Martínez-Giron R, Doganci L, Ribas-Barceló A.
Trichomes in respiratory samples. Diagn Cytopathol 2008; 36: 882-3.

Presence of trichomes (plant hairs) in samples of respiratory apparatus is showed in this work. It is highlighted the differential diagnosis with certain micro-organisms.

Martínez-Girón R, Esteban JG, Ribas A, Doganci L.
Protozoa in respiratory pathology: a review. Eur Respir J. 2008 Nov; 32: 1354-70.

Interesting monographic work where the mainly articles in the medical literature about protozoal pulmonary pathology have been compiled.

ABSTRACT
Among the micro-organisms that may affect the respiratory apparatus are the protozoa. The diseases they may give rise to constitute a relatively uncommon group of respiratory ailments with, in the majority of cases, an underlying clinical situation corresponding to states of suppressed immunity (AIDS, transplants, malign haemopathies, corticotherapy, etc.). Other factors, such as visits to endemic areas and immigration, also have to be taken into account. In view of the probable increase in the number of cases and the appearance of new emerging diseases, it is the intention of the present work to review the publications available, in different fields of medicine, that refer to the principal kinds of protozoa (Entamoeba, Acanthamoeba, Balamuthia, Leishmania, Trypanosoma, Trichomonas, Lophomonas, Cryptosporidium, Cyclospora, Toxoplasma, Plasmodium, Babesia, Encephalitozoon, Enterocytozoon and Balantidium) and, at the same time, detail and comment on the latest findings on this subject.

Martínez-Giron R, Doganci L, Ribas A.
From the 19th century to the 21st, an old dilemma: ciliocytophthoria, multiflagellated protozoa, or both? Diagn Cytopathol 2008; 36: 609-11.

In this letter to the editor, a reflection on a debated dilemma in respiratory cytopatology is made. On the basis of the last publications appeared in the scientific literature and their last findings in the microscopic observation of samples from respiratory apparatus, the authors propose the existence of multiflagellated protozoa, during a lot of time unnoticed, into airways.

Martínez-Girón R, van Woerden H, Ribas-Barceló A.
Could inhaled mite faeces introduce pathogens to the lungs? Microbes Infect 2008; 10: 452-3.

In this letter to the Editor, the authors describe which may be the way of entrance to the airways of dust mites’ multiflagellated protozoa, trough the inhalation of mite faeces.

Martínez-Girón R, Ribas A, Astudillo-González A.
Flagellated protozoa in cockroaches and sputum: the unhygienic connection? Allergy Asthma Proc 2007; 28: 608-9.

In this letter to the editor, the similarity between the morphological features of a multiflagellated protozoon (Lophomonas blattarum) found in the intestinal extracts of a cockroach (Blatella germanica) and the sputum of asthmatic patient is shown. Moreover, the pathogen effect of such protozoa in the respiratory epithelium is postulated.

Rafael Martínez-Girón, Andrés Ribas-Barceló, Aurora Astudillo-González, David Calvo-Temprano.
Histologic Findings and Comparison with Sputum Smears in Pulmonary Aspiration of Vegetable Particles in Syringomyelia: A Case Report. Acta Cytol 2007; 51:921–924.

In this work, presence of vegetable matters in pulmonary parenchyma, in a case of aspiration pneumonia, are compared with those observed in cytological sputum smears.

ABSTRACT
Background: Pulmonary aspiration of vegetable matter may be a serious cause of lung damage, requiring, almost always, the help of a histopathology examination. We report the case of a 55-year-old woman with a granulomatous pneumonitis due to repeated pulmonary aspiration of vegetable particles and affected by a syringomyelia. Histological findings from a lobectomy section are shown and compared with those observed in different cytological sputum samples. Conclusion: The recognition of uncommon morphologic structures, and their comparison with others already known, both in histological sections and in cellular smears, may be useful when it comes to establishing a sure diagnosis.

Ribas A, Martínez-Girón R, Ponte-Mittelbrum C, Alonso-Cuervo R, Iglesias-Llaca F.
Immunosupression, flagellated protozoa in the human airways and metronidazole: observations on the state of the art. Transpl Int 2007; 20: 811-2.

In this letter to the editor a case corresponding to a HIV (+) patient who present a severe respiratory failure with a good response to the therapy with metronidazole, because the presence of flagellated protozoa in bronchial aspirates is described.

Martínez-Girón R, van Woerden HC, Ribas-Barceló A.
Experimental method for isolating and identifying dust mites from sputum in pulmonary acariasis. Exp Appl Acarol 2007; 42: 55-59

In this work, a method for detecting and identifying house dust mites from expectoration samples is described. Through sputum liquefaction with bleach, liquid resulting was observed under the microscope.

ABSTRACT
The aim of this study was to pilot a simpler and more effective method for identifying dust mites in sputum. Dust mites and their allergens have been implicated in respiratory diseases, including pulmonary acariasis, and several studies have identified mites in sputum. Further research is dependent on the development of a faster and simpler diagnostic test. We have demonstrated that dust mites artificially introduced into sputa, could be identified after the sputa were liquefied with bleach, when the liquid sample was observed under the microscope. Liquefaction times for serous, mucous, purulent and hemoptoic sputa varied from 10 to 30 min (mean 17.5). The test had a sensitivity of 80% (95% CI 68.2-88.2%) as 46/60 mites were identified. This procedure can be performed quickly at room temperature, is simple, inexpensive, repeatable, and less labourious than previous methods.

Martínez-Girón R, Ribas-Barceló A.
Erythrocytes as funguslike artifacts in pulmonary cytology. Acta Cytol 2007; 51: 247-8.

In this letter to the editor, an artefact observed in erythrocytes, corresponding to cytological samples of the respiratory apparatus, is described. This finding could be mistaken with certain pathogen fungal species such as Cryptococcus neoformans and Pneumocystis jiroveci.

Martínez-Girón R, Ribas-Barceló A.
Pitfall in sputum cytology: Protoctista resembling adenocarcinoma cells. Diagn Cytopathol 2007; 35: 32-33.

In this work the authors show the presence in a cytological sputum smear of a peculiar contaminant catalogued as a microalga belonging to the Chlorophyta class. It is emphasised that, due to its morphological characteristics, this structure may be confused with a group of cancerous cells.

Martínez-Girón R, Ribas A. Asthma, cockroaches and protozoal forms: chance or not chance?
Ann Allergy Asthma Immunol 2006; 97: 818-9.

In this Letter to the Editor, the authors describe the existence of peculiar protozoal forms in cockroach intestinal extracts, very similar in morphology to the ones observed in the house dust mites. Besides, is postulated the mechanism for which these protozoal forms may to act as pathogens of respiratory epithelia through the "Protease-Activated Receptors" (PARs).

Ribas A, Martínez-Girón R.
Protozoal forms in house dust mites and respiratory allergy. Allergy Asthma Proc 2006; 27: 347-49.

An article without precedent, in which the authors demonstrate for the first time the presence of particular protozoal forms in the intestinal content of dust mites, mentioning the possibility that these protozoal forms may be implicated in the cause of respiratory allergies (allergic rhinitis and bronchial asthma).

ABSTRACT
Background: Presence of mites in sputum smears has been described with possible implications through direct action of dust mites inside the lungs and of the possibility of them being a causal factor in asthma. Objective: Due to the impact and frequency of allergic respiratory diseases associated with exposure to dust mites, we examine extracts of the intestinal content of dust mites in order to find a special factor to link the allergic respiratory diseases and the dust mites. Methods: Were examined 600 slides of house hold dust with an average of 5 (3-8) mites being observed on each, some 3000 in all. Results: Among the remains of intestinal contents of the mites, the presence was observed of various protozoal forms with filiform projections. These forms were very similar in morphology to those previously observed by us, under the same conditions of phase contrast, in the sputa of asthmatic patients and the nasal extrusions of patients with allergic rhinosinusitis. Conclusions: The discovery of these protozoal forms may be the nexus necessary to connect these diseases with the arthropods mentioned.

Martínez-Girón R, González-López JR, Esteban JG, García-Miralles MT, Álvarez-de-los-Heros C, Ribas-Barceló A.
Worm-like artifacts in exfoliative cytology. Diagn Cytopathol 2006; 34: 636-39.

Article with a selected iconography showing diverse structures cataloghed as artifacts and contaminants from cytological smears, and such as could be confused with true worms.

ABSTRACT
The presence of worms in cytological smears is occasionally reported, although various other structures exist that may be confused which such parasites. We present eight worm-like artifacts observed in routine Papanicolaou smears. Recognition of these structures is important to avoid overvaluation or confusion with true worms.

Martínez-Girón R, Ribas-Barceló A.
An unusual protozoon as a contaminant in a sputum smear. Acta Cytol 2006; 50: 354.

In this letter to the editor, the authors describe the presence of a particular type of ameba (tecameba) in a cytological smear from a sputum sample. Besides the morphological description, speculation is made as to its source.

Martínez-Girón R, Jodra-Fernández O, Tormo-Molina R, Esteban JG, Ribas-Barceló A.
Uncommon structures simulating helminth eggs in sputum. Acta Cytol 2005; 49: 578-80.

In this letter to the editor, the authors pay special attention to the differential diagnosis between various contaminating structures observed in the cytological smears of sputum samples, and certain helminth eggs.

Martínez-Girón R, González-López JR, Escobar-Stein J, Jou-Muñoz C, García-Miralles MT, Ribas-Barceló A.
Freshwater Microorganisms and Other Arthropods in Papanicolaou Smears. Diagn Cytopathol 2005; 32: 222-225.

Article based on the presence of unusual contaminants in cytological samples and smears, showing, fundamentally, various types of arthropods.

ABSTRACT
Several types of contaminants have been reported in cytopathology. The purpose of this study was to show unusual contaminants in cytological smears, such as freshwater microorganisms and other arthropods. In different routine Papanicolaou smears (sputum, cervicovaginal, and voided urine) we mainly found fragments of mites and insects, caused by an intrinsic contamination of the samples or an extrinsic contamination of the smears.

Ribas A, Martínez-Girón R, Sánchez-del-Río J, González-Alonso D.
Protozoal Forms in the Sputum of Immunocompromized Patients. Scand J Infect Dis 2005; 37: 205-210.

On the basis of the high incidence of protozoal diseases among immunodepressed patients, and an increase in the number of cases of asthma in patients with AIDS the authors demonstrate the presence of protozoa forms different from those known at present in the sputa of immunodepressed patients, especially those with AIDS.

ABSTRACT
The aim of this study is to determine whether, in situations of marked immunological deficit, principally among patients with AIDS, there is a greater frequency of protozoal forms. Comparative study was of 2 groups of patients, 1 an immunocompromized group, main HIV+, and the other a non-immunocompromized group with different respiratory disorders (control group). A cytological study was carried out using 295 sputum smears, obtained between 1994 and 2003, from patients at the Central University Hospital of Asturias, Spain. Smears were valid for 106 patients, 83 of whom presented HIV infection. Protozoa were detected in 72 of this group. Our findings indicate a greater number of protozoal forms in the sputa of patients with AIDS than among the other 2 groups analysed (patients without AIDS and control group).

Martínez-Girón R, Ribas-Barceló A, García-Miralles MT, López-Cabanilles D, Tamargo-Peláez ML, Torre-Bayón, Fernández-Álvarez L.
Airborne Fungal Spores, Pollen Grains, and Vegetable Cells in Routine Papanicolaou Smears. Diagn Cytopathol 2004; 30: 381-385.

By means of an abundant iconography the authors show various contaminants of vegetable origin and spores of anemophilous fungi that have been encountered in cytological smears.

ABSTRACT
The objective was to demonstrate the presence of airborne fungal spores, pollen grains, and vegetable cells in smears and establish their significance. Microscopic examination was of smears stained by the Papanicolaou technique. We found several types of airborne spores (Alternaria, Exserohilum, Aspergillus, Cladosporium, Epicoccum, Curvularia and Ascosmycete), pollen grains (Lilium, bullrush, Pinus, Acacia, hazelnut, and oak), and several types of vegetable cells. The existence of these structures may be due to intrinsic or to extrinsic contamination of the sample. Anemophilous fungi spores and pollen grains have been shown to possess great allergenic capacity. Pollen grains and vegetable cells may be mistaken for certain microorganisms or malignant cells.

Martínez Girón R, Jou Muñoz C, Escobar Stein J, García Miralles T, Ribas Barceló A.
Contaminantes poco habituales en extendidos de esputos (Unusual contaminants in sputum smears). Rev Esp Patol 2003; 36: 301-306.

In this paper several types of structures are described in cytological sputum smears that have been considered a contaminant of the samples themselves or of the cytological smears during the staining procedure. In the case of microalgae, their presence in tap water is evaluated.

SUMMARY
Approach: To describe a series of contaminants through microscopic observation of a cytological sputum smears. Material and methods: Sputum smears stained using the Papanicolaou technique. Results: We have observed, in 15000 samples from patients admitted with various respiratory pathologies during the last 10 years, the presence of different types of microalgae, vegetal cells, grains of pollen, and various crystals. Conclusions: The existence of contaminants in sputum smears is a relatively frequent occurrence of certain biological significance, it being necessary on occasions to establish a differential diagnosis, given their similarity with other structures such as fungi and various protozoa.

Ribas A, Jou C, Escobar J.
Ciliocythophthoria and ameboflagellates. Acta Cytol 2003; 47: 705-8.

In this letter the author insists on the importance of distinguishing morphologically the degenerative phenomena in ciliate cells of ameboflagellate protozoal forms.

Martínez-Girón R, Ribas-Barceló A, García-Miralles MT, López-Cabanilles D, Tamargo-Peláez ML, Torre-Bayón, Fernández-Álvarez L.
Diatoms and Rotifers in Cytological Smears. Cytopathology 2003; 14: 70-72.

The authors describe the presence in cytological smears of a special type of microscopic worms (rotifers) and of a certain class of algae (diatoms). Emphasis is placed on contamination of the water by tap water, and the healthiness of the same.

ABSTRACT
We describe several uncommon contaminants presumably derived from the tap water used in the staining procedure of cytological specimens. We would like to draw attention to the occasional presence of diatoms and fragments of rotifers in cytological specimens. Whilst most of these entities are harmless curiosities, they may cause concern as to their nature and significance.

Martínez-Girón R, Ribas-Barceló A.
Algae in Cytologic Smears. Acta Cytol 2001; 45: 936-940.

The presence is described for the first time of various classes of microalgae in various types of cytologic smears. The authors insist on the fact that the observation of algae in the microscope preparations is due to contamination of the samples by tap water containing such organisms.

ABSTRACT
Objective: To desmonstrate the presence of algae in smears and establish their significance. Study Design: Microscopic examination of smears stained by the Papanicolaou technique. Results: We found 12 different species of algae, clustered in three categories: Cyanophita (blue algae), Chrysophyta (yellow algae) and Chlorophyta (green algae). Conclusion: Algae in smears are infrequently observed, with few bibliographic references. Their presence is due to intrinsic or extrinsic contamination. They may be confused with other structures, such as fungi, Charcott crystals or adenocarcinoma cells.

Ribas A, Mosquera JA.
¿Es el asma bronquial una enfermedad infecciosa? (Is bronchial asthma an infectious disease?) Arch Bronconeumol 1999; 35: 308-11.

In this work (editorial) the authors formulate the parasitary hypothesis on the origin of asthma, mentioning at least three forms of the parasite (Vetusta Jacobi): ameboid, flagellate and cystic. Emphasis is also placed on the task of isolating, cultivating and reproducing the disease in experimental animals.

Ribas A, Mosquera JA.
Ameboflagellates in bronchial asthma. Acta Cytol 1998; 42: 685-90.

This article describes for the first time the existence of certain structures, described by the authors as ameboflagellated protozoa, in the sputa of asthma patients. The same study details a series of morphological characteristics that differentiate protozoa forms from the cytoplasm remains of ciliate bronchial cells.

ABSTRACT
Objective: To distinguish between the existence of detached ciliary tufts (DCTs) and the possibility of protozoa in the sputum of asthma patients. Study Design: One hundred six samples of sputum obtained from 97 patients hospitalized with either asthma or other respiratory diseases were examined blindly. The combination of such criteria as movement, absence of basal plate, existence of red granules, positivity for ultraviolet light and Heidenhain#s iron hematoxylin stain (for protozoa) was employed to distinguish between DCTs and true protozoa. Results: The presence of ameboflagellates in sputum has a diagnostic accuracy of 86% in predicting or ruling out the possibility of acute asthma. Conclusion: The presence of ameboflagellate forms is closely related to the existence of bronchial asthma, and these results reflect some etiopathogenic significance in asthma.