Neonatal pneumonia caused by Trichomonas vaginalis

Szarka, Krisztina; Temesvári, Péter; Kerekes, Attila; Tege, A.; Repkény, A.

doi:10.1556/amicr.49.2002.1.2

Cited by 23 publications

(13 citation statements)

References 35 publications

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“…Approximately 50% of infections present with non-typical symptoms ranging from vaginitis, cervicitis and vulvitis in women, to urethritis, prostatitis and pruritis in men [12,13]. Neonatal ocular and respiratory infections have also been described in neonates of infected mothers [14,15]. Chronic infections have been associated with pre-term birth and low birth-weight neonates, cervical cancer and increased HIV transmission amongst the most alarming [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis

et al. 2003

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Trichomoniasis is the most common, sexually transmitted infection. It is caused by the flagellated protozoan parasite Trichomonas vaginalis. Symptoms include vaginitis and infections have been associated with preterm delivery, low birth weight and increased infant mortality, as well as predisposing to HIV/AIDS and cervical cancer. Trichomoniasis has the highest prevalence and incidence of any sexually transmitted infection. The 5-nitroimidazole drugs, of which metronidazole is the most prescribed, are the only approved, effective drugs to treat trichomoniasis. Resistance against metronidazole is frequently reported and cross-resistance among the family of 5-nitroimidazole drugs is common, leaving no alternative for treatment, with some cases remaining unresolved. The mechanism of metronidazole resistance in T. vaginalis from treatment failures is not well understood, unlike resistance which is developed in the laboratory under increasing metronidazole pressure. In the latter situation, hydrogenosomal function which is involved in activation of the prodrug, metronidazole, is down-regulated. Reversion to sensitivity is incomplete after removal of drug pressure in the highly resistant parasites while clinically resistant strains, so far analysed, maintain their resistance levels in the absence of drug pressure. Although anaerobic resistance has been regarded as a laboratory induced phenomenon, it clearly has been demonstrated in clinical isolates. Pursuit of both approaches will allow dissection of the underlying mechanisms. Many alternative drugs and treatments have been tested in vivo in cases of refractory trichomoniasis, as well as in vitro with some successes including the broad spectrum anti-parasitic drug nitazoxanide. Drug resistance incidence in T. vaginalis appears to be on the increase and improved surveillance of treatment failures is urged.

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Section: Introductionmentioning

confidence: 99%

Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis

et al. 2003

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“…Interestingly, other trichomonad species have also been identified in human lungs by molecular means. These include T. vaginalis (4,15,18), P. hominis (8), and a new Tetratrichomonas species that had not previously been reported as a human parasite (9). Thus, the presence of these protozoa in the human respiratory tract is not unusual, and we have recently shown that trichomonads are frequently found in lungs of immunocompromised patients in association with Pneumocystis organisms (5).…”

Section: Case Reportmentioning

confidence: 97%

Molecular Identification of Tritrichomonas foetus -Like Organisms as Coinfecting Agents of Human Pneumocystis Pneumonia

et al. 2006

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Trichomonads closely related to the bovid parasite Tritrichomonas foetus were identified in the bronchoalveolar lavage sample from a patient with AIDS in association with Pneumocystis pneumonia. This human case of T. foetus-like infection emphasizes the zoonotic potential of trichomonads, although the existence of a human-host-adapted T. foetus strain cannot be excluded. CASE REPORTA 54-year-old woman was admitted to the intensive care unit of Mantes-la-Jolie hospital, presenting with fever, severe fatigue, and dyspnea with polypnea that had been increasing over the previous month. The patient was known to be seropositive for human immunodeficiency virus, which was revealed 3 years previously following pneumocystosis. At that time, an antiretroviral therapy was proposed but the patient denied the diagnosis. Since the patient had no history of blood transfusion or injection of illicit drugs, transmission by unprotected sex remained the presumed mode of human immunodeficiency virus contamination. In addition, the patient was overweight and had type 2 diabetes. Hemodynamic parameters were within normal limits. Blood gases were 52 mm Hg O 2 and 36 mm Hg CO 2 . A chest X-ray showed bilateral interstitial syndrome and several alveolar opacities. Bronchoalveolar lavage (BAL) was performed by fiber optic bronchoscopy and confirmed pneumocystosis. Interestingly, microscopic examination of a MayGrünwald-Giemsa-stained cytospin slide revealed numerous cells assumed to be trichomonad organisms, mixed with Pneumocystis parasites. The BAL sample was therefore immediately frozen for further analysis. Nasal oxygenation, intravenous injection of trimethoprim-sulfamethoxazole and methylprednisolone hemisuccinate, and subcutaneous injection of insulin were started, and recovery was rapid. On day 4, the patient was transferred to the Department of Infectious Diseases of the same institution where the investigations were completed. The CD4 cell count was 60 per mm 3 , with a CD4/CD8 ratio of 0.06.Plasma viral load was 5.34 log 10 copies/ml. Hypercalcemia with hyperparathyroidism was also noticed. The patient returned home 13 days after her hospitalization with trimethoprim-sulfamethoxazole per os. Antiretroviral therapy and exploration of hyperparathyroidism were scheduled.

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“…T. vaginalis is considered the only pathogenic trichomonad and causes infection mainly of the genitourinary tract. However, the presence of this protozoan parasite in the human respiratory tract has been reported previously (3)(4)(5). In addition, with more sensitive molecular methods, other trichomonads, namely, Trichomonas tenax, Pentatrichomonas hominis, Tritrichomonas foetus, Tetratrichomonas gallinarum, and a new Tetratrichomonas species, have been found in a number of cases in the respiratory tracts of humans (6,7).…”

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confidence: 99%

“…As was shown in our case, mechanical exposure of healthy conjunctivae to vaginal secretions harboring T. vaginalis parasites led to conjunctival infection in an adult man. In addition, rare cases of respiratory tract infections in infants born to mothers with histories of genital trichomoniasis indicate the same route of transmission (4,5). The recent molecular detection of T. vaginalis in pharyngeal specimens from three HIV-infected men with histories of orogenital sexual activity (10) highlights the need for further research to unravel the transmission dynamics and pathogenesis of extragenital trichomoniasis.…”

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confidence: 99%

Bilateral Conjunctivitis Due to Trichomonas vaginalis without Genital Infection: an Unusual Presentation in an Adult Man

Abdolrasouli

Croucher

Roushan³

et al. 2013

J Clin Microbiol

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eWe report an unusual case of extragenital infection with Trichomonas vaginalis of the conjunctiva of a 32-year-old man. Only one other similar case has been reported in the English language literature. The present report reinforces the widening pathologic spectrum of trichomonads in humans, especially in the context of emerging extragenital infections. CASE REPORTA 32-year-old Iranian man presented to a private infectious disease clinic with a 2-week history of inflamed conjunctivae and a yellowish, purulent discharge emanating from both eyes. He was previously prescribed topical 1% chloramphenicol ointment by another clinician a week after the onset of his symptoms with no obvious improvement. On physical examination, he appeared well and his vision was normal. A diagnosis of bacterial conjunctivitis was made, and the patient was started on oral flucloxacillin at 250 mg every 6 h to cover the staphylococcal infection often associated with conjunctivitis and topical 0.3% ciprofloxacin and 0.5% chloramphenicol eye drops.Before starting treatment, multiple conjunctival swabs were collected from the lower conjunctiva with flexible, fine, plasticshafted Dacron swabs premoistened with sterile saline for microbiological investigation, including bacterial and viral cultures and microscopy in accordance with routine practice. For bacterial culture, swabs were directly inoculated into Columbia blood agar, chocolate agar, and MacConkey agar, where only scanty normal skin flora was isolated after 48 h of incubation and later identified as Staphylococcus epidermidis. Viral cultures for adenoviruses, herpes simplex viruses 1 and 2, and enteroviruses were all negative. Results of direct immunofluorescence microscopy and culture for Chlamydia trachomatis were negative.Interestingly, microscopic examination of a Gram-stained smear revealed moderate numbers of nondescript cell-like structures that were indistinguishable mixed with numerous white blood cells, predominantly polymorphonuclear leukocytes. In an attempt to identify the cell-like structures seen on the Gramstained smear, a second Giemsa-stained smear was examined on the same day. On the basis of the morphological features of the cells, namely, an amoeboid shape, the presence of one or two elliptically shaped nuclei, and a poorly defined cytoplasm, a provisional identification of trichomonad parasites was made. Two original separate eye swabs (left and right) were retrieved roughly 5 h postcollection and immediately inoculated into Kupferberg Trichomonas culture medium (QUELAB) for further analysis. This medium was supplemented with heat-inactivated bovine serum, penicillin G (10,000 U/ml), streptomycin (10,000 g/ml), and amphotericin B (25 g/ml). Cultures were incubated at 37°C in the presence of 5 to 7% CO 2 and examined microscopically on days 2, 5, and 7. Subsequently, two cultures became positive for mobile trophozoites of trichomonads.At this stage, considering the isolation of the trichomonads from both eyes, the patient was recalled to the clinic. When he arri...

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Neonatal pneumonia caused by Trichomonas vaginalis

Cited by 23 publications

References 35 publications

Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis

Drug resistance in the sexually transmitted protozoan Trichomonas vaginalis

Molecular Identification of Tritrichomonas foetus -Like Organisms as Coinfecting Agents of Human Pneumocystis Pneumonia

Bilateral Conjunctivitis Due to Trichomonas vaginalis without Genital Infection: an Unusual Presentation in an Adult Man

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