Abstract
BackgroundIn patients with chronic respiratory disease, Pneumocystis jirovecii (P. jirovecii) colonization is observed, and may influence disease progression and systemic inflammation. Pneumocystis pneumonia causes interstitial changes, so making a diagnosis of PCP in patients who have interstitial pneumonia (IP) with P. jirovecii colonization is sometimes difficult based on radiography.MethodsThis study investigated the prevalence of P. jirovecii colonization in IP patients and assessed pulmonary injury due to P. jirovecii 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 Pneumocystis pneumonia (n = 7) were enrolled in this prospective study. P. jirovecii DNA was detected in sputum samples, while serum markers and the lymphocyte count were measured in the peripheral blood.ResultsIP patients (idiopathic pulmonary fibrosis and collagen vascular-related IP) who received oral corticosteroids had a high prevalence of P. jirovecii colonization (23.3%). In IP patients, oral corticosteroid therapy was a significant risk factor for P. jirovecii colonization (P < 0.05). Serum markers did not show differences between IP patients with and without P. jirovecii colonization. The β-D-glucan level and lymphocyte count differed between patients with Pneumocystis pneumonia or P. jirovecii colonization.ConclusionSerum levels of KL-6, SP-A, SP-D, and β-D-glucan were not useful for detecting P. jirovecii colonization in IP patients. However, the serum β-D-glucan level and lymphocyte count were useful for distinguishing P. jirovecii colonization from pneumocystis pneumonia in IP patients.
Highlights
MethodsThis study investigated the prevalence of P. jirovecii colonization in interstitial pneumonia (IP) patients and assessed pulmonary injury due to P. jirovecii colonization by measurement of serum markers (KL-6, surfactant protein A (SP-A), surfactant protein D (SP-D), and (1→3) β-D-glucan (β-D-glucan)) and the peripheral lymphocyte counts, prospectively
In patients with chronic respiratory disease, Pneumocystis jirovecii (P. jirovecii) colonization is observed, and may influence disease progression and systemic inflammation
After acute exacerbation of interstitial pneumonia (IP) occurs in IP patient with P. jirovecii colonization, it is difficult to distinguish IP associated with Pneumocystis pneumonia (PCP) from IP without PCP based on the clinical and radiological features
Summary
This study investigated the prevalence of P. jirovecii colonization in IP patients and assessed pulmonary injury due to P. jirovecii 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. P. jirovecii DNA was detected in sputum samples, while serum markers and the lymphocyte count were measured in the peripheral blood. The IPF group (n = 29, men/women = 18/11, age = 64.7 ± 10.2 years) included 22 patients with usual interstitial pneumonia (UIP) and 7 patients with non-specific interstitial pneumonia (NSIP). The PCP group (n = 7, men/women = 4/3, age = 61.6 ± 10.8 years) included 1 patient with ulcerative colitis, 3 with lung cancer, 1 with adrenal deficiency, 1 with human immunodeficiency virus, and 1 with polymyositis.
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