Pulmonary Lophomonas blattarum infection in patients with kidney allograft transplantation

Abstract

Summary The aim of the study was to analyse the clinical manifestation and management of pulmonary Lophomonas blattarum infection in four allograft transplantation recipients retrospectively. Four patients with pulmonary L. blattarum infection were diagnosed by using Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) examination. Their clinical manifestation and management are summarized. Four cases of pulmonary L. blattarum were found during the period from the second month to the third month after transplantation. Concurring infection by other pathogens was found in three of them. Common initial symptoms included fever (>38 °C) without cough and breathlessness. Lower lobe shadowing could be found on chest X‐ray. Body temperature decreased to the normal range in three patients and to 37.5 °C in the other one, after intravenous injection of metronidazole and tapering immunosuppressant. Radiological examination confirmed improved health condition of the patients afterwards. Two patients received repeated FOB and only dead L. blattarum was found. Pulmonary L. blattarum infection in allograft transplant recipients carry relatively obscure initial symptoms. Possible L. blattarum infection needs to be screened in post‐transplantation pulmonary infection patients with similar symptoms, especially in those who respond poorly to anti‐infection treatment. Microscopic examination of BAL fluid can help to identify pulmonary L. blattarum infection and metronidazole is an ideal treatment choice.

Late Onset Pulmonary Lophomonas blattarum Infection in Renal Transplantation: A Report of Two Cases

“…All of the articles reported that L. blattarum was sensitive to short-term metronidazole treatment (3,4). The present case 1 was also sensitive to about one month of metronidazole treatment initially, but his lung radiological manifestation did not recover to normal, with the negative L. blattarum examination by bronchoscopy.…”

“…Human pulmonary L. blattarum infection is a rare disease with reports only in China (3,4). There were total 15 cases L. blattarum infection reported prior to the present cases.…”

“…We suggest for those organ transplant recipients residing in regions suitable for the growth of cockroaches and termites, and presenting with fever and radiological abnormality irresponsive to regular antibacterium or anti-virus therapy, L. blattarum infection should be considered in the differential diagnosis. Timely bronchoscopy examination with BAL analysis is a useful and safe tool for the diagnosis of pulmonary L. blattarum infection and other pneumonia without definite pathogen (3,7).…”

“…By the inhalation of dust polluted by L. blattarum, L. blattarum can parasitize in the lung of the patient. L. blattarum is a rare protozoa, but it has been reported to be involved in pulmonary infections in patients at an early stage after transplantation (3). In this report we present two cases of pulmonary Lophomonas blattarum infection which occurred more than one year after operation in renal transplant recipients with normal allograft function and relatively normal immunity.…”

Hallazgo de Lophomonas sp. en secreciones del tracto respiratorio de niños hospitalizados con enfermedad pulmonar grave

“…El Lophomonas blattarum es un parásito habitual de la flora intestinal de las cucarachas (Periplaneta americana); en China se halló en muestras de secreciones respiratorias de pacientes adultos con neumonías bacterianas que no responden a tratamiento (3)(4)(5)(6) . También ha sido encontrado en muestras de esputo de pacientes asmáticos y algunos consideran que puede tener alguna implicancia en la recurrencia de crisis en pacientes asmáticos (7,8) .…”