**2. Medical importance of arthropods**

The different ways in which arthropods are related to the health and well-being of man are classified into three groups:

	- Entomophobia. Including illusory parasitosis
		- a. Disturbances and blood loss
	- Accidental damage to sense organs
		- a.Poisoning
	- Dermatosis
		- a.Myiasis and associated infestations
		- b.Allergies and associated conditions
	- Competitors
	- Predatory parasites

The taxonomic scope of arthropods should be considered together with pentastomids, since the latter have always been considered as a phylum or class apart from the arthropods, however pentasthomids such as the *Linguatula serrata* whose adult forms live in the nose of dogs (and exceptionally in the human). Embryonated eggs are released via nasal mucosa or feces. If the intermediate hosts ingest the eggs, the primary four-legged larva emerges and migrates via blood vessels to the internal organs. When the final host ingests raw or undercooked meat from the infected intermediate host, the adult form develops in the nasal tract. These can be parasites of the respiratory tract and cavities of reptiles, birds and mammals. Humans can also be accidental hosts and can be infected by ingesting eggs that later develop nymphs in their tissues (visceral pentastomiasis), or ingest meat infected with nymphs in their tissues, developing in the nose and pharynx adult forms (nasopharyngeal pentastomiasis) or Halzoun disease [20].

In 1973, Lavoipierre and Rajamanickam cited cockroaches as intermediate hosts of long-necked pentasthomids [21].

#### **2.1 Nomenclature**

The modern system of naming and classifying animals dates from the 10th edition of Linnaeus Systema Naturae (1758), in which not only the first complete and ordered group of animals but also a new system of nomenclature appeared. It was Linnaeus who first devised the method of substituting specific unique names for the descriptive phrases that until then had been used in combination with the words that are now known as generic names. Linnaeus recognized six classes of animals; the fifth is the insect, whose definition allowed the inclusion of a large number of creatures that are no longer called insects, rather with their popular name, such as spiders, mites, crabs and centipedes. Its Insecta class was divided into seven orders; each of which contained several genera and each of which included numerous species [22].

#### **2.2 Order dictyoptera**

#### *2.2.1 Cockroaches and praying mantises*

The only members of this order that have any medical importance are the cockroaches (suborder Blattoidea) associated with man. These rather flattened insects, sometimes similar to beetles that move quickly, are familiar to most people; they can be easily distinguished from beetles by their very flexible, wirelike antennas [23].

**261**

*Bronchopulmonary Lophomoniasis, Infection by Endocommensal Protozoa of Intradomiciliary…*

The cockroaches form an ancient group, which goes back to the Silurian and which has few changes in its general structure since the Devonian, around 320 million years ago. They were very abundant in the Carboniferous marshes, as indicated by their fossil remains in the coal deposits of that period. They are taxonomically admitted in a separate order together with the mantids, in the Dictyoptera or as a suborder of the Orthoptera, in addition to the evidences that show a strong ances-

Order Dictyoptera Cockroaches and mantids

The species associated with man attack stored food and infest premises used for storing, preparing and cooking food, such as bakehouses and kitchens, as well as sewers and rubbish dumps. They are known to carry pathogenic viruses, bacteria and helminths and to act as intermediate host for such pathogens as the nematode *Gongylonema pulchrum* Molin (gullet worm) and the Acanthocephalus *Moniliformis moniliformis* Bremser; they are also capable of causing allergic dermatitis. More than a dozen species have some degree of medical importance, but the following six species, all with worldwide distributions, are the principal vectors: the common cockroach (Blackbeetle) (*Blatta orientalis*), the American cockroach (*Periplaneta americana*), the Australian cockroach (*P. australasiae*), the German cockroach (*Blattella germanica*), the brown-banded cockroach (*Supella supellectilium*\*

The following descriptions are key to identify the adults of six medically impor-

Front wings absent or underdeveloped, not reaching the tip of the abdomen.

4.General grayish brown color, pronotum and front wings stamped (**Figure 6F**)

5.Front wings with a pale yellow stripe along the basal part of the anterior

6.Front wings without a pale yellow stripe along the basal part of the anterior

8.Pronotum without dark bands (brown with translucent lateral margins). Forewings dark basally and pale distally in the male, and dark with pale bands

9.Legs from reddish brown to dark brown. Uniformly opaque pronotum. Total

in the female (**Figure 6E**) *Supella supellectilium* **(Serville).**

length greater than 15 mm (**Figure 6A**) *Blatta orientalis* **L.**

7.Pronotum with two conspicuous longitudinal dark bands. Front wings uniform

1.Well-developed forewings, reaching at least the tip of the abdomen.

2.Total length (up to the tips of the front wing) more than 18 mm.

3.Total length (up to the tips of the front wing) less than 17 mm.

margin (**Figure 6C**) *Periplaneta australasiae* **(Fab).**

margin (**Figure 6B**) **American Periplaneta (L.).**

color (**Figure 6D**) *Blattella germanica*.

*DOI: http://dx.doi.org/10.5772/intechopen.89219*

*Taxonomic classification of cockroaches [24].*

**Class Insecta** Subclass Pterygota Division Exopterygota

**Table 1.**

tral relationship with the termites [24] (**Table 1**).

(Serville) and the Madeira cockroach (*Leucophaea maderae*).

tant species of cockroaches:

*Leucophaea maderae* **(Fab).**

*Bronchopulmonary Lophomoniasis, Infection by Endocommensal Protozoa of Intradomiciliary… DOI: http://dx.doi.org/10.5772/intechopen.89219*


**Table 1.**

*Parasitology and Microbiology Research*

arthropod)

○ Competitors

○ Predatory parasites

○ Mechanical vectors (more or less casual transmission)

• Arthropods as natural enemies of medically harmful insects

○ Intermediary guests (as passive carriers)

○ Foretic carriers of harmful arthropods

ryngeal pentastomiasis) or Halzoun disease [20].

of long-necked pentasthomids [21].

**2.1 Nomenclature**

numerous species [22].

**2.2 Order dictyoptera**

like antennas [23].

*2.2.1 Cockroaches and praying mantises*

○ Mandatory vectors (including some degree of development within the

The taxonomic scope of arthropods should be considered together with pentastomids, since the latter have always been considered as a phylum or class apart from the arthropods, however pentasthomids such as the *Linguatula serrata* whose adult forms live in the nose of dogs (and exceptionally in the human). Embryonated eggs are released via nasal mucosa or feces. If the intermediate hosts ingest the eggs, the primary four-legged larva emerges and migrates via blood vessels to the internal organs. When the final host ingests raw or undercooked meat from the infected intermediate host, the adult form develops in the nasal tract. These can be parasites of the respiratory tract and cavities of reptiles, birds and mammals. Humans can also be accidental hosts and can be infected by ingesting eggs that later develop nymphs in their tissues (visceral pentastomiasis), or ingest meat infected with nymphs in their tissues, developing in the nose and pharynx adult forms (nasopha-

In 1973, Lavoipierre and Rajamanickam cited cockroaches as intermediate hosts

The modern system of naming and classifying animals dates from the 10th edition of Linnaeus Systema Naturae (1758), in which not only the first complete and ordered group of animals but also a new system of nomenclature appeared. It was Linnaeus who first devised the method of substituting specific unique names for the descriptive phrases that until then had been used in combination with the words that are now known as generic names. Linnaeus recognized six classes of animals; the fifth is the insect, whose definition allowed the inclusion of a large number of creatures that are no longer called insects, rather with their popular name, such as spiders, mites, crabs and centipedes. Its Insecta class was divided into seven orders; each of which contained several genera and each of which included

The only members of this order that have any medical importance are the cockroaches (suborder Blattoidea) associated with man. These rather flattened insects, sometimes similar to beetles that move quickly, are familiar to most people; they can be easily distinguished from beetles by their very flexible, wire-

**260**

*Taxonomic classification of cockroaches [24].*

The cockroaches form an ancient group, which goes back to the Silurian and which has few changes in its general structure since the Devonian, around 320 million years ago. They were very abundant in the Carboniferous marshes, as indicated by their fossil remains in the coal deposits of that period. They are taxonomically admitted in a separate order together with the mantids, in the Dictyoptera or as a suborder of the Orthoptera, in addition to the evidences that show a strong ancestral relationship with the termites [24] (**Table 1**).

The species associated with man attack stored food and infest premises used for storing, preparing and cooking food, such as bakehouses and kitchens, as well as sewers and rubbish dumps. They are known to carry pathogenic viruses, bacteria and helminths and to act as intermediate host for such pathogens as the nematode *Gongylonema pulchrum* Molin (gullet worm) and the Acanthocephalus *Moniliformis moniliformis* Bremser; they are also capable of causing allergic dermatitis. More than a dozen species have some degree of medical importance, but the following six species, all with worldwide distributions, are the principal vectors: the common cockroach (Blackbeetle) (*Blatta orientalis*), the American cockroach (*Periplaneta americana*), the Australian cockroach (*P. australasiae*), the German cockroach (*Blattella germanica*), the brown-banded cockroach (*Supella supellectilium*\* (Serville) and the Madeira cockroach (*Leucophaea maderae*).

The following descriptions are key to identify the adults of six medically important species of cockroaches:


**Figure 6.**

*Species of cockroaches of medical importance. A, C, D, E and F are vector agents of viruses, helminths and bacteria for both humans and animals. B is a host of the endocomponent* Lophomonas blattarum*, a multifilated protozoan [23].*

Young cockroaches are similar to those of adults but lack wings [25] (**Figure 6E** and **F**).

The legs of insects are mainly for walking or running. The prominent antennas are filiform and multiarticulate. The mouthparts are of the generalized bitingchewing type (Orthoptera type). In most species, there are two pairs of wings; in some, the wings are vestigial, and in others, for example in *Blatta orientalis*, they are well developed in the male and short in the female. The outer pair of wings (tegmina) is narrow, thick and coriaceous; the inner pair is membranous and folds like a fan. It is assumed that the common name in English, cockroach, is derived from the pronunciation of Cockroach name in Spanish (koo-kah-rah-chah) [24].

#### **3. Presentation of a clinical case**

This is a 60-year-old male doctor by profession, originally from Pachuca Hidalgo, who has lived in the municipality of Cadereyta for 18 years. Denies trips abroad, without physical activity, and indicates adequate personal hygiene. He refers to the diagnosis 9 years ago of non-Hodgkin lymphoma and is in treatment with radiotherapy and chemotherapy. Due to edema after treatment, thoracocentesis and pericardiocentesis were performed, as well as gastrostomy, which he maintained for 1 year. Six months ago, he presented with respiratory symptoms, characterized by fever, malaise, cough with expectoration, and data of mild respiratory insufficiency. It is treated with antibiotics, and salbutamol is administered; however, the symptoms reappear after 15 days.

One month ago, he presented with respiratory symptoms with the same characteristics, and he reported that a chest X-ray was performed with unspecified pneumonia data. Presents 6 days ago asthenia, adynamia, hyporexia, malaise, fever of 38.5°C, self-medicated Levofloxacin 750 mg every 12 h, Ceftriaxone 1 g every 24 h, Paracetamol and Metamizol 500 mg orally. Three days

**263**

(**Figure 7a** and **b**).

**Figure 8.**

**Figure 7.**

*process. 400×. Photo. Villagrán-Herrera.*

*observed. 400×. Photo Villagrán-Herrera.*

*Bronchopulmonary Lophomoniasis, Infection by Endocommensal Protozoa of Intradomiciliary…*

*Wet assembly with saline solution. Multiflagellated trophozoites and cysts were observed in a sample of unstained morning sputum. The vacuole and the many flagella in its narrow part are seen in some forms. These characteristics are compatible with* Lophomonas blattarum*. Erythrocytes are seen that reveal a throat bleeding* 

*(a and b) Wet assembly with saline solution, where trophozoites and cysts of* Lophomonas blattarum *are* 

later, productive cough is added, expectoration with blood streaks, and later, it becomes a uniform reddish color; likewise, the cough persists and the amount of phlegm increases. There is mild dyspnea and no predominance of hours, and salbutamol is self-medicated, showing improvement with the application of the medication. Currently fever, general malaise and mild headache persist. Freshly emitted specimens of sputum are requested and fresh observations are made with saline and several smears, which are stained with Hematoxylin and Eosin (H/E), Papanicolaou and Giemsa. The study on fresh smears reveals trophozoites and cysts of a protozoan multiflagellate identified as *Lophomonas blattarum*

A large amount of polymorphonuclear leukocytes was observed in the smears

before staining, coinciding with an acute inflammatory process (**Figure 8**).

*DOI: http://dx.doi.org/10.5772/intechopen.89219*

*Bronchopulmonary Lophomoniasis, Infection by Endocommensal Protozoa of Intradomiciliary… DOI: http://dx.doi.org/10.5772/intechopen.89219*

*Parasitology and Microbiology Research*

(**Figure 6E** and **F**).

*a multifilated protozoan [23].*

**Figure 6.**

**3. Presentation of a clinical case**

however, the symptoms reappear after 15 days.

Young cockroaches are similar to those of adults but lack wings [25]

*Species of cockroaches of medical importance. A, C, D, E and F are vector agents of viruses, helminths and bacteria for both humans and animals. B is a host of the endocomponent* Lophomonas blattarum*,* 

are filiform and multiarticulate. The mouthparts are of the generalized bitingchewing type (Orthoptera type). In most species, there are two pairs of wings; in some, the wings are vestigial, and in others, for example in *Blatta orientalis*, they are well developed in the male and short in the female. The outer pair of wings (tegmina) is narrow, thick and coriaceous; the inner pair is membranous and folds like a fan. It is assumed that the common name in English, cockroach, is derived from the

pronunciation of Cockroach name in Spanish (koo-kah-rah-chah) [24].

This is a 60-year-old male doctor by profession, originally from Pachuca Hidalgo, who has lived in the municipality of Cadereyta for 18 years. Denies trips abroad, without physical activity, and indicates adequate personal hygiene. He refers to the diagnosis 9 years ago of non-Hodgkin lymphoma and is in treatment with radiotherapy and chemotherapy. Due to edema after treatment, thoracocentesis and pericardiocentesis were performed, as well as gastrostomy, which he maintained for 1 year. Six months ago, he presented with respiratory symptoms, characterized by fever, malaise, cough with expectoration, and data of mild respiratory insufficiency. It is treated with antibiotics, and salbutamol is administered;

One month ago, he presented with respiratory symptoms with the same characteristics, and he reported that a chest X-ray was performed with unspecified pneumonia data. Presents 6 days ago asthenia, adynamia, hyporexia, malaise, fever of 38.5°C, self-medicated Levofloxacin 750 mg every 12 h,

Ceftriaxone 1 g every 24 h, Paracetamol and Metamizol 500 mg orally. Three days

The legs of insects are mainly for walking or running. The prominent antennas

**262**

*(a and b) Wet assembly with saline solution, where trophozoites and cysts of* Lophomonas blattarum *are observed. 400×. Photo Villagrán-Herrera.*

#### **Figure 8.**

*Wet assembly with saline solution. Multiflagellated trophozoites and cysts were observed in a sample of unstained morning sputum. The vacuole and the many flagella in its narrow part are seen in some forms. These characteristics are compatible with* Lophomonas blattarum*. Erythrocytes are seen that reveal a throat bleeding process. 400×. Photo. Villagrán-Herrera.*

later, productive cough is added, expectoration with blood streaks, and later, it becomes a uniform reddish color; likewise, the cough persists and the amount of phlegm increases. There is mild dyspnea and no predominance of hours, and salbutamol is self-medicated, showing improvement with the application of the medication. Currently fever, general malaise and mild headache persist. Freshly emitted specimens of sputum are requested and fresh observations are made with saline and several smears, which are stained with Hematoxylin and Eosin (H/E), Papanicolaou and Giemsa. The study on fresh smears reveals trophozoites and cysts of a protozoan multiflagellate identified as *Lophomonas blattarum* (**Figure 7a** and **b**).

A large amount of polymorphonuclear leukocytes was observed in the smears before staining, coinciding with an acute inflammatory process (**Figure 8**).

After the identification of the multiflagellated protozoan, treatment with metronidazole of 500 mg every 8 h was started orally for 7 days, improving symptoms, decreasing dyspnea and continuing with unproductive cough. Control studies are carried out 15 days after the last antiparasitic intake, and the samples were negative for the presence of this protozoan.
