An emerging new respiratory pathogen, Lophomonas blattarum, found in bronchoalveolar lavage in an immunodeficient patient with asthma

Abstract

Infections with unusual organisms are frequently found in patients with primary and acquired immunodeficiency. It is estimated that 1 in 1200 individuals in the United States have a diagnosis of primary immunodeficiency, with common variable immunodeficiency (CVID) accounting for approximately 35% of the cases. 1 Boyle JM Buckley RH. Population prevalence of diagnosed primary immunodeficiency diseases in the United States. J Clin Immunol. 2007; 27: 497-502 Crossref PubMed Scopus (317) Google Scholar CVID is a heterogeneous disorder that is primarily a defect of the humoral immune system, although approximately 50% of patients have T cell defects as well. Patients with CVID have increased susceptibility to infections, particularly of the upper and lower respiratory tract, and increased incidence of autoimmune diseases and neoplasms. 2 Bonilla FA Kahn DA Ballas ZK Chinen J Frank MM Hsu JT et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015; 136 (1186-1205.e1-e78) Abstract Full Text Full Text PDF PubMed Scopus (394) Google Scholar Common pathogens causing respiratory tract infections in CVID include Streptococcus pneumoniae, Haemophilus influenza, and Staphylococcus aureus.2 Bonilla FA Kahn DA Ballas ZK Chinen J Frank MM Hsu JT et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015; 136 (1186-1205.e1-e78) Abstract Full Text Full Text PDF PubMed Scopus (394) Google Scholar Although parasitic infections can occur, the most often described is Giardia infection of the gastrointestinal tract. 2 Bonilla FA Kahn DA Ballas ZK Chinen J Frank MM Hsu JT et al. Practice parameter for the diagnosis and management of primary immunodeficiency. J Allergy Clin Immunol. 2015; 136 (1186-1205.e1-e78) Abstract Full Text Full Text PDF PubMed Scopus (394) Google Scholar Infections with other parasites particularly of the respiratory tract have rarely been described. Lophomonas blattarum is a flagellated protozoa found in the gut of cockroaches and termites which has been found to cause rare bronchopulmonary infections, although there are no published cases in the United States to date. 3 Martinez-Girón R Cornelis van Woerden H. Lophomonas blattarum and bronchopulmonary disease. J Med Microbiol. 2013; 62: 1641-1648 Crossref Scopus (35) Google Scholar ,4 Chaudhury A Parija SC. Lophomonas blattarum: a new flagellate causing respiratory tract infections. Trop Parasitol. 2020; 10: 7-11 Google Scholar The most often reported symptoms of L blattarum infection are fever and productive cough. The infection is usually responsive to treatment with metronidazole. 3 Martinez-Girón R Cornelis van Woerden H. Lophomonas blattarum and bronchopulmonary disease. J Med Microbiol. 2013; 62: 1641-1648 Crossref Scopus (35) Google Scholar ,4 Chaudhury A Parija SC. Lophomonas blattarum: a new flagellate causing respiratory tract infections. Trop Parasitol. 2020; 10: 7-11 Google Scholar