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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 4  |  Issue : 2  |  Page : 38-40

Community-acquired pneumonia caused by Lophomona sp.


1 Department of Emergency, Critical Care Service, National Hospital Dos de Mayo, Lima, Peru
2 Department of Medicine, Critical Care Service, Regional Hospital Santa Rosa, Puerto Maldonado, Peru
3 Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain

Date of Web Publication28-Sep-2017

Correspondence Address:
Díaz Willy
Department of Emergency, Critical Care Service, Hospital Nacional Dos de Mayo, MINSA, C/Miguel Grau 13, 15003 Lima
Peru
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cai.cai_8_17

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  Abstract 

Human infection with Lophomonas sp. a protozoan that parasitizes the intestinal tracts of termites and cockroaches is extremely rare; also clinical features are not fully understood. China is the country with the majority of cases reported in the literature. Here, we reported a case of Lophomonas sp. infection confirmed by tracheal aspirate on the microscopic observations. The patient was a 49-year-old male from a jungle city called "Madre de Dios" where he works as taxi driver and stonemason. He was admitted to the Intensive Care Unit on February 5, 2013, because the course with respiratory failure and hypoxemia, high fever, and generalized myalgias. The patient was successfully treated by metronidazole 500 mg t.i.d. for 17 days. This is the first case report of Lophomonas sp. in Madre de Dios city in Peru.

Keywords: Community-acquired pneumonia, infection, Lophomona sp, protozoan


How to cite this article:
Willy D, Patricia C, Rainier O, Nestor L. Community-acquired pneumonia caused by Lophomona sp. Community Acquir Infect 2017;4:38-40

How to cite this URL:
Willy D, Patricia C, Rainier O, Nestor L. Community-acquired pneumonia caused by Lophomona sp. Community Acquir Infect [serial online] 2017 [cited 2019 Jul 16];4:38-40. Available from: http://www.caijournal.com/text.asp?2017/4/2/38/215804


  Introduction Top


Lophomonas sp. is protozoan that parasitizes the intestinal tracts of termites and cockroaches and wood roaches. It is reported in the literature that can cause human infections in a variety of tissues and organs (lungs, reproductive system, or kidney). However, is extremely rare human disease, where the majority of reported cases were from the south of China.[1],[2] Clinical presentation of Lophomonas sp. is not specific; the most common symptoms are similar to other respiratory conditions such as asthma, pneumonia, bronchiectasis, or pulmonary abscess. Physical examination in the patient's reports the presence of crackling and sibilants in both lungs. Chest X-ray and computed tomography show partial nodular or linear opacities scattered along both lungs, which may be migratory and associated with a degree of bronchial obstruction.


  Case Report Top


The patient was a 49-year-old male was admitted on February 4, 2013, he had a 4 days disease time, characterized by fever, generalized myalgias, jaundice, abdominal pain, developed rapidly history of lower respiratory infection with hypoxemia, tachypnea, tachycardia so enter to Intensive Care Unit (ICU).

On admission an ICU, his vital signs were; blood pressure (systolic/diastolic) 100/50 mmHg, pulse rate 100 beats/min, respiratory rate 28 breaths/min, and body temperature 38.7°C. He presented respiratory failure with a PaO2/FiO2 111 and requirements of invasive mechanical ventilation, his X-ray of chest showed multiple condensation in both lung fields [Figure 1]. Admission antibiotic therapy was not effective. Laboratory biochemical tests; count blood cell were normal. A sputum smear was negative for tuberculosis bacilli, NS1 antigen ELISA negative for dengue virus, negative Hepatitis B surface antigen, negative blood culture, and negative HIV test. Three days after hospitalization, treatment antibiotic with meropenem and vancomycin, without clinical improvement is found Lophomona sp. in tracheal aspirate [Figure 2]. The patient was treated with metronidazole 500 mg b.i.d. for 17 days. Her symptoms were relieved after treatment; retired mechanical ventilation [Table 1].
Figure 1: X-ray posterioranterior of chest on admission

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Figure 2: X-ray of chest posterioranterior at last day of treatment

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Table 1: Support evolution and antibiotic treatment


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  Discussion Top


In Peru, when we have a respiratory clinical picture first thing that is studied is pulmonary tuberculosis, in the area described this case is endemic of dengue virus, for this reason, it is necessary to study it.

The identification of this protozoan in human samples has been based on the identification of morphological characteristics under light microscopy using fresh and dyed samples of the airways including sputum, bronchoalveolar lavage, bronchial brushing, and tracheal aspirates. Multiflagellate protozoa are difficult to differentiate from ciliary bronchioles. This risk may be reduced in the future with the development of molecular identification methods.[2],[3]

Mu XL et al. refers the cases diagnosed as lung infection by Lophomonas blattarum in our country, were misdiagnosed. Currently, there is no evidence to show Lophomonas blattarum as a pathogen that can cause lung infection.[4] But Zerpa et al. Shows a series of photos and videos of the diagnostics of their cases.[5]

Acknowledgments

We would like to thank Catia Cilloniz Ph.D. and Adrian Ceccato for their collaboration of this report case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Adl SM, Simpson AGB, Farmer MA, et al. The new higher level classification of eukaryotes with emphasis on the taxonomy of protists, Journal of Eukaryotic Microbiology 2005;52:399-451.  Back to cited text no. 1
    
2.
Rafael Martinez-Giron and Hugo Cornelis van Woerden. Lophomonas blattarum and bronchopulmonary disease. Journal of Medical Microbiology 2013;62:1641-8.  Back to cited text no. 2
    
3.
Vijayan VK. Is the incidence of parasitic lung diseases increasing, and how may this affect modern respiratory medicine? Expert Rev Respir Med 2009; 3:339-4.  Back to cited text no. 3
[PUBMED]    
4.
Mu XL, Shang Y, Zheng SY, Zhou B, Yu B, Dong XS, et al. A study on the differential diagnosis of ciliated epithelial cells from Lophomonas blatarum in bronchoalveolar lavage fluid. Zhonghua Jie He He Hu Xi Za Zhi 2013;36: 646-50.  Back to cited text no. 4
[PUBMED]    
5.
Zerpa R, Ore E, Patiño L, Espinoza YA. Lophomonas sp. in respi-ratory tract secretions in hospitalized children with severe lung disease. Rev Peru Med Exp Salud Publica 2010;27:575-7.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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