For example, in a controlled human 4 h PM 2.5 exposure (to a mean value of 37.8 g/m 3 ), a significant increase occurred in vascular inflammation and acute phase injury markers like serum amyloid A, C-reactive protein, soluble intercellular adhesion molecule-1, and soluble vascular cell adhesion molecule-1
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After reviewing literature and conducting a two-round Delphi survey with 42 experts, a consensus emerged that emphasizes prioritizing clinical symptoms in diagnosis, with serum B12 as a screening marker supported by methylmalonic acid or homocysteine levels for additional confirmation
In most cases, symptoms include fever, chills, loss of appetite, nausea, muscle painsparticularly in the backand headaches
