title: Inflammatory markers and pulmonary granuloma infiltration in sarcoidosis.
abstract: OBJECTIVE
  Previous studies have demonstrated increases of inflammatory mediators in sarcoidosis while epidemiological studies have also demonstrated an association with increased fungi exposure. This study measured the level of β-glucan in the lungs and of inflammatory mediators in serum, and correlated both with the extent of pulmonary granuloma infiltration.
  
  
  METHODS
  This is a cross-sectional study of 98 patients with sarcoidosis and 26 controls. β-glucan, a cell wall constituent of fungi, was measured in bronchoalveolar lavage. Inflammatory mediator levels were determined in serum. The extent of granuloma infiltration was estimated on the chest X-ray. Exposure to fungi at home was determined by taking air samples in bedrooms and analysing for the presence of β-N-acetylhexosaminidase.
  
  
  RESULTS
  Significantly, higher levels of β-glucan were found in broncho-alveolar lavage in subjects with sarcoidosis as compared with controls. There were significant positive relationships between the extent of granuloma infiltration and the levels of the different inflammatory mediators, except for interleukin-10. Domestic fungal exposure was higher among subjects with sarcoidosis.
  
  
  CONCLUSIONS
  This is the first time that a specific agent, previously suspected to be related to the risk of sarcoidosis, has been detected in the lung of subjects with sarcoidosis and related to the levels of inflammatory mediators and the degree of home exposure to fungi. The results suggest that exposure to fungi should be explored when investigating patients with sarcoidosis.
authors.affiliation: Clinic of Pulmonary Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Marjeta
authors.initials: M
authors.lastname: Terčelj
authors.affiliation: Clinic of Pulmonary Diseases and Allergy, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Salobir
authors.affiliation: Laboratory Department, Children's Hospital, University Medical Center, Ljubljana, Slovenia.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Zupancic
authors.affiliation: Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Branka
authors.initials: B
authors.lastname: Wraber
authors.affiliation: BioFact Environmental Health Research Center, Lerum, Sweden.
authors.forename: Ragnar
authors.initials: R
authors.lastname: Rylander
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000378:metabolism*; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry*; D003430:Cross-Sectional Studies; D005260:Female; D006099:Granuloma / Q000378:metabolism*; D006801:Humans; D007249:Inflammation / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017565:Sarcoidosis, Pulmonary / Q000378:metabolism*
chemical_list: D015415:Biomarkers
keywords: fungi; inflammation; sarcoidosis; β-N-acetylhexosaminidase; β-glucan