When a Ciliate Meets a Flagellate: A Rare Case of Colpoda spp. and Colpodella spp. Isolated from the Urine of a Human Patient. Case Report and Brief Review of Literature

SIMPLE SUMMARY: In the era of new emerging diseases, particularly seen in patients with impaired immunity, it is of outmost importance to recognize unusual etiologic agents and to provide solutions regarding their treatment and prophylaxis. Our paper presents the first recorded evidence of the parasites Colpoda spp. and Colpodella spp. isolated together from the urine of a human patient. Although the patient did not experience any urinary symptoms and we discovered the parasites purely incidental, their disappearance was noticed after a combined therapy with two antibiotic drugs. In order to better understand the involvement of these two parasites in human pathology, we performed a brief review of the existing medical literature. Isolation of these parasites was recorded in different areas of the globe; however, we encountered a discrepancy in the diagnostic techniques used to identify these parasites. In medical parasitology molecular techniques provide the most accurate diagnostic but optical microscopy diagnosis, based on morphologic description of the parasites is also a useful, accessible and affordable diagnostic tool and it should not be neglected in cases involving rare parasites, where molecular diagnosis is not wildly available. ABSTRACT: An often-overlooked side of the population aging process and the steady rise of non-communicable diseases reflects the emergence of novel infectious pathogens on the background of an altered host immune response. The aim of this article was to present the first record of a ciliate and flagellate protozoa recovered from the urine of an elderly patient and to review the existing medical literature involving these parasites. A 70-year-old female patient was admitted for breathing difficulties on the basis of an acute exacerbation of COPD (Chronic obstructive pulmonary disease) with respiratory insufficiency. The patient reported a long history of multiple comorbidities including COPD Gold II, chronic respiratory insufficiency, chronic heart failure NYHA III (New York Heart Association Functional Classification), type 2 diabetes and morbid obesity. During routine examinations, we ascertained the presence of two unusual protozoa, a ciliate and a flagellate, in the patient’s urine samples, identified on morphological criteria to be most likely Colpoda spp. and Colpodella spp., with similarities to C. steinii and C. gonderi. The presence of these parasites was not associated with any clinical signs of urinary disease. Following a combined treatment with ceftriaxone and metronidazole, we observed the disappearance of these pathogens upon discharge from the primary care clinic. This study highlights the importance of including unusual pathogens in the differential diagnosis of cases which involve immunosuppression.