPCR) in broncholaveolar lavage help to diagnose the infection. Given Trimethoprim/Sulfamethoxazole toxicity, systematic prescription of Toxoplasma gondii chemoprophylaxis is not commonly approved in liver transplantation.
Subject(s)
Immunocompromised Host , Liver Transplantation/adverse effects , Lung Diseases, Parasitic/pathology , Toxoplasmosis/pathology , Fatal Outcome , Female , Humans , Lung Diseases, Parasitic/etiology , Middle Aged , Tissue DonorsABSTRACT
Respiratory illness is an important cause of morbidity and mortality in patients with human immunodeficiency virus (HIV). The spectrum of pulmonary disease that can affect patients with HIV is wide and includes opportunistic infection with many fungal, viral, and parasitic organisms. This article reviews the clinical presentation; approach to diagnosis; and management of fungal, viral, and parasitic pneumonias that can develop in patients with HIV including respiratory disease caused by Aspergillus, Cryptococcus, Histoplasma, Coccidioides, Cytomegalovirus, Toxoplasma, and Strongyloides. Because clinical symptoms and radiographic patterns are often insensitive at distinguishing these pulmonary infections, this review particularly focuses on specific host risk factors and diagnostic testing to consider when approaching HIV patients with respiratory illness.
Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , HIV Infections/complications , Pneumonia/etiology , AIDS-Related Opportunistic Infections/microbiology , HIV Infections/mortality , Humans , Lung Diseases, Fungal/epidemiology , Lung Diseases, Fungal/etiology , Lung Diseases, Parasitic/epidemiology , Lung Diseases, Parasitic/etiology , Pneumonia/epidemiology , Pneumonia/microbiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Risk FactorsSubject(s)
Hematopoietic Stem Cell Transplantation , Lung Diseases, Parasitic/etiology , Strongyloides stercoralis , Strongyloidiasis/etiology , Animals , Fatal Outcome , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Lung Diseases, Parasitic/diet therapy , Male , Middle Aged , Strongyloidiasis/drug therapySubject(s)
Diarrhea , Eosinophilia , Exanthema , Ivermectin/administration & dosage , Lung Diseases, Parasitic , Strongyloides stercoralis , Strongyloidiasis , Aged, 80 and over , Animals , Antigens, Helminth/analysis , Antiparasitic Agents/administration & dosage , Diagnosis, Differential , Diarrhea/diagnosis , Diarrhea/etiology , Eosinophilia/diagnosis , Eosinophilia/etiology , Exanthema/diagnosis , Exanthema/etiology , Feces/parasitology , Female , Humans , Lung Diseases, Parasitic/diagnostic imaging , Lung Diseases, Parasitic/etiology , Strongyloides stercoralis/immunology , Strongyloides stercoralis/isolation & purification , Strongyloidiasis/blood , Strongyloidiasis/complications , Strongyloidiasis/diagnosis , Strongyloidiasis/physiopathology , Tomography, X-Ray Computed/methods , Treatment OutcomeSubject(s)
Intestinal Diseases, Parasitic/etiology , Lung Diseases, Parasitic/etiology , Pemphigus/complications , Strongyloidiasis/etiology , Adult , Albendazole/therapeutic use , Animals , Anthelmintics/therapeutic use , Colistin/therapeutic use , Eosinophilia/etiology , Fatal Outcome , Female , Hemoptysis/etiology , Humans , Immunocompromised Host , Intestinal Diseases, Parasitic/parasitology , Lung Diseases, Parasitic/parasitology , Pemphigus/immunology , Respiratory Distress Syndrome/etiology , Strongyloides stercoralis/isolation & purification , Strongyloidiasis/parasitology , Teicoplanin/therapeutic useABSTRACT
Toxocara canis and Toxocara cati are roundworms of dogs and cats that can also infect humans worldwide. Although these parasites do not reach the adult stage in the human host the larvae migrate to different organs and can persist for many years. Migration of larvae through the lungs may result in respiratory distress such as wheezing, coughs, mucous production and hyper-reactivity of the airways. Epidemiological and experimental studies suggest that infection with this helminth contributes to the development of allergic manifestations, including asthma. These findings are however conflicting since in others studies no association between these two immunopathologies has been found. This article reviews information on Toxocara spp. and findings from epidemiological and experimental studies on the association between Toxocara infection and allergic manifestations. In addition, the immunological mechanisms and the factors involved in the helminth allergy-association are discussed.
Subject(s)
Hypersensitivity/etiology , Immunomodulation/physiology , Toxocara/physiology , Toxocariasis/complications , Toxocariasis/immunology , Adult , Animals , Cats , Dogs , Humans , Hypersensitivity/diagnosis , Hypersensitivity/epidemiology , Hypersensitivity/immunology , Lung Diseases, Parasitic/diagnosis , Lung Diseases, Parasitic/epidemiology , Lung Diseases, Parasitic/etiology , Lung Diseases, Parasitic/immunology , Models, Biological , Toxocara/immunology , Toxocariasis/diagnosis , Toxocariasis/transmissionABSTRACT
Lophomonas blattarum, a rare protozoa, was involved in pulmonary infections of transplant recipients. We report 2 cases of late onset pulmonary L. blattarum infection in renal transplant recipients with normal graft function and relative normal immune function. The diagnosis in both cases was confirmed by bronchoscopy and broncho alveolar lavage (BAL) fluid examination. Both cases were sensitive to metronidazole treatment, but one case did not completely recover during the follow-up. The diagnosis and treatment were discussed to facilitate improvement in the recognition of this rare infection, especially in transplant recipients.
Subject(s)
Kidney Transplantation/adverse effects , Lung Diseases, Parasitic/etiology , Protozoan Infections/etiology , Adult , Animals , Antiprotozoal Agents/therapeutic use , Cockroaches/parasitology , Humans , Insect Vectors/parasitology , Lung Diseases, Parasitic/diagnosis , Lung Diseases, Parasitic/drug therapy , Male , Metronidazole/therapeutic use , Middle Aged , Protozoan Infections/diagnosis , Protozoan Infections/drug therapy , Tomography, X-Ray ComputedABSTRACT
Multiple lung hydatidosis associated with cardiac localization is rare, whereas large arterial localization is exceptional and involves a poor prognosis. The authors report the case of a 26-year-old man living in a rural area, without a past medical history. He presented chest pain, hydatidoptysis and syncope. A chest x-ray revealed multiple bilateral cysts. A chest CT scan detected multiple cysts in the heart, the pericardium and multiple pulmonary cysts. Echocardiography revealed cysts in the right and left auricle, the pulmonary artery as well as the pericardium. Medical three treatments were administered before surgical intervention on the heart cysts under extracorporeal circulation, revealing an enormous hydatid cyst at the beginning of the aorta. Unfortunately, the patient died during the immediate postoperative phase.
Subject(s)
Aorta , Aortic Diseases/parasitology , Echinococcosis/complications , Heart Diseases/parasitology , Lung Diseases, Parasitic/etiology , Adult , Aortic Diseases/diagnosis , Echinococcosis/diagnosis , Fatal Outcome , Heart Diseases/diagnosis , Humans , Lung Diseases, Parasitic/diagnosis , MaleSubject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Lung Diseases, Parasitic/etiology , Toxoplasmosis/etiology , Adolescent , Adult , Antiprotozoal Agents/therapeutic use , Cord Blood Stem Cell Transplantation/adverse effects , Female , Genotype , Humans , Immunocompromised Host , Leukemia, Lymphocytic, Chronic, B-Cell/therapy , Lung Diseases, Parasitic/drug therapy , Lung Diseases, Parasitic/parasitology , Male , Myelodysplastic Syndromes/therapy , Opportunistic Infections/drug therapy , Opportunistic Infections/etiology , Opportunistic Infections/parasitology , Risk Factors , Toxoplasma/classification , Toxoplasma/genetics , Toxoplasma/isolation & purification , Toxoplasmosis/drug therapy , Toxoplasmosis/parasitology , Transplantation, HomologousSubject(s)
Cyclophosphamide/adverse effects , Immunosuppressive Agents/adverse effects , Lung Diseases, Parasitic/etiology , Lupus Erythematosus, Systemic/complications , Prednisone/adverse effects , Strongyloides stercoralis/isolation & purification , Strongyloidiasis/etiology , Acute Disease , Adult , Animals , Colombia/ethnology , Cyclophosphamide/administration & dosage , Cyclophosphamide/therapeutic use , Drug Therapy, Combination , Endemic Diseases , Fatal Outcome , Humans , Immunocompromised Host , Lung Diseases, Parasitic/parasitology , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/immunology , Male , Prednisone/administration & dosage , Prednisone/therapeutic use , Respiratory Insufficiency/etiology , Shock, Septic/etiology , Strongyloidiasis/epidemiology , Strongyloidiasis/parasitologyABSTRACT
Lung disease during active human visceral leishmaniasis is frequently reported. As such, studies have associated pulmonary symptoms to interstitial pneumonitis with a mononuclear infiltrate. However, the immune response in this condition has never been described before. The aim of this study was to determine the immunophenotypic pattern and cytokine profile of lung involvement (IPL) in human visceral leishmaniasis. Quantitative methods of analysis were performed using immunohistochemistry, and were compared with a control group of normal lung. Interstitial macrophages and cd8 cells were increased in IPL, and IL-4 as well as TNF-alpha displayed increased expression when compared to the control group. This inflammatory process with a Th2 pattern, as suggested by increased IL-4 and low IFN-gamma expression, is consistent with the immune response in other organs of visceral leishmaniasis. The microenvironment of the immune response in this condition is associated with lung disease in patients with interstitial pneumonitis related to visceral leishmaniasis, increasing the chance of bacterial infection.
Subject(s)
Leishmaniasis, Visceral/immunology , Lung Diseases, Interstitial/immunology , Lung Diseases, Parasitic/immunology , CD8-Positive T-Lymphocytes/immunology , Cell Proliferation , Humans , Immunohistochemistry , Interferon-gamma/biosynthesis , Interleukin-4/biosynthesis , Leishmaniasis, Visceral/complications , Lung Diseases, Interstitial/parasitology , Lung Diseases, Parasitic/etiology , Macrophages/immunology , Tumor Necrosis Factor-alpha/biosynthesisABSTRACT
Pulmonary cryptosporidiosis is a rare complication of intestinal cryptosporidiosis in AIDS patients. We report the epidemiological, clinical, radiological, microbiological and immunological findings in 5 AIDS patients with pulmonary cryptosporidiosis. Diagnosis was based on the detection of acid-fast oocysts in sputum or aspirated bronchial material using the Kinyoun technique. Microbiology laboratories should be alert to the possibility of Cryptosporidium spp oocysts presence in respiratory specimens from patients with advanced HIV/AIDS disease and pulmonary involvement.