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Pleuropulmonary Parasitic Infections of Present JMID/ 2018; 8 (4):165-180 Journal of Microbiology and Infectious Diseases doi: 10.5799/jmid.493861 REVIEW ARTICLE Pleuropulmonary Parasitic Infections of Present Times-A Brief Review Isabella Princess1, Rohit Vadala2 1Department of Microbiology, Apollo Speciality Hospitals, Vanagaram, Chennai, India 2Department of Pulmonary and Critical Care Medicine, Primus Super Speciality Hospital, Chanakyapuri, New Delhi, India ABSTRACT Pleuropulmonary infections are not uncommon in tropical and subtropical countries. Its distribution and prevalence in developed nations has been curtailed by various successfully implemented preventive health measures and geographic conditions. In few low and middle income nations, pulmonary parasitic infections still remain a problem, although not rampant. With increase in immunocompromised patients in these regions, there has been an upsurge in parasites isolated and reported in the recent past. J Microbiol Infect Dis 2018; 8(4):165-180 Keywords: helminths, lungs, parasites, pneumonia, protozoans INTRODUCTION environment for each parasite associated with lung infections are detailed hereunder. Pulmonary infections are caused by bacteria, viruses, fungi and parasites [1]. Among these Most of these parasites are prevalent in tropical agents, parasites produce distinct lesions in the and subtropical countries which corresponds to lungs due to their peculiar life cycles and the distribution of vectors which help in pathogenicity in humans. The spectrum of completion of the parasite`s life cycle [6]. parasites causing pleuropulmonary infections There has been a decline in parasitic infections are divided into Protozoans and Helminths due to health programs, improved socio- (Cestodes, Trematodes, Nematodes) [2]. Clinical economic conditions. However, the latter part of diagnosis of these agents remains tricky as the last century has seen resurgence in parasitic parasites often masquerade various other infections due to HIV, organ transplantations clinical conditions in their presentation. The and increase in use of immunosuppressive commonest mimics of parasitic infections are agents [6]. Due to this reason, pulmonary tuberculosis and lung carcinoma [3,4]. physicians have developed a renewed interest in To help clinicians and students understand the recent times in understanding pulmonary spectrum of all these parasitic lung infections, parasitic infections. This has also intrigued an we discuss their epidemiology, clinical interest among research fanatics to invent newer presentation, laboratory diagnosis, radiological diagnostic tools in diagnosing these agents. diagnosis and management. This review intends Definitions [7]: to provide comprehensive knowledge about all parasites associated with pleuropulmonary Definitive host: Definitive hosts are the ones in infections, the early detection of which results in which the parasite matures or passes its sexual successful clinical outcomes. stage. They are otherwise termed as primary hosts. I. Epidemiology of pleuropulmonary parasitic infections Intermediate host: Intermediate or secondary hosts are those in which the parasite passes its Since parasites have a diverse mode of asexual state or is in a larval form. transmission, life cycle, host-parasite relationship, the distribution is varied. The Parasites which infect respiratory system of epidemiological triad of agent, host, and humans could be protozoans or helminths [8]. Correspondence: Dr. Isabella Princess, Department of Microbiology, Apollo Speciality Hospitals, Vanagaram, Chennai, India, E mail : [email protected] Received: 19 July 2018 Accepted: 01 October 2018 Copyright © JMID / Journal of Microbiology and Infectious Diseases 2018, All rights reserved 166 Princess I & Vadala R, Pleuropulmonary parasitic infections The protozoan pulmonary infections are: pulmonary ascariasis, pulmonary Pulmonary malaria, pulmonary amoebiasis, ancylostomiasis, pulmonary paragonimiasis, pulmonary leishmaniasis, pulmonary pulmonary schistosomiasis, pulmonary hydatid trypanosomiasis, pulmonary toxoplasmosis, and disease, pulmonary trichinellosis etc. [9]. The pulmonary babesiosis [9]. Helminthic pulmonary agents causing pleuropulmonary infections, host infections are: Tropical pulmonary eosinophila factors, prevalence (global and national), and caused by filarial parasites, pulmonary mode of transmission are detailed hereunder in dirofilariasis, pulmonary strongyloidiasis, tables 1-5. Table 1. List of parasitic agents causing pleuropulmonary infections [2,5]. PROTOZOANS HELMINTHS Amoeba : Cestodes : Entamoeba histolytica Echinococcus granulosus Hemoflagellates : Echinococcus multilocularis Leishmania donovani Echinococcus vogeli Trypanosoma cruzi Trematodes : Sporozoa : Paragonimus westermani Plasmodium falciparum Schistosoma haematobium Plasmodium knowlesi Schistosoma mansoni Babesia microti Intestinal nematodes : Coccidian parasites : Hookworm (Anycylostoma duodenale, Necator Toxoplasma gondii americanus) Cryptosporidium parvum Strongyloides stercoralis Miscellaneous Protozoa : Strongyloides fuelleborni Balantidium coli Ascaris lumbricoides Somatic nematodes : Wuchereria bancrofti Mansonella ozzardi Trichinella spiralis Larva migrans : Toxacara canis / Toxocara cati Capillaria aerophila Ascaris suum Mammomonogamus laryngeus Gnathostoma spinigerum Table 2. Host-parasite relationship of Protozoan parasites causing pulmonary infections [5]. Parasites (Agent) Host Route of transmission Entamoeba Ingestion of food/water contaminated with cyst, sexual contact, Man histolytica vector Vertebrate host: Man, dog, rodents; Insect Leishmania donovani Bite of infected sandfly, blood transfusion. vector: Sandfly Humans; Vector : reduvid bugs, kissing Contamination of abrasions with reduvid bug`s feces, blood Trypanosoma cruzi bugs, triatomine bugs transfusion Plasmodium Definitive host: Female Anopheles falciparum mosquito Bite of female Anopheles mosquito, blood transfusion. Plasmodium Accidental host: Man knowlesi Definitive host: Deer tick (Ixodes scapularis) Babesia microti Bite of ticks, blood transfusion Accidental host : Man Definitive host : Cats, felines Ingestion of sporulated oocyst from soil, food, water, ingestion Toxoplasma gondii Intermediate host : Man, other mammals of tissue cyst, blood transfusion. (sheep, goat, pig, cattle) Cryptosporidium Man, other animals Ingestion of contaminated food/water, autoinfection parvum Natural host: Pig Balantidium coli Ingestion of food/water contaminated with cysts Accidental host: Man J Microbiol Infect Dis www.jmidonline.org Vol 8, No 4, December 2018 167 Princess I & Vadala R, Pleuropulmonary parasitic infections Table 3. Host-parasite relationship of helminths causing pulmonary infections [5]. Parasites Host Route of transmission CESTODES Definitive host: Dogs, other canine Echinococcus animals granulosus Intermediate host: Sheep Accidental intermediate host: Man Definitive host: Foxes, wolves, dogs, Echinococcus cats Ingestion of food contaminated with eggs multilocularis Intermediate host: Small wild rodents Mechanical vectors for eggs: flies Accidental intermediate host: Man Definitive host: Wild felids like wild cats, Echinococcus vogeli jaguars, brush dogs Intermediate host: Rodents TREMATODES Schistosoma Definitive host: Man Penetration of skin by infective cercariae haematobium Intermediate host: Fresh water snails present in contaminated water Schistosoma mansoni Definitive host: Man, dogs, cats Paragonimus Eating uncooked, salted, pickled crab/cray First intermediate host: Snails Second westermani fish containing metacercariae intermediate host: Crab NEMATODES Penetration of skin by third stage (filariform) Hookworm Man larva Strongyloides stercoralis Penetration of skin by third stage (filariform) Man Strongyloides fuelleborni larva Ingestion of embryonated eggs from Ascaris lumbricoides Man contaminated soil, water, food Definitive host: Man Penetration of third stage filariform larvae Wuchereria bancrofti Intermediate host: Mosquito (Culex, deposited by mosquito bite rarely Aedes or Anopheles) Definitive host: Man Penetration of third stage filariform larvae Mansonella ozzardi Intermediate host: Culicoides deposited by insect bite Human are unusual hosts, lower Bite of mosquito containing L3 filariform Dirofilaria immitis animals larvae Optimum host: Pig, Accidental host: Ingestion of raw or uncooked pork or meat Trichinella spiralis Man containing L1 larvae LARVA MIGRANS Felines are natural host, humans act as Toxocara species Ingestion of embryonated eggs in soil abnormal host Capillaria aerophila Carnivores. Human infection is rare Embryonated eggs Ascaris suum Pigs. Human infection is rare Ingestion of egg with an L2 larva Mammomonogamus Cattle. Human infection is rare Ingestion of larva or egg containing larva laryngeus Definitive host: Cats, dogs Gnathostoma Accidental definitive host: Man Ingestion of fish containing L3 larva (or rarely spinigerum Intermediate host: 1st - crustaceans, 2nd Cyclops containing L3 larva) - fresh water fish J Microbiol Infect Dis www.jmidonline.org Vol 8, No 4, December 2018 168 Princess I & Vadala R, Pleuropulmonary parasitic infections Table 4. Global and national distribution of protozoan parasites causing pulmonary infections [5,10-12]. Parasites Global distribution Prevalence in Indian states Entamoeba China, Central and South America, Indian Maharashtra, Tamil Nadu, Chandigarh histolytica subcontinents Leishmania Bangladesh, India, Sudan, Ethiopia, Brazil Bihar, Jharkhand, West
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