From Interventional Pulmonary Medicine (Dr Khemasuwan), Henry Ford Hospital, Henry Ford Health System; and Department of Anatomical Pathology (Dr Farver) and Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute (Dr Mehta), Cleveland Clinic Foundation.
CORRESPONDENCE TO: Atul C. Mehta, MD, FCCP, Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH 44195; e-mail: Mehtaa1@ccf.org
FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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We thank Dr Martínez-Girón for his interest in our article in CHEST1 and appreciate the astute observation. His input certainly supplements our article, and we agree that parabasalids, the flagellated protozoa, can occasionally cause lung diseases.
Pulmonary infestation from Lophomonas blattarum is extremely rare.2 The majority of the case reports are from Southern China, probably because its hosts (termites and cockroaches) are abundantly found in this region.3 Pulmonary symptoms are nonspecific and include productive cough, hemoptysis, and dyspnea. Only 7% of patients have a history of asthma and 36% have eosinophilia.2 The diagnosis is made by microscopic examination of the sputum smear and/or BAL. Metronidazole is the treatment of choice for L blattarum infection.
Trichomonas vaginalis is a common sexually transmitted pathogen. Occasionally, it has been reported involving the respiratory tract of neonates and adults.4 In the majority of neonates, premature rupture of fetal membrane has been documented. There are only two adult cases with respiratory tract involvement by T vaginalis. These patients had a history of orogenital contact.4 Most of these cases were successfully treated with metronidazole.
Thus, the respiratory involvement of parabasalids is extremely rare in adults. These patients have unique exposure risks to the organisms. The clinical presentation is relatively nonspecific. The diagnosis is solely made by identification of the organisms in the specimens from respiratory tract. The pulmonologists should have a high clinical suspicion of parabasalids infection in a proper clinical context.
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