Aberrant and accidental trichomonad flagellate infections: rare or underdiagnosed?

The clinical significance and frequency of human infections with trichomonad flagellates in aberrant locations (locations other than the predilection sites) and accidental infections (infections with non-human trichomonads) are unclear. The total number of case reports in the literature is low, with the identification of the infection largely the outcome of investigations for the cause of clinical signs. At least seven species have been identified in either aberrant or accidental infections, with these infections occurring worldwide. Results of prospective and retrospective surveys of adults with respiratory disease suggest that aberrant and accidental trichomonad infections are less rare than the number of case reports suggest, with Trichomonas tenax being the most frequent. Surveys of neonates and infants suggest that aberrant Trichomonas vaginalis infections can be higher and more serious than suggested by the few case reports. The density and location of infection might be as important, if not more so, than species in determining pathogenicity. Molecular diagnostic methods including DNA sequencing can be used to better diagnose infections and enable identification to assist in determining the clinical significance of different species. Raising awareness of these infections among clinicians and adding them to their differential lists are strongly suggested.