Collective Outbreak of Severe Acute Histoplasmosis in Immunocompetent Chinese: The Clinical characteristics and Continuous Monitoring of Serum Cytokines/Chemokines

Abstract Background: Acute histoplasmosis is a rare fungal disease and is likely to be misdiagnosed in clinic. In this paper we attempted to find some easy potential specific diagnostic and disease severity predictors of acute histoplasmosis, on the basis of so far the biggest collective outbreak of severe acute histoplasmosis by inhaled fungi in Chinese. Methods: 10 immunocompetent Chinese were infected when they were working in Guyana, South America. Their clinic characteristics, as well as their blood samples were collected for analysis, and then Person rank correlation was employed to check the associations between the indicators and their clinic conditions. Results: At admission, their CRP, PCT, LDH and CysC were increased, CD4/CD8 was decreased (<1), and β2-MG was increased in 9 of them. For cytokines and chemokines, IL-4 was always <1.3pg/ml, and the IL-12, INF-a, TNF-a were always less than reference values. The results of Person rank correlation analysis showed that β2-MG, CysC, G-test, N/L, LDH were in positive associations to CRP, PCT, which were significantly correlated to the disease severity as well. Then IL-6, IL-8, IL-10 were in positive associations to CRP, PCT, β2-MG, CysC, G-test, N/L, and LDH, too. Conclusions: β2-MG, CysC, N/L, LDH, IL-6, IL-8, IL-10 may be reasonably potential diagnostic and disease severity predictors of acute histoplasmosis, but more examinations are still needed for further verification. More relevant indicators should also be taken into account for improving the accuracy of diagnosis and differential diagnosis.