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Updated: Aug 18, 2026
A Preclinical Model of Exertional Heat Stroke in Mice
Published on: July 1, 2021
Elevated serum beta-D-glucan level and depressed neutrophil phagocytosis in a heatstroke patient
Mayuki Aibiki1, Saori Ohtsubo, Takashi Nishiyama
1Ehime University, School of Medicine, Department of Emergency Medicine, Shitsukawa 454, Shigenobu, Onsen, Ehime 791-0259, Japan. aibiki@m.ehime-u.ac.jp
Abstract:
Endotoxemia has been reported as a mechanism for the fatal sequela after heatstroke. Subsequent disseminated fungal infection in a heatstroke patient has been also described. Beta-D-glucan, a constituent of the fungal cell wall, is an early diagnostic measure for fungal infection. In a heatstroke case, we examined for the first time levels of serum beta-d-glucan and endotoxin. A 34-year-old man with a body temperature of 43.5 degrees C was admitted in a state of shock. Prior to the development of disseminated intravascular coagulopathy (DIC), a remarkable elevation of serum beta-D-glucan level to 116 pg/mL (normal level<6.0 pg/mL) was revealed on the first day of admission. However, serum endotoxin was not detected when using a method that excluded beta-D-glucan contamination from endotoxin measurement (normal level<1.0 pg/mL). This change of beta-D-glucan level was accompanied by a depressed neutrophil function, especially in phagocytosis of 34% (normal range 70-90%) but not in bacterocidal function (81% versus a normal range of 70-100%). After intensive care including continuous hemodiafiltration, the patient regained consciousness but remained ataxic due to cerebellar infarction, which might have resulted from DIC, and subsequent bilateral fungal oculitis were revealed 45 days after admission. This case report demonstrates the elevation of serum beta-D-glucan but normal endotoxin levels after heatstroke, which may prompt further study to re-examine the serum levels of endotoxin in such catastrophic insults.
Insights
Heatstroke can lead to fungal infections, indicated by elevated beta-D-glucan levels. This case found high beta-D-glucan but no endotoxin, suggesting a need to re-evaluate endotoxin
Area of Science:
- Medical Mycology
- Critical Care Medicine
- Toxicology
Background:
- Heatstroke is a critical medical emergency with potential fatal sequelae.
- Endotoxemia and disseminated fungal infections are reported complications of heatstroke.
- Beta-D-glucan is a biomarker for fungal infections.
Observation:
- A heatstroke patient presented with a body temperature of 43.5°C and shock.
- Serum beta-D-glucan was significantly elevated (116 pg/mL) on admission.
- Serum endotoxin levels were undetectable using a contamination-controlled method.
Findings:
- Elevated serum beta-D-glucan suggests fungal infection post-heatstroke.
- Normal serum endotoxin levels challenge the endotoxemia hypothesis in this case.
- Neutrophil phagocytosis was impaired, but bactericidal function remained intact.
Implications:
- This case highlights the potential role of fungal infections in heatstroke mortality.
- Findings suggest beta-D-glucan may be a more sensitive marker than endotoxin in certain heatstroke cases.
- Further research is warranted to clarify the role of endotoxin and fungal markers in severe heatstroke.
