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.

Clinical Characteristics of Human Pulmonary Dirofilariasis in Japan: An Uncommon Differential Diagnosis of a Solitary Pulmonary Nodule.

Human pulmonary dirofilariasis (HPD) is a zoonotic disease caused by Dirofilaria immitis. Most HPD cases are asymptomatic and are either detected during annual health checkups or incidentally identified during the investigation of other diseases, particularly primary or metastatic pulmonary lung cancers. However, the frequency and clinical features of Japanese patients with HPD remain unclear. We analyzed data from the Japanese Medical Abstract Society database and identified 69 cases between 1978 and 2022. The incidence of HPD increased until the 2000s but declined markedly in the 2010s. The incidence is higher in the southwestern region and lower in the northeastern region of Japan. Health checkups are the primary diagnostic opportunities. The Chugoku and Shikoku regions have had high incidence rates per population. The diagnosis of HPD using a noninvasive procedure is typically difficult because of the absence of specific clinical symptoms, and approximately 70% of the cases are detected using video-assisted thoracoscopic surgery. Climate change may increase the incidence of HPD in the northeastern region of Japan, and travel to countries with poor vector control may be a risk factor for HPD transmission. Physicians should consider this parasitic infectious disease when examining patients presenting with solitary lung nodules.

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.

Parasitic lung diseases.

Parasitic lung diseases are caused by a number of parasites as a result of transient passage in the lung or as a result of an immunologic reaction. The clinical presentation may be in the form of focal or cystic lesions, pleural effusion or diffuse pulmonary infiltrates. With increasing globalisation, it is important to consider parasitic infections in the differential diagnosis of lung diseases. This is particularly important since early identification and prompt therapy result in full cure of these conditions. In this review, we summarise the most common parasitic lung diseases.

What Findings on Chest CTs Can Delay Diagnosis of Pleuropulmonary Paragonimiasis?

PURPOSE: The purpose of this study was to investigate which findings were delayed in diagnosis with respect to chest CT findings of paragonimiasis. METHODS: This retrospective, informed questionnaire study was conducted to evaluate chest CT scans of 103 patients (58 men and 45 women; mean age 46.1 ± 14.6 years). The patients were diagnosed with paragonimiasis from 2003 to 2008 in four tertiary hospitals. Statistical analysis was performed using the chi-square test to identify differences between an initially correct diagnosis and an incorrect one of paragonimiasis on chest CT scans, for which we evaluated such variables as the location of lesion, type of parenchymal lesions, and worm migration track. RESULTS: Nodular opacities on chest CT scans were the most common findings (53/94, 56.4%). The sign of worm migration tracks was only present in 18.1% of cases (17/94). Although statistically insignificant, the form of consolidation (18/25, 72%) and mass (6/8, 75%) on CT was common in correct diagnostics, and the form of the worm migration track (12/17, 70.6%) was high in correct diagnostics. CONCLUSION: A delayed diagnosis of paragonimiasis may often be made in patients with non-nodular, parenchymal lesions who are negative for worm migration track on chest CT scans.

A note on the relationship between fecal larval excretion and Protostrongylus rufescens lungworm burden in sheep.

The examination of feces for stages of parasitic helminths is the most widely used methodology for the intravital diagnosis in domestic animals of patent endoparasitism including pulmonary nematode infections. Although there is only little information on the relationship of lungworm larval excretion and corresponding parasite burdens, fecal larval counts are used as indirect measure ("biomarker") for the intensity of infection, for instance in anthelmintic efficacy studies. To assess the relationship between fecal larval and Protostrongylus rufescens parasite counts in sheep, log-transformed data of 14 naturally infected animals were analyzed. The larval excretion of the sheep was monitored in approximately weekly intervals over 6 weeks before lungworm recovery. Analyses were performed on the larval counts (at a single time point or counts averaged over several consecutive time points) relating to parasite counts. Fecal larval counts and the P. rufescens nematode burden (range, 17 to 406) were significantly and strongly correlated (p < 0.05 for all analyses; Spearman's r > 0.6) with the number of larvae excreted increasing with increasing lungworm burden. Subsequently performed regression analysis demonstrated a statistically significant strong linear relationship between P. rufescens worm and fecal larval counts (p < 0.01 for all analyses; R2, range 0.5094 to 0.8150). Analyses based on larval counts averaged over two or more consecutive time points resulted in higher Spearman's r and R2 compared with analyses based on single time point larval counts. Despite of some variability, the analyses indicate that fecal larval counts can be regarded as a useful measure of the P. rufescens burden in sheep.

Dirofilaria immitis Pulmonary Dirofilariasis, Slovakia.

Dirofilaria immitis is a parasite related to pulmonary dirofilariasis in humans, its accidental hosts. We detected an autochthonous case of D. immitis infection in a woman from Slovakia. The emergence and spread of this parasite in Europe indicates a critical need for proper diagnosis of infection.

Human Pulmonary Dirofilariasis: A Review for the Clinicians.

Human pulmonary dirofilariasis (HPD) is a rare zoonotic disease caused by Dirofilaria immitis, the nematode responsible for canine cardiopulmonary dirofilariasis (dog heartworm). The incidence of HPD is on the rise throughout the world due to increased awareness and factors affecting the vector (mosquito). Humans are accidental hosts for D. immitis. Most patients are asymptomatic and present with an incidental pulmonary nodule that mimics primary or metastatic pulmonary malignancy. Some patients suffer from pulmonary and systemic symptoms in the acute phase of pneumonitis caused by pulmonary arterial occlusion by the preadult worms resulting in pulmonary infarction and intense inflammation. These patients may have ill-defined pulmonary infiltrate on chest radiology. Pulmonary nodules represent the end result of initial pneumonitis. There are no specific clinical, laboratory, or radiologic findings that differentiate HPD from other causes of a pulmonary nodule. Although serologic tests exist, they are usually not commercially available. The majority of patients are diagnosed by histopathologic identification of the decomposing worm following surgical resection of the lesion.

Pulmonary coin lesion caused by Dirofilaria immitis - a report of two cases with a minireview of the literature.

Dirofilariasis is a rare zoonosis, transmitted from infested dogs or other carnivorous animals to humans via mosquitoes. Two male patients with a solitary, peripheral, well-defined, coin-like pulmonary lesion in the right upper lobe were presented. Rapid enlargement of the lesion within a few months suggested malignancy, resulting in surgical removal. Microscopic examination of the resected lung revealed necrotic circumscribed lesions with embolized parasites in the vessels. Both parasites were females of the species Dirofilaria immitis. They represent the first reported cases of pulmonary dirofilariasis in Slovenia. Awareness of this entity is important in the differential diagnosis of pulmonary coin lesions.

Lungworms in ruminants from Brazil: A retrospective epidemiological study over four decades.

Lungworms such as Dictyocaulus spp. in cattle and small ruminants, and Muellerius capillaris and Protostrongylus rufescens in small ruminants are important pathogens, causing respiratory disease in these livestock species. Despite their veterinary importance, lungworms of livestock have been poorly studied in certain regions of the world, including Brazil. Therefore, much of their epidemiology and economic impacts on production remain unknown. This article aims to provide a comprehensive overview of the historical and current data published on lungworm infection of domestic ruminants in Brazil. This review consisted of a comprehensive search of technical and scientific publications between January 1980 to December 2020, using online sources such as PubMed, Google Scholar and Scielo. Twenty-four articles published over the last 40 years reporting lungworms exclusively in cattle (n = 16), goats (n = 6) and sheep (n = 1) in Brazil were included. In addition, a study (n = 1) with both goats and sheep were also utilized. Overall, 12 studies were based only on post-mortem examination, five in the detection of specimens in fecal samples, and seven were based on fecal analysis followed by post-mortem examination. Out of all studies, 66.7% (n = 16) articles registered D. viviparus, 4.2% (n = 1) D. filaria, 8.3% (n = 2) P. rufescens, 16.7% (n = 4) M. capillaris, and 4.2% (n = 1) co-infection by D. filaria and M. capillaris. The existence of suitable environmental conditions, as well as intermediate and definitive hosts in Brazil contribute for the survival and development of these nematode species. The majority of the reports of lungworms originate from the Southern and Southeastern regions of the country, whose mild temperatures likely contribute to their occurrence. Finally, lungworms of ruminants have been reported over the past four decades in Brazil, but most of the information was obtained at post-mortem examination. Therefore, further studies to investigate epidemiological aspects in different hosts and regions of the country are needed.

Cardiopulmonary alterations by ultrasound in a patient with uncomplicated mixed malaria infection: a case report from the Amazon Basin.

BACKGROUND: Information on cardiopulmonary complications in clinical malaria is sparse and diagnosis may be difficult in resource-limited areas due to lack of proper diagnostic tools and access to medical care. A case of pericardial effusion and pulmonary alterations assessed by ultrasound in a patient with uncomplicated mixed malaria infection is described. CASE PRESENTATION: A previously healthy 23-year-old male from the Amazon Basin was diagnosed with mixed infection of Plasmodium vivax and Plasmodium falciparum by peripheral blood smear. The patient presented with mild malaria symptoms without signs of severe malaria, but reported moderate chest pain and shortness of breath. Laboratory analyses revealed thrombocytopenia and anemia. The electrocardiogram had PR depressions and bedside ultrasound of the cardiopulmonary system showed pericardial effusion (18 mm) accompanied by multiple B-lines in the lungs, identified as vertical artifacts extending from the pleural line. Cardiac biomarkers were normal. The patient was treated according to national guidelines for malaria and suspected pericarditis, respectively. At follow-up on day 5, the pericardial effusion (9mm) and B-lines had markedly decreased. By day 21 the patient was asymptomatic, had completed the treatment, and the electrocardiogram and ultrasound findings had normalized. CONCLUSIONS: This case report highlight the usefulness of bedside ultrasound to identify cardiopulmonary involvement in patients with uncomplicated malaria and relevant symptoms.

Schistosomes in the Lung: Immunobiology and Opportunity.

Schistosome infection is a major cause of global morbidity, particularly in sub-Saharan Africa. However, there is no effective vaccine for this major neglected tropical disease, and re-infection routinely occurs after chemotherapeutic treatment. Following invasion through the skin, larval schistosomula enter the circulatory system and migrate through the lung before maturing to adulthood in the mesenteric or urogenital vasculature. Eggs released from adult worms can become trapped in various tissues, with resultant inflammatory responses leading to hepato-splenic, intestinal, or urogenital disease - processes that have been extensively studied in recent years. In contrast, although lung pathology can occur in both the acute and chronic phases of schistosomiasis, the mechanisms underlying pulmonary disease are particularly poorly understood. In chronic infection, egg-mediated fibrosis and vascular destruction can lead to the formation of portosystemic shunts through which eggs can embolise to the lungs, where they can trigger granulomatous disease. Acute schistosomiasis, or Katayama syndrome, which is primarily evident in non-endemic individuals, occurs during pulmonary larval migration, maturation, and initial egg-production, often involving fever and a cough with an accompanying immune cell infiltrate into the lung. Importantly, lung migrating larvae are not just a cause of inflammation and pathology but are a key target for future vaccine design. However, vaccine efforts are hindered by a limited understanding of what constitutes a protective immune response to larvae. In this review, we explore the current understanding of pulmonary immune responses and inflammatory pathology in schistosomiasis, highlighting important unanswered questions and areas for future research.

The effect of pasture molluscicide on small lungworm infections and the productivity of grazing lambs.

The aim of this study was to assess the effect of pasture molluscicide treatment on the prevalence and severity of small lungworm infections, and the productivity of lambs grazing improved pastures in southeastern Australia. A randomised control field trial of 260 Merino-cross lambs was conducted on a commercially managed farm in South Australia with a history of high small lungworm prevalence. Separate groups of lambs rotationally grazed irrigated lucerne paddocks treated with iron chelate molluscicide or untreated control paddocks. Lambs were monitored every 2-6 weeks from weaning until slaughter with liveweight, lungworm and gastrointestinal nematode infection status measured. At slaughter indicators of small lungworm infection via inspection and carcass characteristics were assessed. The density of the intermediate host snail and lucerne pasture availability were also measured. There was a higher population of adult Prietocella barbara molluscs in the Control paddocks compared to the Treatment paddocks after molluscicide had been applied and prior to grazing commencing (206 vs. 14 snails/m2, respectively; P = 0.03; 95 % CI 8, 528). However, the overall mollusc density was similar between Control and Treatment. The prevalence of small lungworm infections was quite low during the trial (0-13 %), in both Control and Treatment lambs, except at day 94 when 48 % of 28 Control lambs were positive compared to none of 27 Treatment lambs (P < 0.001; 95 % CI 30, 66). A similar proportion of Treatment and Control lambs had evidence of small lungworm infection lesions at slaughter (both 67.8 %). Control lambs grew slightly faster than Treatment lambs, with an average daily gain of 202 (± 3 SEM) g/head/day for Control and 190 (± 4 SEM) for Treatment (P < 0.001) during the 112-day trial. Despite historic evidence of very high prevalence of lungworm infection in this region of southeastern Australia, iron chelate molluscicide treatment prior to lambs grazing the pasture had no demonstrable effect on the prevalence and severity of small lungworm infections, nor the productivity of lambs grazing these pastures. This study indicates that for a commercial sheep farm, additional molluscicide treatments of pastures after they are established, for the prevention of small lungworm infection, may not be warranted. Furthermore, requirements for more precisely monitoring snails are discussed.

Risk factors for lungworm-associated milk yield losses in grazing dairy cattle.

Dictyocaulus viviparus, the causative agent of bovine parasitic bronchitis, is an important parasite of dairy cattle. Infections can lead to substantial economic losses, due to mortality, reduced weight gain and milk production and treatment costs. There have been relatively few studies investigating herd management risk factors for infections with D. viviparus and lungworm-associated production losses. The aims of this study were (1) to assess the impact of (sub)clinical lungworm infections on productivity in dairy cows and, (2) to identify or confirm risk factors, related to herd management, for infections in grazing dairy cattle. Using a recombinant Major Sperm Protein (MSP)-based ELISA, the presence of D. viviparus antibodies in bulk tank milk (BTM) samples was evaluated on 717 and 634 farms at two-week intervals during two grazing seasons (2018 and 2019). Associations between milk antibody levels and production data (mean milk yield in kg/cow/day, percentage of fat and protein) were assessed, as well as associations with putative risk factors in the herd management, gathered through a questionnaire survey. In both years, there was a substantial, but non-significant, difference in the annual mean milk yield on farms with at least one BTM sample above the cut-off of 0.41 ODR, compared with the mean milk yield on farms that stayed under this threshold on each sampling day (-0.17 and -0.70 kg milk/cow/day in 2018 and 2019, respectively). In 2019, this association was stronger, and significant, when the cut-off was exceeded in at least two consecutive BTM samples (-1.74 kg milk/cow/day). BTM results were also significantly negatively associated with the closest milk production data during the two-weekly BTM sampling intervals in 2019. A single or two consecutive positive tests were used in the risk factor analysis as a proxy for lungworm-associated milk yield losses. Purchase of new animals (Odds Ratio (OR) = 2.68) and the proportion of the first grazing season covered by preventive anthelmintic treatment (OR up to 3.88, depending on proportion) were positively associated with lungworm-associated milk yield losses, while mowing at least 50 % of the pastures (OR = 0.57) was negatively associated with lungworm-associated milk yield losses. Our results suggest that the ELISA holds promise to identify herds with significant production losses due to lungworm infections, under the condition that BTM sampling is done repeatedly during the grazing season. Based on the confirmed risk factors, adjustments of the farm management could perhaps mitigate these losses.