Iberoamerican Journal of Medicine
https://iberoamjmed.com/article/doi/10.53986/ibjm.2024.0004
Iberoamerican Journal of Medicine
Case Report

Differential diagnosis of lophomaniasis in patients with COVID-19 in northern Mexico: a case report

Diagnóstico diferencial de lofomaniasis en pacientes con COVID-19 en el norte de México: reporte de un caso

José de Jesús Alba-Romero, Benjamín Nogueda-Torres, Rosa María Sánchez-Manzano, Damari Lizeth Alba-Romero, Aurora Martínez-Romero

Downloads: 0
Views: 522

Abstract

Pulmonary lophomoniasis is a rare infection produced by a multiflagellated and anaerobic pyriform or oval protozoan belonging to the family of Lophomonadidae. The study aimed learn the differential diagnosis of lophomoniasis in patients with COVID-19 in northern Mexico. Clinical case of a 37-years-old male patient diagnosed with pneumonia, respiratory syndrome, hemoptysis, and fever, which suggested pulmonary tuberculosis. Bronchial lavage was performed, and laboratory tests were requested, an RT-PCR test to search for SARS-CoV-2, which was positive. The results for TB and KOH for fungi were negative. In addition to the protocol, a fresh examination was performed by placing a drop from the sample on a glass slide and observing it with a 10X objective, then 40X searching for clinically structural elements. As a result, multiflagellated cellular elements in the continuous movement were observed that morphologically correspond to the genus Lophomonas spp concluding the bacteriological protocol of bronchial secretions should consider fresh examination to search for trophozoites of Lophomonas spp. Medical and laboratory personnel are unaware of the protozoa Lophomonas spp, since the fresh examination in the analysis protocol is not considered. This paper reports the first case of Lophomonas infection in a patient caused by chronic lung disease.

Keywords

Lophomonas spp.; Respiratory medicine; Chronic lung disease

Resumen

La lofomoniasis pulmonar es una infección rara producida por un protozoo piriforme u ovalado multiflagelado y anaeróbico perteneciente a la familia de los Lophomonadidae. El estudio tuvo como objetivo conocer el diagnóstico diferencial de lofomoniasis en pacientes con COVID-19 en el norte de México. Caso clínico de un paciente masculino de 37 años con diagnóstico de neumonía, síndrome respiratorio, hemoptisis y fiebre, que sugería tuberculosis pulmonar. Se realizó lavado bronquial y se solicitaron pruebas de laboratorio, prueba RT-PCR para búsqueda de SARS-CoV-2, la cual resultó positiva. Los resultados de TB y KOH para hongos fueron negativos. Además del protocolo, se realizó un nuevo examen colocando una gota de la muestra en un portaobjetos de vidrio y observándola con un objetivo de 10X, luego 40X en busca de elementos clínicamente estructurales. Como resultado se observaron elementos celulares multiflagelados en movimiento continuo que morfológicamente corresponden al género Lophomonas spp, por lo que el protocolo bacteriológico de secreciones bronquiales debe considerar examen en fresco para búsqueda de trofozoítos de Lophomonas spp. El personal médico y de laboratorio desconoce la presencia del protozoo Lophomonas spp, ya que en el protocolo de análisis no se considera el examen en fresco. Este artículo reporta el primer caso de infección por Lophomonas en un paciente causado por una enfermedad pulmonar crónica.

Palabras clave

Lophomonas spp.; Medicina respiratoria; Enfermedad pulmonar crónica

References

1. Morales-Muñoz G, Ceferino-Contreras Y, Cadenas-Caballero J, Méndez-Arias AG. Pulmonar Lophomoniasis. Med Crít. 2019;33 (3):150-4.
2. Cazorla-Perfetti D, Morales Moreno P, Navas Yamarte P. [Identification of Lophomonas blattarum (Lypermastigia: Cristomonadida, Lophomonadidae), causal agent of bronchopulmonary lophomaniasis, in synanthropic cockroachs from the Coro Vuniversity Hospital, Falcon State, Venezuela]. Saber. 2015;27(3):511-4.
3. Vásquez-Revilla HR, Revilla-Rodríguez E, Millán-Villa V, Itzel A. Identification of Lophomonas blattarum in the bronchial secretion of a patient with COVID-19. Case report and literature review. Med Crít. 2022;36(3):183-6. doi: 10.35366/105386.
4. Nakhaei M, Fakhar M, Sharifpour A, Banimostafavi ES, Zakariaei Z, Mehravaran H, et al. First Co-morbidity of Lophomonas blattarum and COVID-19 Infections: Confirmed Using Molecular Approach. Acta Parasitol. 2022;67(1):535-8. doi: 10.1007/s11686-021-00468-3.
5. Keche A, Khatoon S, Sahu D. Detection of a Lophomonas, a rare pathogen in Bronchoalveolar lavage. Trop Parasitol. 2022;12(2):124-6. doi: 10.4103/tp.tp_97_21.
6. Moya-Salazar J, Salazar-Hernandez R, Lopez-Hinostroza M, Contreras-Pulache H. Lophomonas isolation in sputum sample at Peru. Lung India. 2021;38(4):359-61. doi: 10.4103/lungindia.lungindia_696_20.
7. Torres A, Cilloniz C, Niederman MS, Menéndez R, Chalmers JD, Wunderink RG, et al. Pneumonia. Nat Rev Dis Primers. 2021;7(1):25. doi: 10.1038/s41572-021-00259-0.
8. Khan M, Adil SF, Alkhathlan HZ, Tahir MN, Saif S, Khan M, et al. COVID-19: A Global Challenge with Old History, Epidemiology and Progress So Far. Molecules. 2020;26(1):39. doi: 10.3390/molecules26010039.
9. Crisafulli E, Manco A, Ferrer M, Huerta A, Micheletto C, Girelli D, et al. Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease. Semin Respir Crit Care Med. 2020;41(6):817-29. doi: 10.1055/s-0040-1702196.
10. Fakhar M, Safanavaei S, Nakhaei M, Esmaeili S, Banimostafavi ES, Spahbodi F, et al. Molecular evidence of upper and lower respiratory infection due to Lophomonas in a post-kidney transplantation patient. Clin Case Rep. 2022;10(2):e05492. doi: 10.1002/ccr3.5492.
11. Baluku JB, Nuwagira E, Bongomin F, Denning DW. Pulmonary TB and chronic pulmonary aspergillosis: clinical differences and similarities. Int J Tuberc Lung Dis. 2021;25(7):537-46. doi: 10.5588/ijtld.21.0034.
12. Koupaei M, Naimi A, Moafi N, Mohammadi P, Tabatabaei FS, Ghazizadeh S, et al. Clinical Characteristics, Diagnosis, Treatment, and Mortality Rate of TB/COVID-19 Coinfectetd Patients: A Systematic Review. Front Med (Lausanne). 2021;8:740593. doi: 10.3389/fmed.2021.740593.
13. Mokhtarian K, Taghipour S, Nakhaei M, Taheri A, Sharifpour A, Fakhar M, et al. Molecular Evidence of Emerged Pulmonary Lophomoniasis due to Lophomonas blattarum among Hospitalized Patients in Southwestern Iran: A National Registry-Based Study. Interdiscip Perspect Infect Dis. 2022;2022:6292823. doi: 10.1155/2022/6292823.
14. Fernandes Q, Inchakalody VP, Merhi M, Mestiri S, Taib N, Moustafa Abo El-Ella D, et al. Emerging COVID-19 variants and their impact on SARS-CoV-2 diagnosis, therapeutics and vaccines. Ann Med. 2022;54(1):524-40. doi: 10.1080/07853890.2022.2031274.
15. Shields AM, Burns SO, Savic S, Richter AG; UK PIN COVID-19 Consortium. COVID-19 in patients with primary and secondary immunodeficiency: The United Kingdom experience. J Allergy Clin Immunol. 2021;147(3):870-875.e1. doi: 10.1016/j.jaci.2020.12.620.
16. Sharifpour A, Zakariaei Z, Fakhar M, Banimostafavi ES, Nakhaei M, Soleymani M. Post-COVID-19 co-morbidity of emerged Lophomonas infection and invasive pulmonary aspergillosis: First case report. Clin Case Rep. 2021;9(9):e04822. doi: 10.1002/ccr3.4822.


Submitted date:
08/09/2023

Reviewed date:
10/10/2023

Accepted date:
10/31/2023

Publication date:
11/07/2023

654a156ca9539565ad5733a4 iberoamericanjm Articles
Links & Downloads

Iberoam J Med

Share this page
Page Sections