Study of Lophomonas blattarum Infection in Kidney Transplant Patients in Mashhad City, Iran

Background. Lophomonas blattarum is a flagellate protozoan which is known as an emerging parasite in the human respiratory system. Organ transplant recipients are considered as immunocompromised patients due to prescription of immunosuppressive drugs. This group of patients is susceptible to opportunistic infection as well as lophomoniasis. This study aims to investigate the prevalence and clinical manifestation of pulmonary infections caused by L. blattarum in kidney transplant recipients. Methods. This is a case-control study including 50 kidney transplant recipients and 50 controls. The sputum samples were collected from 50 kidney transplant recipients with bronchopulmonary infection signs suspected to lophomoniasis admitted in Montaserieh and Imam Reza hospitals, Mashhad, Iran. 50 healthy individuals as the control group were matched for sex and age with case ones. The consent form, checklist, and required information were provided for each patient. All samples were microscopically examined for the flagellated protozoan, L. blattarum, using direct smear. Results. Among 50 kidney transplant recipients suspected to lophomoniasis, L. blattarum was identified in sputum samples of 4 (8%) participants of the case group including one female and three males. None of the samples were positive among the control group. Symptoms in patients of this study were high fever (4 out of 4 patients), cough (3 out of 4 patients), and dyspnea (2 out of 4 patients). Three patients showed a positive response to metronidazole treatment. Conclusion. The results of this study suggest that L. blattarum should be considered as a pathogenic agent in kidney transplant recipients. It is necessary to examine sputum samples in posttransplant pneumonia patients, especially in those resistant to antibacterial therapy.

Protozoan Cysts in Faecal Pellets of German Cockroaches (Blattella germanica), with Particular Emphasis on Lophomonas blattarum

Purpose The aim of this study was to investigate protozoan cysts and oocyts in the faecal pellets of the German cockroach (Blattella germanica), with emphasis on the prevalence of Lophomonas blattarum. Methods Thirty adult Blattella germanica (12 males; 18 females) were trapped near Madrid, Spain. Expelled faecal pellets were collected in the laboratory over 5 days in two plastic containers. Protozoan cysts from one container were weighted and those in the other used for morphologically identification. Results Protozoan cysts/oocysts per gram of faecal pellet were: Nyctotherus sp. (0.0019/g), Entamoeba (0.0007/g), Balantidium coli (0.0001/g), Lophomonas blattarum (0.00038/g). Observation of 189 protozoan cysts/oocysts indicated the following prevalence: Nyctotherus sp. 65 (34.4%); Gregarina spp. 34 (18%); Entamoeba sp. 24 (12.7%); Cryptosporidium sp. 17 (9%); Coccidia 16 (8.4%); Lophomonas blattarum 13 (6.8%); Balantidium coli 4 (2.1%); and unclassified 16 (8.4%). Conclusion Lophomonas blattarum has previously been demonstrated in the gut of cockroaches, but this is the first assessment of the prevalence in Blattella germanica in faecal pellets. The presence of protozoa in faecal pellets provides some evidence for one step in a hypothesised route of respiratory infection whereby protozoa from household insects enter the respiratory tract.