Co-infection of lophomonas blattarum and mycobacterium tuberculosis: Insights from a study in northeastern Iran.

BACKGROUND

Pulmonary tuberculosis (TB) continues to pose a significant global health challenge, especially in low- and middle-income countries. The immune suppression caused by TB increases susceptibility to secondary infections such as Lophomonas blattarum, a rare protozoan that infects the respiratory tract. Co-infection with Lophomonas can complicate TB treatment due to overlapping symptoms, leading to misdiagnosis or delayed care. This study aims to assess the prevalence and clinical impact of L. blattarum co-infection in TB patients and evaluate the need for routine screening in regions with high TB prevalence.

METHODS

This cross-sectional study was conducted in a tertiary care hospital in Mashhad, Iran. Bronchoalveolar lavage (BAL) samples were obtained from 214 patients with respiratory symptoms. TB diagnosis was based on Ziehl-Neelsen staining, culture as the gold standard, and polymerase chain reaction (PCR) targeting the IS6110 and 16S rRNA genes. L. blattarum detection was initially performed through direct light microscopy, and PCR was subsequently attempted using species-specific primers targeting the 18S rRNA gene. Data were analyzed using SPSS version 22, with p-values < 0.05 considered statistically significant.

RESULTS

Of the TB-positive patients, 55.7 % were co-infected with Lophomonas, compared to 29.9 % in the TB-negative group, demonstrating a significant association between TB and Lophomonas infection (p < 0.001). The highest prevalence of Lophomonas infection was observed in patients over 60 years old. Despite molecular attempts to identify Lophomonas using PCR, the results were inconclusive, and microscopy served as the primary diagnostic tool.

CONCLUSION

The high rate of Lophomonas co-infection in TB patients underscores the need for routine screening, particularly in regions with high TB prevalence. Early detection of co-infections can improve patient outcomes and prevent complications from misdiagnosis or delayed treatment.