Geospatial Analysis and Molecular Epidemiologic Study of Emerging Pulmonary Lophomoniasis in Iran: A National Registry-Based Study

INTRODUCTION: Bronchopulmonary lophomoniasis (BPL) is a protozoan pulmonary disease that has been reported sporadically, but its incidence has been increasing. However, the epidemiology and risk factors of the disease have not been clearly identified. The current study aims to identify BPL cases molecularly and assess the demographic and some environmental factors for the first time on the prevalence of BPL as a national registry-based study in Iran. Methodology. The study tested 960 patients with lower respiratory tract symptoms whose bronchoalveolar lavage samples were submitted from seven provinces of Iran to the Iranian National Registry Center for Lophomoniasis. They were tested for BPL by a newly developed polymerase chain reaction test. The study assessed the association of Normalized difference vegetation index (NDVI), digital elevation model (DEM), and geographic latitude as environmental factors and sex and age as demographic factors on the prevalence of BPL. Geospatial information systems methods and chi-squared and Pearson's correlation tests were used for the assessment of geographical and environmental factor effects and statistical analysis, respectively. RESULTS: Of the 960 patients, 218 (22.7%) tested positive for BPL; the highest and lowest prevalence rates were reported from the south and northeast of Iran, respectively. The study found a correlation between geographic latitude and age with BPL prevalence, but no association was found for gender, NDVI, or DEM. Most patients were over 40 years old, and the rate of disease was higher in southern latitudes. CONCLUSION: Age and geographical latitude were found to be risk factors for BPL. More exposure to dust and/or chronic pulmonary problems may explain the higher prevalence of the disease in older adults. Higher rates of BPL in lower latitudes may be due to warmer weather and longer days, which can confine individual activities indoors and result in more contact with domestic insects and infected dust.