Diagnosis of pulmonary lophom*oniasis in an elderly anthracosis patient with resistant respiratory symptoms: A literature review and a case report study (2024)

Associated Data

Data Availability Statement

Abstract

Keywords: anthracosis, Lophom*onas blattarum infection, lophom*oniasis, parasite disease

1. INTRODUCTION

Anthracosis is the asymptomatic, mild form of pneumoconiosis caused by carbon accumulation in the lungs from repeated exposure to air pollution or inhaling smoke or coal dust particles. Cough and dyspnea are the most critical symptoms of anthracosis in most patients. In severe cases, anthracosis can lead to respiratory complications such as chronic bronchitis, enlarged mediastinal lymph nodes such as vocal cord paralysis, broncho‐lithiasis, or even respiratory failure.1, 2

Studies reported a strong association with diseases such as chronic obstructive pulmonary disease (COPD), parasite disease, tuberculosis, and lung cancer. Routine check‐ups can help monitor the progression of anthracosis and prevent further complications.2, 3

Empirical treatments such as bronchodilators (short or long‐acting), corticosteroids (inhalation or systemic), and antibiotics have been utilized. Other supportive measures like oxygen therapy and chest physiotherapy may also be considered depending on the severity of the condition.4, 5

Lophom*onas blattarum (L. blattarum) is an uncommon protozoan parasite discovered in the intestines of arthropods, including co*ckroaches and termites. L. blattarum, categorized as an opportunistic pathogen, can lead to bronchopulmonary infections, particularly in individuals with compromised immune systems. This protozoan is typically spread through waste and dust when the host is in motion. It has the capacity to invade multiple tissues such as the sinuses, reproductive system, and respiratory system in humans. Clinical manifestations are typically nonspecific and include symptoms like cough, production of sputum, fever, chest discomfort, and respiratory distress.6, 7

Lophom*onas blattarum infections are often underdiagnosed due to the nonspecific symptoms it presents. Diagnosis can be challenging and typically involves identifying the parasite in respiratory secretions or tissue samples. Treatment usually consists of metronidazole or tinidazole medications, although treatments' effectiveness can vary. Prevention of L. blattarum infections involves controlling the arthropod populations in living areas and maintaining good hygiene practices.8, 9

Several cases of lophom*onas infection in patients with immunocompromised conditions and other underlying diseases have been reported to date. However, there is no evidence of infection of lophom*onas in anthracosis patients worldwide. The presence of lophom*oniasis in anthracosis patients may lead to increased inflammation, impaired lung function, and a higher risk of respiratory infections. This combination can potentially exacerbate respiratory symptoms and complications in affected individuals. Healthcare providers must consider both anthracosis and lophom*oniasis when evaluating individuals with respiratory symptoms, especially those exposed to coal dust or living in environments where co*ckroaches are prevalent.10, 11 This research discusses the diagnosis and treatment of a 77‐year‐old man who was found to be infected with both lophom*onas and anthracosis. The case highlights the importance of considering multiple infectious agents in patients with complex medical histories and symptoms.

2. CASE PRESENTATION

3. DISCUSSION

Anthracosis causing destruction and deformation of the bronchi is termed anthracofibrosis, an occupational disease. Although anthracofibrosis is reduced in Western industrial countries, it is still widespread in some third‐world countries. The severity of anthracosis can vary depending on the duration and intensity of exposure to the particles.1, 2, 3 The diagnosis of anthracosis is typically made through imaging studies (chest X‐rays and CT scans), which can show characteristic findings such as linear or nodular opacities in the lungs.2, 3 Bronchoscopy is the gold standard for diagnosing anthracosis. Anthracosis may be detected in different images as simple flat anthracosis, deep‐seated retracted anthracosis (originating from an anthracitic lymph node beside the bronchus), and protruded black discoloration of mucosa with or without narrowing of bronchi. In addition to black lesions, bronchial swelling with infiltration, erythema, and thickening that may cause obliteration of bronchi may be seen. Bronchoscopy allows for direct visualization of the bronchial mucosa and the collection of biopsy samples for further analysis. It is a valuable tool in diagnosing and managing anthracosis, providing vital information for treatment planning and monitoring of the disease progression.4, 5

Treatment of anthracosis usually involves avoiding further exposure to coal dust and managing symptoms such as cough and shortness of breath. In more severe cases of anthracofibrosis, interventions such as bronchoscopic procedures or surgery may be necessary to relieve airway obstruction.2, 5

Clinically significant pulmonary protozoan infections are uncommon but have become more acknowledged due to compromised immune states in recent years. Several research studies have indicated that several factors may impact the occurrence of parasitic diseases and anthracosis in individuals, such as socio‐demographic characteristics (such as gender and age), pre‐existing medical conditions, and living in areas where anthracosis and parasitic infections are more prevalent. Additionally, studies have documented cases of co‐infection or superinfection of lophom*oniasis in individuals with underlying health issues.7 In our study, the patient had diabetes, which could affect the immune system and lead to immunosuppression. This may have contributed to the patient's increased susceptibility to infections.

Lophom*onas represents a genus of unicellular flagellated protozoa that predominantly inhabit the digestive tract of termites. These organisms are commonly acknowledged as symbiotic entities residing within the hindgut of termites. Distinguishing Lophom*onas blattarum from ciliated epithelial cells solely based on morphological characteristics under a light microscope can pose challenges, potentially leading to misdiagnoses. Therefore, employing techniques such as bronchoscopy biopsy smear, sputum smear, or bronchoalveolar lavage (BAL) can facilitate the identification of L. blattarum in patients. Infections attributed to L. blattarum typically manifest with atypical and nonspecific clinical symptoms, predominantly impacting the respiratory system and likely being transmitted through airborne routes.7, 8, 9 These infections exhibit resemblances in terms of clinical manifestations and radiological characteristics. The absence of distinctive symptoms can create complexities in diagnosing and treating these infections, making it difficult to distinguish them from other medical conditions. Scholars propose that these infections should be considered in patients displaying symptoms such as eosinophilia, severe respiratory infection, immunosuppression, and unsuccessful response to antimicrobial therapy. Radiographic findings from X‐rays and CT scans related to these infections comprise patchy or streaky shadows, cystic lesions, abscesses, ground‐glass opacity, patchy consolidation, and pleural effusion. These findings present challenges in distinguishing this co‐infection from other common diseases that feature similar radiographic presentations.9, 10, 11

Further research is necessary to understand the mechanisms behind this infection in anthracosis patients. The development of anthracosis can lead to chronic lung inflammation, which may disrupt the normal functioning of the immune system. Histopathology of lung tissue reveals carbon and free particles within the macrophage cytoplasm of the bronchial wall and mediastinal lymph nodes. Serum cytokines, notably interleukin 8 (IL‐8), are recognized as biomarkers for pneumoconiosis progression. IL‐8 plays a vital role in recruiting and activating neutrophils in response to silica exposure, leading to the initiation and spread of inflammatory responses in both lungs.2, 3, 4

Further investigation showed that an increase in these markers and inflammatory processes could provide an environment for the parasite disease in anthracosis patients. Chronic inflammation may result in the release of pro‐inflammatory cytokines and other mediators that can suppress the immune response and impair the body's ability to fight off infections. Furthermore, the presence of coal dust particles in the lungs can also interfere with the immune cells' clearance of pathogens and other foreign particles. This can further weaken the immune system and make individuals more susceptible to infections. In summary, anthracosis‐induced chronic inflammation and interference with immune cell function in the lungs can contribute to immunodeficiency by impairing the body's ability to mount an effective immune response against pathogens.2, 3, 4 In a study by Aggarwal etal. (2023), most patients with anthracosis and anthracofibrosis showed diffuse pulmonary involvement, and the changes caused by fibrosis, adhesion, airway inflammation, volume reduction, and pleural effusion contribute to the development and progression of pulmonary protozoan infections in individuals with anthracosis.5

This may lead to more severe symptoms and complications in individuals with anthracosis, underscoring the need to monitor and manage inflammation in these patients. Additionally, understanding the relationship between inflammatory markers and parasite diseases could help improve treatment strategies and outcomes for those affected by anthracosis. Further research is crucial to comprehensively grasp the mechanisms at work and devise precise interventions for vulnerable individuals. In a study by Kiani etal. (2018), they reported that there were significant differences in the CD4/CD8 ratio in BAL fluid between 30 anthracosis cases and the control group, and significant differences were found in levels of CD4/CD8 in two groups (p = 0.02).2 Lee etal. (2010), conducted a study on 110 coal mines. According to their findings, IL‐8 levels were significantly higher than those in the control group. The levels were also linked to the degree of pneumoconiosis control.3 Also, the study by Lee etal. (2015), on coal mine workers with pneumoconiosis revealed that IL‐8 levels in individuals with the condition were notably elevated compared to the controls.4

Focusing on prevention strategies is crucial to reduce the risk of lophom*onas infections in patients with anthracosis. Here are some steps that can help decrease the risk of lophom*onas infections in individuals with anthracosis: avoid exposure to contaminated water sources (including lakes, rivers, or ponds), practice good hygiene (such as washing hands with soap and water before eating and after using the bathroom), maintain a healthy immune system (healthy diet, regular exercise, and managing underlying health conditions), avoid sharing personal items, and seek advice if experiencing any signs of this infection. By following these preventive measures, individuals with anthracosis can reduce their risk of lophom*onas infections and maintain their overall health and well‐being.

Our study had strengths. We reported an exceptionally rare case of lophom*onas infection in a patient diagnosed with anthracosis. Based on the patient's illness, clinical examination, and initial radiography findings, we initially isolated the patient, suspecting possible opportunistic infections. We alerted all close contacts and screened them for potential infections. Additionally, we averted complications from each pathogen through prompt diagnosis and suitable treatment. However, we encountered limitations. The definitive diagnosis of lophom*onasis required sending the patient's sample to another center, leading to delays. Despite the delays in obtaining a definitive diagnosis for lophom*onasis, our team remained vigilant in monitoring the patient's progress and managing their symptoms effectively. The collaborative effort between healthcare providers, laboratory personnel, and infectious disease specialists played a crucial role in the successful treatment outcome for this complex co‐infection case. Moving forward, we aim to streamline our diagnostic processes to minimize delays and enhance our ability to provide timely and accurate care for patients with rare and challenging infectious diseases.

4. CONCLUSION

Anthracosis is a chronic lung disease marked by bronchial mucosa black pigmentation from carbon buildup. Anthracosis causes chronic lung inflammation and immunodeficiency, which are associated with parasitic conditions like lophom*onas. Healthcare providers should consider both anthracosis and pulmonary lophom*onosis when evaluating patients with respiratory symptoms, as early detection and treatment may lead to better outcomes for these individuals affected. The diagnosis and effective management of these conditions can help prevent further complications and improve individual health.

AUTHOR CONTRIBUTIONS

Mohammad Hadi Tajik Jalayeri: Conceptualization; project administration; supervision; writing – review and editing. Narges Lashkarbolouk: Data curation; investigation; resources; writing – original draft; writing – review and editing. Mahdi Mazandarani: Methodology; project administration; visualization; writing – original draft; writing – review and editing.

FUNDING INFORMATION

The authors declare that no funds, grants, or other supports were received during the preparation of this manuscript.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no competing interests.

ETHICS STATEMENT

The purpose of this case report was fully explained to the patient. He was assured that the researchers would maintain confidentiality of his information. The principles of the Declaration of Helsinki conducted this case report.

CONSENT

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor in chief of this journal.

Notes

Tajik Jalayeri MH, Lashkarbolouk N, Mazandarani M. Diagnosis of pulmonary lophom*oniasis in an elderly anthracosis patient with resistant respiratory symptoms: A literature review and a case report study. Clin Case Rep. 2024;12:e9085. doi: 10.1002/ccr3.9085 [CrossRef] [Google Scholar]

DATA AVAILABILITY STATEMENT

The datasets used during the current study are available from the corresponding author on reasonable request. All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.

REFERENCES