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

Abstract

Purpose. Lophomonas spp., is an emerging protozoan parasite that belongs to the Parabasalids (Parabasalia, lophomonadida) which infects the respiratory tracts of humans. Despite the presence of a few reports of human lophomoniasis, the true burden of Lophomonas infection is unknown. This systematic review aimed to elucidate the latest global status of publications reporting human cases of lophomoniasis as a new emerging protozoal disease. Methods. A comprehensive and systematic search was performed in 10 (five English and five Persian) databases for studies reporting cases of lophomoniasis between 1993 and March 2020 (27 years). Then, the selected articles were carefully reviewed and screened based on the inclusion and exclusion criteria. Results. Overall, 32 eligible publications reporting 307 lophomoniasis cases from around the world are included in this review. The patients were aged between 1 month and 84 (mean age = 23.7 years). The highest number of cases (n = 171; 55.7%, P < 0.04 ) significantly belonged to the juvenile age group (aged ≤18 years). The male to female ratio of the cases was almost equal, and no statistically significant difference between them was observed. The maximum number of cases (n = 237) was reported from Iran. Most cases (n = 196; 63.85%) had no history of underlying diseases/organ transplantation P < 0.001 . Moreover, the BAL specimen was the most commonly used clinical sample to diagnose lophomoniasis P < 0.001 . Conclusion. Our findings reveal that the prevalence of lophomoniasis is likely to be markedly underestimated when evaluated based on published case reports. Additionally, our data, at least for the time being, supports the idea that Lophomonas spp. should not be considered as an opportunistic infection. Thus, current work sheds light on some controversial issues regarding the epidemiological aspects of lophomoniasis.

Severe lophomoniasis in a patient with diabetes and past history of COVID-19 in Central Iran: case report

“…However, owing to the similarity of symptoms with other respiratory conditions, diagnosis based solely on clinical findings can be challenging. 1 The main countries reporting cases of L. blattarum infection include China, Iran, and India. 1 In our case, the diagnosis of L. blattarum was established through bronchoscopy and subsequent analysis of BALF at the INRCL.…”

“…1 The main countries reporting cases of L. blattarum infection include China, Iran, and India. 1 In our case, the diagnosis of L. blattarum was established through bronchoscopy and subsequent analysis of BALF at the INRCL. Identification of the mobile flagellated protozoan under light microscopy confirmed the presence of L. blattarum.…”

Case series of complicated bronchopulmonary lophomoniasis. Differential diagnosis of tuberculosis?

“…Pulmonary lophomoniasis majorly affects Latin American and Asian countries, such as Panama and Iran, with a prevalence of 35% and 22.7%, respectively, specifically among people aged >60 years [ 2 , 3 ]. The transmission of Lophomonas to humans remains unclear, albeit certain environmental situations such as rain, temperature, humidity, and geographic latitude have been considered to facilitate the development of the transmitter ( L. blattarum ) [ 3 , 4 ].…”

“…For the development of this disease, immunosuppression or underlying diseases such as tuberculosis (TB) or COPD were considered contributing factors [ 7–9 ]. However, up to 68% of these patients have been reported to be immunocompetents [ 2 , 10 ], possibly due to the temperature and humidity of the bronchial tree, which allows favorable conditions that allow the release of the cyst and adhering firmly to the respiratory mucosa to cause cell damage via cytoadherence, protease, rupture of epithelial barriers, and induction to apoptosis [ 11 ].…”

Geospatial Analysis and Molecular Epidemiologic Study of Emerging Pulmonary Lophomoniasis in Iran: A National Registry-Based Study

“…Data from a systematic review showed that lophomoniasis cases were reported from 10 countries, mostly from Asian countries, such as Iran and China. However, the global true burden of the disease is still unknown [ 6 ]. The main symptoms of BPL are cough, low-grade fever, and dyspnea.…”