**1. Introduction**

#### **1.1** *Lophomonas blattarum*

It is an anaerobic multiflagellated intestinal protozoan, endocommensal in the intestine of some arthropods, such as termites and cockroaches (Dictyoptera: Blattoidea), which contaminate in its path food, dust and clothes with its secretions and feces [1–11].

The genus *Lophomonas*, since 1990, has been considered among the protozoa that cause damage to the respiratory tract, especially in immunocompromised individuals (HIV/AIDS, with neoplasms, and use of corticosteroids and transplants) and in adult and pediatric asthmatic individuals [2–6].

The signs and symptoms of Lophomonas infection are similar to pneumonia and bronchitis or bronchopulmonary pathologies of various etiologies; therefore, a correct diagnosis is difficult. The above requires us to duly attend the microbiological study of expectoration, brushing, biopsy or bronchoalveolar lavage samples, whether fresh or stained preparations, especially when observing multiflagellated forms, since if you do not have enough experience trophozoites of *Lophomonas blattarum* can be confused with ciliated epithelial cell fragments (ciliocytoforia) of the bronchi [5–7].

It is important to note that conventional techniques, such as staining of Gram, Giemsa and Papanicolaou smear, do not allow adequate visualization of multiflagellating. Therefore, it is necessary that upon suspicion, a fresh preparation with saline solution is first performed on all samples of the respiratory tract that arrive at the laboratory for parasitological diagnosis, and subsequently, perfectly extended smears are stained with special dyes such as Masson's trichrome [5].

The most clinically important species are *Lophomonas blattarum* and *Lophomonas striata*. The latter was the species first identified in the intestine of the cockroach *Blatta orientalis* by S. Stein in 1860 [6]. The structure of *L. blattarum* was identified in the optical microscope in 1911 and in 1990 with a scanning and electron microscope. The shape of the Lophomonas trophozoite is usually round, oval or pyriform, ranging in size from 15 to 50 μm in diameter, with a plume of flagella that form a bunch located at the anterior end, the largest being those found far away from the apical fissure. It contains phagocytic vacuoles in its cytoplasm, with outward rhythmic movements directed to the apical end in order to eliminate excretions or trap foreign materials [1] (**Figure 1**).

The cockroaches (**Figure 2**) originate as perfectly recognized pests of closed, dark places, which abound at the beginning of the hot climate and which become visible at night when leaving their natural habitat (sewers) to look for their food in the periphery and/or inside the houses [12]. As vectors were not considered capable of transmitting pathogenic organisms to humans, however, studies were conducted by Roth and Willis in 1957, and citing evidence occurred in a pediatric hospital in Brussels, Belgium, where an epidemic of *Salmonella typhimurium* persisted in newborns, despite the rapid isolation of patients, the absence of healthy carriers and the suppression of direct or indirect contact, except for the isolation of cockroaches. However, it was discovered that at night the cockroaches walked on the clothes, blankets and bodies of the babies, and the bacteria were isolated from the body of a considerable number of insects [13]. The epidemic ceased immediately after a severe control of the cockroaches. Rueger and Olson in 1969 showed that the feces

**257**

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

*In the 1860s, S. Stein discovered some multiflagellates in the cockroach's intestine. Drawings of the structures* 

*identified as* Lophomonas blattarum *and* Lophomonas striata *are shown [7].*

of *Periplaneta americana* infected with *Salmonella oranienburg*, being spread over food and vessels, still contained live bacteria after 3.25–4.25 years [14]. These same authors provided a list of 18 species of domestic cockroaches; from which, it was possible to isolate the pathogenic organisms for man, due to its allergenic exposure

Let us consider Cornwell's paraphrase in 1968, which stated the following: (1) Cockroaches prefer environments where both human pathogens and human

food are found, freely passing from one to the other; (2) cockroaches can carry pathogens both inside and outside their bodies, which remain viable on the cuticle in the digestive tract and feces to the extent that insects can be chronic carriers and (3) the evidence is sufficient to justify the various programs of control for this

They are usually confined to buildings in cold climates, but domestic cockroaches can escape freely, and in temperate, tropical or hot weather, they can migrate to other buildings through drains, garbage dumps, septic tanks and latrines where they feed, both on human feces and on food. Isolates of intestinal diners from trapped cockroaches indicate that they are carriers of microorganisms (viruses, fungi and intestinal parasites). Among the viruses, there are 4 strains of poliovirus; and approximately 40 species of pathogenic bacteria (enterobacteria), the mycobacterium of leprosy, two pathogenic fungi (Aspergillus), and the protozoan *Entamoeba histolytica* are also mentioned. On the other hand, other pathogens that are harbored by these arthropods are mentioned under experimental conditions,

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

**Figure 1.**

**Figure 2.**

or toxicity due to its bite [14] (**Figure 2**).

*Home cockroach. Photo Villagrán-Herrera.*

insects where human health is endangered [15].

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

#### **Figure 1.**

*Parasitology and Microbiology Research*

**1. Introduction**

and feces [1–11].

the bronchi [5–7].

**1.1** *Lophomonas blattarum*

**Keywords:** American periplaneta, multiflagellated protozoan,

and in adult and pediatric asthmatic individuals [2–6].

bronchopulmonary lophomoniasis, endocommensal, immunosuppression

It is an anaerobic multiflagellated intestinal protozoan, endocommensal in the intestine of some arthropods, such as termites and cockroaches (Dictyoptera: Blattoidea), which contaminate in its path food, dust and clothes with its secretions

The genus *Lophomonas*, since 1990, has been considered among the protozoa that cause damage to the respiratory tract, especially in immunocompromised individuals (HIV/AIDS, with neoplasms, and use of corticosteroids and transplants)

The signs and symptoms of Lophomonas infection are similar to pneumonia and bronchitis or bronchopulmonary pathologies of various etiologies; therefore, a correct diagnosis is difficult. The above requires us to duly attend the microbiological study of expectoration, brushing, biopsy or bronchoalveolar lavage samples, whether fresh or stained preparations, especially when observing multiflagellated forms, since if you do not have enough experience trophozoites of *Lophomonas blattarum* can be confused with ciliated epithelial cell fragments (ciliocytoforia) of

It is important to note that conventional techniques, such as staining of Gram, Giemsa and Papanicolaou smear, do not allow adequate visualization of multiflagellating. Therefore, it is necessary that upon suspicion, a fresh preparation with saline solution is first performed on all samples of the respiratory tract that arrive at the laboratory for parasitological diagnosis, and subsequently, perfectly extended

The cockroaches (**Figure 2**) originate as perfectly recognized pests of closed, dark places, which abound at the beginning of the hot climate and which become visible at night when leaving their natural habitat (sewers) to look for their food in the periphery and/or inside the houses [12]. As vectors were not considered capable of transmitting pathogenic organisms to humans, however, studies were conducted by Roth and Willis in 1957, and citing evidence occurred in a pediatric hospital in Brussels, Belgium, where an epidemic of *Salmonella typhimurium* persisted in newborns, despite the rapid isolation of patients, the absence of healthy carriers and the suppression of direct or indirect contact, except for the isolation of cockroaches. However, it was discovered that at night the cockroaches walked on the clothes, blankets and bodies of the babies, and the bacteria were isolated from the body of a considerable number of insects [13]. The epidemic ceased immediately after a severe control of the cockroaches. Rueger and Olson in 1969 showed that the feces

smears are stained with special dyes such as Masson's trichrome [5].

excretions or trap foreign materials [1] (**Figure 1**).

The most clinically important species are *Lophomonas blattarum* and *Lophomonas striata*. The latter was the species first identified in the intestine of the cockroach *Blatta orientalis* by S. Stein in 1860 [6]. The structure of *L. blattarum* was identified in the optical microscope in 1911 and in 1990 with a scanning and electron microscope. The shape of the Lophomonas trophozoite is usually round, oval or pyriform, ranging in size from 15 to 50 μm in diameter, with a plume of flagella that form a bunch located at the anterior end, the largest being those found far away from the apical fissure. It contains phagocytic vacuoles in its cytoplasm, with outward rhythmic movements directed to the apical end in order to eliminate

**256**

*In the 1860s, S. Stein discovered some multiflagellates in the cockroach's intestine. Drawings of the structures identified as* Lophomonas blattarum *and* Lophomonas striata *are shown [7].*

#### **Figure 2.** *Home cockroach. Photo Villagrán-Herrera.*

of *Periplaneta americana* infected with *Salmonella oranienburg*, being spread over food and vessels, still contained live bacteria after 3.25–4.25 years [14]. These same authors provided a list of 18 species of domestic cockroaches; from which, it was possible to isolate the pathogenic organisms for man, due to its allergenic exposure or toxicity due to its bite [14] (**Figure 2**).

Let us consider Cornwell's paraphrase in 1968, which stated the following:

(1) Cockroaches prefer environments where both human pathogens and human food are found, freely passing from one to the other; (2) cockroaches can carry pathogens both inside and outside their bodies, which remain viable on the cuticle in the digestive tract and feces to the extent that insects can be chronic carriers and (3) the evidence is sufficient to justify the various programs of control for this insects where human health is endangered [15].

They are usually confined to buildings in cold climates, but domestic cockroaches can escape freely, and in temperate, tropical or hot weather, they can migrate to other buildings through drains, garbage dumps, septic tanks and latrines where they feed, both on human feces and on food. Isolates of intestinal diners from trapped cockroaches indicate that they are carriers of microorganisms (viruses, fungi and intestinal parasites). Among the viruses, there are 4 strains of poliovirus; and approximately 40 species of pathogenic bacteria (enterobacteria), the mycobacterium of leprosy, two pathogenic fungi (Aspergillus), and the protozoan *Entamoeba histolytica* are also mentioned. On the other hand, other pathogens that are harbored by these arthropods are mentioned under experimental conditions,

such as Coxsackie virus, mouse encephalitis and yellow fever; the bacterial agents of cholera, cerebrospinal fever, pneumonia, diphtheria, undulant fever, anthrax, tetanus, tuberculosis and others; and the protozoa *Pentatrichomonas hominis*, *Giardia intestinalis* and *Balantidium coli,* agents that produce diarrhea or dysentery [13].

A protozoan that is considered important is the sporozoan *Toxoplasma gondii,* which causes human toxoplasmosis and spreads in many mammals besides birds. This disease is common in humans, although asymptomatic, but it can cause congenital defects in the fetus. It has recently been shown that the biological cycle of this coccidium is limited to domestic cats and other felines [16]. Cats can become infected by feeding on parasitized birds and rodents and subsequently transmit the parasite in their feces and a cockroach that feeds on these debris can transmit the parasite to man. Chinchilla and Ruiz in 1976 demonstrated in Costa Rica the potential transmission of *Toxoplasma gondii* by domiciliary cockroaches to humans [17] (**Figure 3**).

These species of cockroaches in urban areas have been seen mainly in nurseries, schools or hospitals, where a certain number of their population had presented lung problems of various types, and these problems were not related to the presence of these insects. It was not until the year 2015 that Dalmiro Cazorla-Perfetti found in dissected intestines of some captured insects, in addition to eggs of geohelminths, trypanosomatids, cysts and trophozoites of a multiflagellated protozoan called *Lophomonas blattarum* [18] (**Figure 4**).

On the other hand, in the city of Wuhan, in an intestinal study of 110 specimens of *Periplaneta americana* (pipe cockroach), they showed in preparations stained with Giemsa and seen at 1000 magnifications, oval, pearly shapes, from 20 to 40 μm, with a tuft of flagella extended down the central axis of the parasite and one of its trumpet-shaped ends enveloped the only nucleus shown. It also showed a thin terminal axostyle posterior to the multiflagellated part. Based on the above morphological characteristics, the parasite was identified as *L. blattarum*. Of the 110 cockroaches, 44 tested positive for *Lophomonas blattarum* (44%) [18] (**Figure 5**).

#### **Figure 3.**

*Biological cycle of* Toxoplasma gondii. *You can see the cockroach enclosed in a red circle, like a transporter or possible reservoir of coccidium [16].*

**259**

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

*Cytoplasmic and multifoflous trophozoite forms of* Lophomonas blattarum *are observed 400× [19].*

The different ways in which arthropods are related to the health and well-being

*Structures found in the intestinal dissections of pipe cockroaches in the city of Wuhan. Staining [18].*

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

**Figure 4.**

**Figure 5.**

**2. Medical importance of arthropods**

a. Disturbances and blood loss

a.Poisoning

○ Dermatosis

○ Accidental damage to sense organs

a.Myiasis and associated infestations

b.Allergies and associated conditions

• Arthropods as vectors or as intermediate hosts

• Arthropods as direct agents of diseases or discomfort

○ Entomophobia. Including illusory parasitosis

of man are classified into three groups:

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

#### **Figure 4.**

*Parasitology and Microbiology Research*

to humans [17] (**Figure 3**).

[18] (**Figure 5**).

*Lophomonas blattarum* [18] (**Figure 4**).

such as Coxsackie virus, mouse encephalitis and yellow fever; the bacterial agents of cholera, cerebrospinal fever, pneumonia, diphtheria, undulant fever, anthrax, tetanus, tuberculosis and others; and the protozoa *Pentatrichomonas hominis*, *Giardia intestinalis* and *Balantidium coli,* agents that produce diarrhea or dysentery [13]. A protozoan that is considered important is the sporozoan *Toxoplasma gondii,* which causes human toxoplasmosis and spreads in many mammals besides birds. This disease is common in humans, although asymptomatic, but it can cause congenital defects in the fetus. It has recently been shown that the biological cycle of this coccidium is limited to domestic cats and other felines [16]. Cats can become infected by feeding on parasitized birds and rodents and subsequently transmit the parasite in their feces and a cockroach that feeds on these debris can transmit the parasite to man. Chinchilla and Ruiz in 1976 demonstrated in Costa Rica the potential transmission of *Toxoplasma gondii* by domiciliary cockroaches

These species of cockroaches in urban areas have been seen mainly in nurseries, schools or hospitals, where a certain number of their population had presented lung problems of various types, and these problems were not related to the presence of these insects. It was not until the year 2015 that Dalmiro Cazorla-Perfetti found in dissected intestines of some captured insects, in addition to eggs of geohelminths, trypanosomatids, cysts and trophozoites of a multiflagellated protozoan called

On the other hand, in the city of Wuhan, in an intestinal study of 110 specimens of *Periplaneta americana* (pipe cockroach), they showed in preparations stained with Giemsa and seen at 1000 magnifications, oval, pearly shapes, from 20 to 40 μm, with a tuft of flagella extended down the central axis of the parasite and one of its trumpet-shaped ends enveloped the only nucleus shown. It also showed a thin terminal axostyle posterior to the multiflagellated part. Based on the above morphological characteristics, the parasite was identified as *L. blattarum*. Of the 110 cockroaches, 44 tested positive for *Lophomonas blattarum* (44%)

*Biological cycle of* Toxoplasma gondii. *You can see the cockroach enclosed in a red circle, like a transporter or* 

**258**

**Figure 3.**

*possible reservoir of coccidium [16].*

*Cytoplasmic and multifoflous trophozoite forms of* Lophomonas blattarum *are observed 400× [19].*

#### **Figure 5.**

*Structures found in the intestinal dissections of pipe cockroaches in the city of Wuhan. Staining [18].*
