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.

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 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.

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.

Methanol poisoning as a new world challenge: A review.

BACKGROUND: Methanol poisoning (MP) occurs often via ingestion, inhalation, or dermal exposure to formulations containing methanol in base. Clinical manifestations of MP include gastrointestinal symptoms, central nervous system (CNS) suppression, and decompensated metabolic acidosis occurred with blurred vision and early or late blindness. OBJECTIVE: This study reviewed the clinical manifestations, laboratory and radiology findings, and treatment approaches in MP. DISCUSSION: Methanol is usually rapidly absorbed after ingestion and metabolized by alcohol dehydrogenase (ADH), then distributed to the body water to reach a volume distribution approximately equal to 0.77 L/kg. It is also eliminated from the body as unchanged parent compounds. Clinical manifestations of MP alone initiate within 0.5-4 h after ingestion and include gastrointestinal symptoms and CNS suppression. After a latent period of 6-24 h, depending on the absorbed dose, decompensated metabolic acidosis occurs with blurred vision and early or late blindness. Blurred vision with normal consciousness is a strong suspicious sign of an MP. The mortality and severity of intoxication are well associated with the severity of CNS depression, hyperglycemia, and metabolic acidosis, but not with serum methanol concentration. After initial resuscitation, the most important therapeutic action for patients with known or suspected MP is correction of acidosis, inhibition of ADH, and hemodialysis. CONCLUSION: Since MP is associated with high morbidity and mortality, it should be considered seriously and instantly managed. Delay in treatment may cause complications, permanent damage, and even death.

Alkaline phosphatase and score of HRCT as indicators for predicting the severity of COVID-19.

BACKGROUND: The clinical symptoms, blood laboratory data, O2 saturation and high-resolution computed tomography (HRCT) findings are critical factors in diagnosis of COVID-19 infection. METHODS: In this study, 105 hospitalized patients suspected of having COVID-19 were evaluated. Finally, the laboratory and HRCT and related factors data of 83 confirmed cases by HRCT and RT-PCR were analyzed. To compare the median of quantitative variables in the two groups, the Mann-Whitney U test was used. Also, to determine the factors associated with the positiveness of the HRCT result, a univariate logistic model was fitted. Moreover, receiver operating characteristic (ROC) curves were constructed to test the ability of the final model to predict the positiveness of HRCT result. RESULTS: 61.40% of the patients had a comorbidity disease. 89.20% had fever, 92.00% cough, 91.40% dyspnea. Abnormal CRP was seen in 77.80% of the patients, followed by 66.70% lymphopenia, and 60.30% neutrophilia. Also, ALP (abnormal vs. normal) and score of HRCT assessment variables had a significant effect on the positiveness of HRCT findings. 87.95% had abnormal HRCT with 41% bilateral multi lobar patchy ground glass opacity (GGO). Moreover, there was a statistically significant association between the level of O2 saturation and HRCT results. CONCLUSION: Our findings showed that male patients with middle age and comorbidity disease were more susceptible to the COVID-19 infection. Additionally, clinical features, blood laboratory findings, O2 saturation and HRCT findings are critical factors in the prognosis of COVID-19 infection.

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.

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.

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.