First Molecular Diagnosis of Lophomoniasis: the End of a Controversial Story

Abstract

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.

Pulmonary Infection with Lophomonas blattarum

“…recently reported the first tool for the molecular diagnosis of L. blattarum, which will help identify this protozoan infection in the future [9].…”

Are Pediatric Infections with Lophomonas blattarum Being Missed?

“…Interestingly, a recent publication disputed all reported cases of L. Blattarum [4]. However, a recent report from Iran confirmed the infection by a molecular test [5].…”

Lophomoniasis associates with chronic immune compromise and respiratory coinfections: a case report.

“…As such, we think that the management of this disease should include a constant monitoring of physiological parameters by blood and urine tests, as well as constant gasometry tests, in order to avoid further complications. As for diagnosis, the PCR test developed by Fakhar et al (8) seems to be a good option, but many laboratories may not find suitable to have in stock a test for a rare disease. As a consequence, the diagnosis should be based on the microscopically observation of the protozoon and supported by both radiographies showing nodular and linear infiltrations and a diagnosis for a non-bacterial, nor viral pneumonia.…”

“…In such tests the protozoon appears as unipolarlly pluriflagellated round, ovoid or piriform cells of 20-60μm in length and 12-20μm in width, that have a highly granular cytoplasm and an inconspicuous nucleus (2,7). In order to avoid the aforementioned diagnostic problems, Fakhar, M et al (2019) proposed a polymerase chain reaction (PCR)-based diagnostic technique (8) that is yet to be widely tested. On the other hand, Lophomonas' cysts are spherical or oblong and surrounded by a homogeneous membrane, and may have a torpid metabolism to withstand the lack of nutriments in the environment.…”