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 PresentationThe 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.
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.
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