Bronchopulmonary infection with lophomonas blattarum:two cases report and literature review

Objective： To improve the recognition and diagnosis on the bronchopulmonary infection with Lophomonas blattarum （L. blattarum）. Methods： The clinical characteristics of 2 patients diagnosed and treated in our hospital were reported, and 42 cases that had been reported from years 1993 to 2007 are analyzed. Results： In our report, the first patient attacked serious asthma time after time, the second patient suffered from bronchiectasis with a protracted infection course. Forty-four cases all have pathogen examination and parasitic expertise. The most common symptoms are fever, cough and expectoration. 1/3 of the patients have increased acidophilic granulocyte in peripheral blood. Chest X film and CT scanning suggest changes were similar to pneumonia. Chronic cases are manifested with bronchial asthma, bronchiectasis and pulmonary abscess. L. blattarum found in phlegm or specimen collected by bronchoscopy provides the most reliable evidence for the diagnosis of this disease. Conclusion： Bronchopulmonary L. blattarum infection is a new kind of diseases. The clinical manifestations are similar to pneumonia, asthma, bronchiectasis infection or pulmonary abscess. L. blattarum found in sputum smear, bronchoscopic brush smear, bronchoscopic biopsy smear, or hronchoalceolar lavage under microscope is the foundation of the diagnosis. The pathogen species has not been finally confirmed. It is still unclear how the pathogen exists in the natural environment, how to transmit to persons and what kind of people would suffer from the disease more easily. Treatment only with antibiotics is not effective to this disease. Metronidazole with dosage of 0.5 g per time and twice per day was effective to most patients, the period of treatment need to last 14-38 d, but multidrug resistance case had been reoorted.

Lophomonas blattarum Infection or Just the Movement o Ciliated Epithelial Cells？

INTRODUCTION Lophomonas blattarum （L. blattarum） is a multiflagellated protozoan, which parasitizes in the intestinal tracts of termites and cockroaches, belonging to the Lophomonas suborder, Hypermastigida order. More than 100 cases of bronchopulmonary L. blattarum infection have been reported since 1993. However, we identified the movable cells from the bronchoalveolar lavage fluid （BALF） of six patients with pulmonary diseases under an electron microscope, and eventually lbund that these cells were actually bronchial ciliated epithelial cells, which were basically identical with reported L. blattarum in morphology under light microscope in the literature, Through careful literature review, we found that all of the reported L. blattarum infections were just diagnosed by morphology under light microscope rather than electron microscope, isolation and culture, or molecular procedures; images exhibited in these literatures were all compatible with the microscopic characteristics of bronchial ciliated epithelial cells.