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Bee stings usually result in mild allergic reactions; however, mass envenomation can cause severe complications such as rhabdomyolysis, hemolysis, shock, or multi-organ damage. Rhabdomyolysis can result in acute renal failure either by tubular obstruction by myoglobin casts or by direct cytotoxic injury. We present a case of a 12-year-old female child who presented with sudden onset anuria and hypertension following mass envenomation by bees. A renal biopsy was performed, the microscopic evaluation of which revealed tubular injury, with associated intratubular pigmented casts. The casts stained positive for myoglobin immunohistochemical stain, thus confirming a diagnosis of myoglobin cast nephropathy. The patient was given IV steroids and underwent seven sessions of hemodialysis, following which there was complete recovery of renal function.
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Objective:To investigate the predictive value of procalcitonin (PCT) in the development of acute kidney injury (AKI) in patients after bee stings.Methods:A total of 105 bee stings patients admitted to Mianyang Central Hospital from May 2019 to August 2021 were enrolled and were divided into AKI group (37 cases) and non-AKI group (68 cases) according to the occurrence of AKI. Baseline demographic information [gender, age, body mass index (BMI), sting season, sting site, number of stings, underlying disease, clinical manifestations, and inflammatory factor levels] were collected and compared between the two groups. Logistic regression model was used to analyze the risk factors associated with the occurrence of AKI in bee stings patients. Pearson model was used to analyze the correlation between PCT and other indicators; the receiver operator characteristic curve (ROC curve) were drawn to analyze the predictive value of each indicator on the occurrence of AKI in bee stings patients.Results:There were significant differences in age, number of bee stings, and vomiting after admission between the two groups of patients. The levels of serum creatinine (SCr), PCT, interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP) were significantly higher in the AKI group than those in the non-AKI patients [SCr (μmol/L): 122.36±32.45 vs. 76.74±28.52, PCT (μg/L): 1.42±1.05 vs. 0.34±0.21, IL-6 (ng/L): 277.52±120.25 vs. 112.14±73.34, hs-CRP (mg/L): 7.64±3.26 vs. 3.01±2.13, all P < 0.05]. Serum PCT levels were positively correlated with serum SCr, IL-6, and hs-CRP levels in patients with AKI after bee stings ( r values of 0.486, 0.393, and 0.425, respectively; P = 0.002, 0.016, and 0.009, respectively). Multivariate Logistic analysis showed that age, SCr, PCT, IL-6, and hs-CRP were independent risk factors for AKI in patients with bee stings. The ROC curve analysis showed that the area under the ROC curve (AUC) of age, SCr, PCT, IL-6 and hs-CRP for predicting AKI in patients with bee stings were 0.622 [95% confidence interval (95% CI) was 0.516 to 0.727], 0.722 (95% CI was 0.601 to 0.843), 0.869 (95% CI was 0.781 to 0.958), 0.739 (95% CI was 0.627 to 0.851) and 0.799 (95% CI was 0.700 to 0.900), respectively. The best cut-off value of PCT was 0.742 μg/L, the sensitivity was 75.70% and the specificity was 90.50%. Conclusions:The serum PCT level was significantly elevated in patients with AKI after bee stings, which is an independent risk factor for AKI after bee stings. Serum PCT level has better predictive efficacy for AKI after bee stings and can be used as a valid biomarker for clinical prediction.
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Objective:To investigate the effect of plasma exchange (PE) and continuous blood purification(CRRT) on children with bee sting poisoning and multiple organ dysfunction syndrome (MODS).Methods:From January 2016 to September 2019, 37 children aged 9 months to 11 years with bee sting and MODS were treated with dexamethasone 0.5 mg/kg or methylprednisolone 3 mg-5 mg/kg anti allergic and anti-inflammatory and organ support. Among them, 26 cases were treated with plasma exchange and continuous blood purification (treatment group), and the rest 11 cases were only given conventional treatment, but did not receive blood purification treatment (control group).The critical illness score, liver and kidney functions, myolysis, pulmonary hemorrhage/pulmonary edema, coagulation disorders, shock, hemolysis, gastrointestinal failure and other organ damage, ICU stay time, mechanical ventilation time, organ dysfunction recovery time and clinical outcomes were retrospectively analyzed. In the treatment group, 18 cases started blood purification before 12 h after MODS (early treatment group) and 8 cases started blood purification after 12 h (delayed treatment group).Results:There was no significant difference in age, sex, child critical illness score, onset time and organ function damage between the treatment and control groups ( P>0.05). The cure rate of the treatment group was higher than that of the control group [(25/26 (96.15%) vs 8/11 (72.73%), P=0.036]. There was no significant difference in ICU stay between the control group and the treatment group [(10.03±7.74) d vs (12.01±6.95) d, P>0.05]. Among the 25 survivors in the treatment group, one patient had mild renal function damage and one patient had multiple necrosis of skin, subcutaneous and muscle tissue. Compared with 4 of the 8 survivors in the control group, the residual organ function damage in the treatment group was significantly less than that in the control group [(2/25 (8.00%) vs 4/8 (50.00%), P=0.031)].The recovery of liver function, renal function, myolysis and hemolysis in the treatment group was faster than those in the control group (all P < 0.05). The initiation of blood purification within 12 h after the occurrence of MODS required fewer times of plasma exchange and shorter CRRT time, ICU stay and ventilator time (all P < 0.05). Conclusions:In children with bee sting combined with MODS, plasma exchange and continuous blood purification can achieve better therapeutic effect and better clinical outcome.
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Arthropod bites are a common problem worldwide that are capable of inflicting injury, inciting allergic reactions, and transmitting systemic disease. Members of the Hymenoptera order in particular are of importance as they are nearly ubiquitous in nature and few such as bees, are also used for commercial purposes. These insects have stinging apparatus that deliver venom to the affected tissues during a bite. Hymenopteran venoms contain a mixture of proteins, peptides, and small organic molecules that produce varied effects. Stings from bees, wasps, and ants produce a wide array of clinical manifestations that can be local or systemic. Additionally, these stings may cause life-threatening allergic reactions. Anaphylaxis following a Hymenoptera sting is the most common serious systemic complication. Local reactions can be immediate or delayed. In a few instances, local or disseminated infections have also been reported following bee stings; although very rarely have proved fatal in severe cases. Infection rates are found to be higher in immunodeficiency states. Infections at site of a bee sting can result in the localized pustular lesion with peripheral induration or in severe cases deep necrotizing fascia infection with sepsis and multisystem organ failure. Here we report a case of a bee sting in the upper lip leading to the painful swelling with abscess formation successfully treated with antibiotics, incision, and drainage. Numerous mechanisms for infection in arthropod stings have been described; in our case report, we would like to highlight the importance of timely identification and appropriate management of the infections that may have a significant impact on the overall outcome.
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Ocular bee stings are known to cause corneal melts, corneal infiltrates, cataracts, and secondary glaucoma. Our patient presented with scleritis, corneal infiltrates, and endophthalmitis after a ocular bee sting. Topical treatment led to resolution of anterior segment inflammation, but the scleritis and vitreous inflammation worsened. Vitrectomy with intravitreal antibiotics was done and scrapings from the scleral abscess showed growth of Aspergillus fumigatus on culture. Repeat vitrectomy with silicone oil was needed for retinal detachment. Oral and intravitreal antifungals led to resolution of inflammation with attached retina. This is the first reported case of bee sting-induced fungal endophthalmitis with scleritis.
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Purpose: The purpose of this study is to describe the presenting features, management strategies, and clinical outcome following bee sting injury to the cornea. Methods: Retrospective case series involving 11 eyes of 11 patients with corneal bee sting injuries who presented over a period of 2 years. Nine of these 11 eyes had the presence of intact bee stinger in the cornea, which was removed immediately under an operating microscope and sent for microbiological and histopathological evaluation. The patients were managed as per the individual treatment protocol of the respective treating physicians. Results: Six eyes (54.5%) had a good clinical outcome (best-corrected visual acuity [BCVA] >20/40) with medical therapy alone with no need for surgical intervention. Five eyes (45.5%) had a poor clinical outcome (BCVA <20/40) with medical therapy and required surgery; of which three required a combined penetrating keratoplasty with cataract surgery, while one required isolated cataract surgery and one underwent penetrating keratoplasty. Glaucoma was present in 3/5 eyes undergoing surgery, one of which required a trabeculectomy. Five of the six eyes who had a good clinical outcome with medical therapy alone had been treated with concomitant oral steroids, along with topical antibiotic-steroid combination therapy. Conclusion: Oral corticosteroid supplementation to the topical steroid antibiotic treatment in patients with corneal bee sting injury where corneal involvement and anterior reaction is severe at presentation or inflammation not ameliorating with topical steroids alone prevents serious vision-threatening complications such as corneal decompensation, cataract, and glaucoma.
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Abstract INTRODUCTION: Hymenoptera injuries are commonly caused by stinging insects. In Amazonas state, Brazil, there is no information regarding distribution, profile, and systemic manifestations associated with Hymenoptera injuries. METHODS: This study aimed to identify risk factors for systemic manifestation using the Brazilian Notifiable Diseases Surveillance System (2007 to 2015). RESULTS: Half of Hymenoptera injuries were caused by bee stings. Hymenoptera injuries were concentrated in Manaus, and 13.36% of cases displayed systemic signs. Delayed medical assistance (4 to 12 hours) presented four times more risk for systemic manifestations. CONCLUSIONS: Simple clinical observations and history of injury are critical information for prognostic improvement.
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Humans , Animals , Male , Female , Child , Adolescent , Adult , Young Adult , Hymenoptera/classification , Insect Bites and Stings/epidemiology , Bees , Brazil/epidemiology , Risk Factors , Disease Notification , Middle AgedABSTRACT
Bee stings result in diverse clinical manifestations from localized pain, rash to life-threatening systemic allergic reactions or toxic reactions. Toxic reactions include skin necrosis, pancreatitis, acute renal failure, hemolysis or coagulopathy, while systemic allergic reactions present with IgE-mediated anaphylaxis. We experienced a 63-year-old woman who developed rhabdomyolysis and diabetic ketoacidosis after bee sting. The patient was accompanied by pulmonary edema due to acute kidney injury, which was recovered by intensive hemodialysis treatment. Here, we report a rare and serious case induced by bee sting with a review of the literature.
Subject(s)
Female , Humans , Middle Aged , Acute Kidney Injury , Anaphylaxis , Bees , Bites and Stings , Diabetic Ketoacidosis , Exanthema , Hemolysis , Hypersensitivity , Necrosis , Pancreatitis , Pulmonary Edema , Renal Dialysis , Rhabdomyolysis , SkinABSTRACT
Objective To investigate the effects of separate and direct bee sting punctures at acupoints on ESR and RF in rheumatoid arthritis. Method Seventy-two patients with rheumatoid arthritis were randomized to observation and control groups, 36 cases each. The observation group received separate bee sting puncture at acupoints and the control group, direct bee sting puncture at acupoints. In both groups, treatment was given once every other day, three times a week, one week as a course, for two courses. ESR and RF were measured in the two groups before treatment and at one and two weeks after. Result ESR and RF changed significantly in both groups after treatment compared with before (P<0.05). The effects of the two treatments on rheumatoid arthritis-related ESR and RF were equal and there was no statistically significant difference between the two groups (P>0.05). Conclusion Both separate and direct bee sting punctures at acupoints can reduce ESR and RF in rheumatoid arthritis. Separate bee sting puncture at acupoints is easy for the patients to accept.
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Objective To investigate the change of coagulation indexes in the patients with bee sting injury .Methods A total of 294 cases of bee sting injury were selected as the study subjects and divided into the mild bee sting injury group (A ,1 -2 sites) , moderate bee sting injury group(B ,3-10sites) ,severe bee sting injury group(C ,11-20sites) and extremely severe bee sting injury group(D ,≥21sites) according to the number of sting site .Meanwhile 40 healthy people were selected as the control group .The changes of prothrombin time(PT),internation alnormalized ratio(INR),activated partial thromboplastin time(APTT)and fibrinogen(FIB) were compared among groups .Results PT and APTT in the severe bee sting injury group and extremely severe bee sting injury group were significantly prolonged within 4-9 h after bee sting injury compared with the control group (P＜0 .05) .APTT , PT and INR had obviously dose effect positive correlation with bee sting sites (r=0 .583 ,0 .340 ,0 .327 ,P＜0 .01) .Conclusion APTT is closely correlated with bee sting sites and seeing doctor time ,which can serve as the effective monitoring indexes in the treatment process of bee sting injury .
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In this case report study a 41-year-old man envenomed by a bee sting and diagnosed as Kounis syndrome secondary to hymenoptera envenomation. The patient developed a typical course of myocardial infarction, but the electrocardiogram changes were reversed to almost normal limits. He had a nonsignificant mild lesion in the proximal port of right coronary artery in coronary angiography. The case recovered and discharged after 6 days hospitalization. The clinical implications and pathophysiology of this dangerous association are discussed.
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Bee stings can cause mortal anaphylactic reactions, which are also precursors to some other mortal events. Kounis syndrome (KS), or allergic myocardial infarctions, are well known concomitant events with every type of allergic reaction. KS should be considered in all patients with allergic events and concomitant chest pain admitted to emergency rooms. The clinical symptoms may not always be clear in these cases. The symptom of chest pain may not be seen in some mono- and poli-neuropathic conditions, particularly in diabetes, transplantation and drug user patients. We present a patient with KS secondary to bee sting.
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ObjectiveTo observe the clinical efficacy of bee-sting therapy in treating chronic colitis.MethodTotally 101 patients with chronic colitis were randomized into two groups, 39 cases in the control group and 62 cases in the treatment group.The treatment group was intervened by bee-sting therapy, while the control group was by medication. During the intervention, patients in the two groups were asked to keep bland diet and take more food rich in fiber instead of spicy and stimulating food. Abdominal pain, defecation pattern and frequency were observed during the study, and the clinical efficacies were compared a month later.Result The markedly effective rate was 82.3% in the treatment group versus 61.5% in the control group, and the therapeutic efficacyof the treatment group was significantly higher than that of the control group (P<0.05), and the improvements of pain relief and defecation occurred earlier in the treatment group than in the control group.ConclusionBee-sting therapy has advantages of faster pain relief and long-standing therapeutic efficacy.
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Objective To investigate the changes of WBC count and neutrophil ratio (NEU% ) in the patients with bee sting inju‐ry .Methods According to the number of bee sting and different time going to hospital ,the WBC count and NEU% in 315 cases of bee sting injury were analyzed and compared with those in healthy population .Results The changes of WBC count and NEU% had statistically significant difference between the patients with bee sting injury and the healthy people (P< 0 .05) .The changes of WBC count and NEU% had statistically significant difference between the patients with more than 20 bee sting injuries and the pa‐tients with less than 3 bee sting injuries(P<0 .05) .The WBC count had obvious difference between the patients with treatment within 3 h after bee sting and the patients with treatment at other time (P<0 .05) .Conclusion The WBC count and NEU% are obviously increased after bee sting ,which is closely correlated with the bee sting injury number and the time going to hospital .
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Aim: Based on traditional claims and practice, the antiplasmodial activity of bee stings and its effect on haematological indices was investigated in P. berghei infected mice. Methodology: Sixteen albino mice were intraperitoneally infected with chloroquine sensitive P. berghei strain and divided into four groups each consisted of four animals. Group I was set up as negative control of 0.2 ml normal Saline/kg body weight, group II as 5 mg chloroquine/kg body weight, group III had suppressive treatment and group IV was administered curative treatment. The thin blood smear was used to determine the parasiteamia counts and the haematological parameters were estimated on day 7. Results: The result of percentage chemosuppression shows that bee stings suppress the parasitaemia to 56.6%. Also, the suppressive and curative groups show longer mean survival period of 15.0 and 20.0 respectively. The haematological studies show that the level of packed cell volume (PCV) and haemoglobin concentration (HB) of infected untreated group was significantly (p<0.05) lower when compare with all other experimental groups, where as chloroquine treated group shows significant increase compared to the bee treated groups. The Red blood cell (R.B.C.) counts was significantly (p<0.05) lowered in infected untreated group when compare with suppressive and chloroquine treated groups. However the white blood cell (WBC) counts was significantly (p<0.05) higher in infected bee sting treated when compare to the infected untreated and infected chloroquine treated groups. Conclusion: Based on the result obtained, this study confirms the antiplasmodial activity of bee stings and suggests its potential as drug agent or lead against malaria.
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Aim: Based on the traditional and scientific claims of intra-dermal antiplasmodial activity of bee stings, its effect on liver and serum enzymes in Plasmodium berghei-infected mice were investigated. Methodology: Twenty albino mice were intra-peritoneally infected with P. berghei and divided into four animals per group. Group I was set up as negative control (parasitized untreated), group II as parasitized treated with 5 mg chloroquine/kg body weight, group III as suppressive treated, group IV as curative treated and group five as not parasitized not treated. Results: The results of serum alanine transaminase (ALT) and aspartate transaminase (AST) of the infected treated with chloroquine shows significant increase when compared to other experimental groups (p˂ 0.05). Whereas, there was increase in liver AST in group II, group III and group IV when compared to not parasitized not treated (p˂ 0.05). Also, there was significant decrease in liver ALT activity in all the experimental groups. The serum and liver gamma glutamyl transferase (GGT) showed no significant difference (p<0.05) in the curative and suppressive groups when compared to the standard drug (chloroquine). Whereas, parasitized not treated group shows significant increase (p<0.05) in the liver GGT and ALP when compared with other experimental groups. Therefore, these increases in specific activity of the parasitized untreated group might be due to infection. Conclusion: It can be concluded that bee sting have ameliorative effect against changes caused by P. berghei.
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Objective To analysis the the effect of Ji Desheng Sheyao on coagulation,liver, kidney function in bee sting injury patients with severe toxic effect.Methods 42 bee sting injury patients with severe toxic effect were collected.Corresponding treatment and nursing measures were given respectively, after the treatment, the coagulation function,liver, kidney function and nursing effect were detected in all patients.Results After treatment compared with control group,there was no significant difference in the coagulation function of the patients in the experimental group;the serum levels of ALT,AST and TBIL were lower in the experimental group (P<0.05); the serum levels of BUN and Scr were lower in the experimental group(P<0.05);the incidence of complications was lower, and the nursing satisfaction was higher in the experimental group(P<0.05).Conclusions Ji Desheng Sheyao and good nursing measures can significantly reduce oxidative stress in patients with severe toxic effect , improve liver and kidney function, reduce the incidence of complications, improve patient care satisfaction.
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Acute myocardial injury due to honey bee sting is rare, only a few studies have discussed the relationship between honey bee sting and myocardial injury. Massive envenomation by honey bees can cause multiorgan dysfunction due to toxic effects of massive envenomation and systemic anaphylactic reactions.
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La neuritis óptica es la inflamación aguda del nervio óptico y su forma atípica se produce por la inflamación del nervio óptico como parte de un proceso de causa infecciosa, inmune, granulomatosa, o por contigüidad. Las picaduras por himenópteros (abejas, avispas, hormigas) han sido asociadas con diferentes cuadros clínicos, que van desde manifestaciones locales hasta cuadros sistémicos como anafilaxis, glomerulonefritis y afectación del sistema nervioso central (lesiones vasculares e isquémicas, neuritis óptica y lesiones desmielinizantes). Desde 1960 se han documentado casos de neuritis ópticas asociadas a las picaduras de himenópteros, que adoptan las formas de neuritis óptica anterior isquémica e inflamatoria. Se presenta el caso de una paciente, mujer de 62 años de edad, que luego de tres días de haber sufrido picadura por abeja en párpado inferior izquierdo, presentó disminución de la agudeza visual de ambos ojos y escotoma central, concomitante con cefalea y dolor ocular bilateral exacerbado con los movimientos oculares. Al examen oftalmológico la agudeza visual se encontraba disminuida (visión en bultos). En el fondo de ojo se evidenció de forma bilateral discos ópticos de bordes borrados. En la resonancia magnética ocular se observó engrosamiento hiperintenso del nervio óptico izquierdo. Por las características clínicas y el antecedente epidemiológico se planteó el diagnóstico de neuritis óptica bilateral. Se inició pulsos de metilprednisolona, con posterior mejoría de la clínica.
Optic neuritis is an acute inflammation of the optic nerve and, in its atypical form, is caused by inflammation of the optic nerve as part of infectious, immune, granulomatous, or contiguity processes. Hymenoptera stings (bees, wasps and ants) have been associated with different clinical presentations, ranging from local events to systemic manifestations, such as anaphylaxis, glomerulonephritis and central nervous system involvement (ischemic vascular lesions, optic neuritis and demyelinating lesions). This is a report of the case of a 62-year-old woman that after three days of being stung by a bee in the left lower eyelid, showed decreased visual acuity of both eyes and central scotoma, concomitant bilateral headache and eye pain, exacerbated by eye movements. The ophthalmological examination showed that visual acuity was decreased and the bilateral fundus examination revealed blurred optic disks edges. Hyperintense thickening of the left optic nerve was observed with an ocular MRI. Due to the clinical manifestations and epidemiological history, the diagnosis of bilateral optic neuritis was established. Treatment with pulses of 1g/daily of methylprednisolone was initiated, for three days, with clinical improvement within 24 hours after receiving the first dose. Since 1960, cases of optic neuritis associated with hymenoptera stings have been documented, which take the form of anterior optic neuritis. A case of a patient who presented clinical features of bilateral optic neuritis after been stung by a bee, with a good clinical outcome after treatment with methylprednisolone is reported.