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Departments of 1 Medicine, 2 Biological and Medical Research and 3 Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh 11211, Saudi Arabia
We examined the specificity of the
recently reported alterations in circulating lymphocytes in heatstroke
by determining lymphocyte subsets in 14 consecutive heatstroke patients
before and after cooling and in 7 heat-stressed controls using single-
or two-color immunofluorescence flow cytometry. The relationship with
catecholamine levels was also studied. In heatstroke, percentages of T
(CD3+/CD19
),
T-helper
(CD4+/CD8),
T-inactive [CD3+/human
leukocyte
antigen-DR],
CD11a+,
CD11c+, and
CD44+ lymphocytes were
significantly decreased, whereas percentages of T-suppressor-cytotoxic
(CD8+/CD4),
natural killer (NK;
CD3/CD16+
or CD56+),
CD3+/CD16+
or CD56+, and
CD54+ lymphocytes were
significantly increased, compared with 11 normal controls. The changes
in the absolute numbers of lymphocyte subsets were in the same
direction and were significant for T-helper, T-suppressor-cytotoxic,
NK,
CD3+/CD16+
or CD56+, and
CD11c+ lymphocytes. Milder but
significant changes in percentages of T-helper, T-suppressor-cytotoxic,
CD11c+, and
CD44+ lymphocytes were seen in
heat stress. Cooling was associated with partial or complete
normalization, further derangement
(CD11a+,
CD11c+), or overcorrection (NK,
T-suppressor-cytotoxic, CD11b+)
of abnormal percentages of lymphocyte subsets. Norepinephrine levels
were significantly elevated in heatstroke (4.7-fold) and heat stress
(3.2-fold), but did not significantly correlate with lymphocyte
subsets. We conclude that heatstroke is associated with significant
changes in percentages and in absolute numbers of a wide range of
circulating lymphocyte subsets that are not related to elevated
catecholamine levels or totally normalized by cooling. Similar, albeit
milder, changes are seen in heat stress, suggesting that the two
syndromes represent a continuum.
catecholamines; cooling; pilgrimage
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