Serum markers in interstitial pneumonia with and without Pneumocystis jirovecii colonization: a prospective study

<p>Abstract</p> <p>Background</p> <p>In patients with chronic respiratory disease, <it>Pneumocystis jirovecii (P. jirovecii) </it>colonization is observed, and may influence disease progression and systemic inflammation. <it>Pneumocystis </it>pneumonia causes interstitial changes, so making a diagnosis of PCP in patients who have interstitial pneumonia (IP) with <it>P. jirovecii </it>colonization is sometimes difficult based on radiography.</p> <p>Methods</p> <p>This study investigated the prevalence of <it>P. jirovecii </it>colonization in IP patients and assessed pulmonary injury due to <it>P. jirovecii </it>colonization by measurement of serum markers (KL-6, SP-A, SP-D, and (1→3) β-D-glucan (β-D-glucan)) and the peripheral lymphocyte counts, prospectively. A total of 75 patients with idiopathic pulmonary fibrosis (n = 29), collagen vascular-related interstitial pneumonia (n = 19), chronic bronchitis or pneumonia (n = 20), and <it>Pneumocystis </it>pneumonia (n = 7) were enrolled in this prospective study. <it>P. jirovecii </it>DNA was detected in sputum samples, while serum markers and the lymphocyte count were measured in the peripheral blood.</p> <p>Results</p> <p>IP patients (idiopathic pulmonary fibrosis and collagen vascular-related IP) who received oral corticosteroids had a high prevalence of <it>P. jirovecii </it>colonization (23.3%). In IP patients, oral corticosteroid therapy was a significant risk factor for <it>P. jirovecii </it>colonization (<it>P </it>< 0.05). Serum markers did not show differences between IP patients with and without <it>P. jirovecii </it>colonization. The β-D-glucan level and lymphocyte count differed between patients with <it>Pneumocystis </it>pneumonia or <it>P. jirovecii </it>colonization.</p> <p>Conclusion</p> <p>Serum levels of KL-6, SP-A, SP-D, and β-D-glucan were not useful for detecting <it>P. jirovecii </it>colonization in IP patients. However, the serum β-D-glucan level and lymphocyte count were useful for distinguishing <it>P. jirovecii </it>colonization from <it>pneumocystis </it>pneumonia in IP patients.</p

Long-term changes in lowland calcareous grassland plots using Tephroseris integrifolia subsp. integrifolia as an indicator species

We investigated the changes to calcareous grassland plots within protected sites, and whether Tephroseris integrifolia subsp. integrifolia can act as a useful indicator species for re-visitation studies within vegetation predicted to remain relatively stable. Twenty-two plots located across lowland England and all formerly containing T. integrifolia were re-surveyed following the methodology used in the original survey undertaken in the 1960s. Pseudo-turnover and between-observer bias were minimised by sampling replicate quadrats at each fixed plot using a single surveyor and at a similar time of year as the original survey. Qualitative details concerning grazing management were obtained for all sites. In contrast to other long-term re-visitation studies, all our study plots were intact and retained diverse, herb-rich vegetation, demonstrating the value of site protection. However, there were clear shifts in vegetation composition, most notably where T. integrifolia was absent, as shown by an increase in Ellenberg fertility and moisture signifying nutrient enrichment, and a decrease in the cover of low-growing, light-demanding specialists, with a change likely to be associated predominantly with grazing management. Whereas in the mid-20th century the greatest threat to calcareous grassland was habitat loss, undergrazing or temporary neglect now appears to pose the principal threat. Distinctive species such as T. integrifolia with marked sensitivity to habitat change provide a potentially useful tool for rapid assessment and monitoring of site quality. Focusing monitoring on such species allows non-expert observers to recognise the early stages of habitat degradation, providing, in effect, a “health check” on individual sites and groups of sites