First Co-morbidity of Lophomonas blattarum and COVID-19 Infections: Confirmed Using Molecular Approach

Abstract

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.

Molecular evidence of upper and lower respiratory infection due to Lophomonas in a post‐kidney transplantation patient

“…14 Moreover, recently co-morbidity of emerged Lophomonas infection and COVID-19, pulmonary aspergillosis and tuberculosis have been reported from Iran. 1,15,16 However, our patient with renal transplantation history was suffering concurrently from upper and lower respiratory involvement due to a Lophomonas infection for a long time. To the best of our knowledge, this is the first report regarding simultaneous pneumonia, tonsillitis, and acute sinusitis due to Lophomonas infection.…”

“…In general, this is due to the fact that the clinical signs and symptoms of the patient with lophomoniasis and even radiological findings are completely nonspecific and are indistinguishable from other infections or similar diseases. 1 , 16 , 17 The main characteristics of pulmonary lophomoniasis are a persistent cough, dyspnea, and radiological abnormalities. 4 , 5 , 11 , 17 These findings are absent in the early stages of Lophomonas infection, which is in contrast to tuberculosis, pulmonary Strongyloides stercoralis infection, Pneumocystis jiroveci pneumonia (PCP), cytomegalovirus (CMV) pneumonia, and tuberculosis.…”

“…At present, diagnosis of lophomoniasis is mainly based on microscopic observation of the parasite in a wet mount and or following a staining technique such as Papanicolaou and Giemsa stains under a light microscope. 1 , 4 , 15 , 16 , 18 , 19 The disadvantages of this method include misdiagnosis of the disease due to the similarity of the parasite to atypical and or degenerated bronchial cells, such as ciliocytophthoria, and its low sensitivity due to small amounts of the clinical sample. 1 , 19 Therefore, microscopic examination of the disease requires a lot of experience and appropriate amounts of the sample.…”

Global Status of Emerging Lophomonas Infection: A Systematic Review of Reported Cases (1993—2020)

“…In this regard, given that one of the inclusion criteria in our study was published papers in the English language, this led to the exclusion of Chinese cases that were recorded in the Chinese language. However, following the establishment of the Iranian National Registry Center for Lophomoniasis (INRCL) at Mazandaran University of Medical Sciences, northern Iran, the development and evaluation of an in-house PCR test for identifying the parasite and the holding of specialized webinars regarding epidemiological, clinical, and laboratory findings of pulmonary lophomoniasis, the number of reported cases from Iran will be increased compared to other countries in the future [ 3 , 12 , 41 – 43 ].…”

“…Moreover, we believe that during the coronavirus (COVID-19) pandemic, comorbidity of Lophomonas and COVID-19 should be ruled out. Hence, early diagnosis and treatment of this dual infection are critically important because misdiagnosis of this protozoan infection could cause severe complications and increase the duration of hospitalization [ 41 – 43 ].…”