Accidente por himenópteros: reporte de caso / Hymenoptera accident: case report

Resumen Los himenópteros es una de las clasificaciones de los insectos, constituida por principalmente tres tipos, la abeja, la avispa y la hormiga de fuego, que provocan picaduras con veneno, generando desde efectos locales hasta sistémicos, con repercusiones leves o mortales sino reciben una atención médica oportuna. Las reacciones sistémicas son dependientes de la respuesta inmunológica, así como de la cantidad de las picaduras. Se presentaran dos casos de fallecimiento a causa de accidente por himenópteros tipo abejas, diagnosticados por la historia médicolegal, hallazgos de autopsia relacionado al efecto sistémico del veneno de las abejas y circunstancias relacionadas a la muerte.

Abstract Hymenoptera is one of the classifications of insects, consisting mainly of three types, the bee, the wasp and the fire ant, which cause pitting with venom generating from local to systemic effects, with slight or fatal repercussions but receive timely medical attention. Systemic reactions are dependent on the immune response, as well as the number of bites. There will be two cases of death due to an accident by hymenopterans type bees, diagnosed by medical-legal history, autopsy findings related to the systemic effect of bee venom and circumstances related to death will be presented.

Acute kidney injury complicating bee stings - a review

ABSTRACT Bee stings can cause severe reactions and have caused many victims in the last years. Allergic reactions can be triggered by a single sting and the greater the number of stings, the worse the prognosis. The poisoning effects can be systemic and can eventually cause death. The poison components are melitin, apamin, peptide 401, phospholipase A2, hyaluronidase, histamine, dopamine, and norepinephrine, with melitin being the main lethal component. Acute kidney injury (AKI) can be observed in patients suffering from bee stings and this is due to multiple factors, such as intravascular hemolysis, rhabdomyolysis, hypotension and direct toxicity of the venom components to the renal tubules. Arterial hypotension plays an important role in this type of AKI, leading to ischemic renal lesion. The most commonly identified biopsy finding in these cases is acute tubular necrosis, which can occur due to both, ischemic injury and the nephrotoxicity of venom components. Hemolysis and rhabdomyolysis reported in many cases in the literature, were demonstrated by elevated serum levels of indirect bilirubin and creatine kinase. The severity of AKI seems to be associated with the number of stings, since creatinine levels were higher, in most cases, when there were more than 1,000 stings. The aim of this study is to present an updated review of AKI associated with bee stings, including the currently advised clinical approach.

Delayed onset renal failure following multiple bee stings.

Bee sting is an uncommon pediatric emergency encountered worldwide and capable of causing acute renal failure, multiorgan dysfunction and occasionally death. We had a two year male child who suffered from multiple bee stings and delayed onset acute renal failure, survived following peritoneal dialysis.

Insuficiência renal aguda por picada de abelhas: relato de casos / Acute renal failure following bee stings: case reports

Rabdomiólise é uma síndrome caracterizada por injúria muscular, mais freqüentemente decorrente de esmagamento e traumas musculares. No entanto, a rabdomiólise pode ter também causas não traumáticas, como por exemplo, picadas de abelhas africanizadas. Descrevemos dois casos de rabdomiólise que apresentaram insuficiência renal aguda dialítica após várias picadas de abelhas.

Rhabdomyolysis is a syndrome characterized by muscle injury, most frequently due to muscle crushing and trauma. However, it may also be induced by non-traumatic causes, for example by means of stinging by Africanized bees. We describe two cases of rhabdomyolysis that presented dialytic acute renal failure after several bee stings.

The characteristics of acute renal failure and pathohistological features in patients with bee stings

Bee-stings possibly caused severe complications such as anaphylaxis, acute renal failure and coagulation disorders potentially leading to death. However, the little attention has actually been paid to acute renal failure. Objectives: To assess the features of acute renal failure resulted from bee-stings and to describe pathohistorical injuries of affected kidneys. Method: prospective observational study, evaluation of pre- and post-treatment. Results: 70 patients with 1 to 270 stings from wasp, hornet, and yellow jacket were hospitalized in Poison Control Center of Bach Mai Hospital during two years 2002 and 2003. The number of stings in patients with acute renal failure ranged from 15 to 105 (mean: 50.5). The duration of anuria phase was from 4 to 45 days (mean: 14.7 days) Conclusions: Acute renal failures accounted for 21.4% (15/70 patients), and resulted from stings of wasp and hornet. Early forced diuresis therapy reduced the percentage patients need of hemodialysis. Pathohistological findings revealed the pattern of acute tubular necrosis.