Leptogenys pujoli, a new amazonian species, and the redescription of Leptogenys famelica Emery, 1896 (Formicidae: Ponerinae)

ABSTRACT We provide an update on the famelica species group, redescribing Leptogenys famelica Emery, 1896 and describing a new species, Leptogenys pujoli n. sp., based on worker specimens. The new species is smaller than L. famelica and can be distinguished by the indistinct mesometanotal suture, and the petiolar node with an anterodorsal margin mostly straight anterior to spiracle in lateral view. Leptogenys famelica is distributed from Costa Rica to Panama, while L. pujoli n. sp. is distributed throughout the Brazilian Amazon, from French Guiana to Bolivia. Some records previously attributed to L. famelica remain uncertain, potentially being either L. famelica or L. pujoli n. sp., or perhaps representing one or more undescribed species. We update the key to Leptogenys workers by Lattke (2011) and include images. We synthesize available knowledge about the possible biology of these species and propose that both L. famelica and L. pujoli n. sp. are generalist predators and that their reproduction is dependent on gamergates.

Segurança da vacinação contra a COVID-19 em doentes referenciados dos cuidados de saúde primários por alergia ao veneno de himenópteros / COVID-19 vaccination safety in patients with hymenoptera venom allergy referred by primary health care

Introdução: As reações de hipersensibilidade após vacinação contra a COVID-19 têm vindo a ser descritas, embora a anafilaxia seja rara. A hipersensibilidade ao veneno de himenópteros constitui a terceira causa mais frequente de anafilaxia em Portugal, embora não pareça aumentar o risco de anafilaxia à vacinação contra a COVID-19. Objetivos: Avaliar a segurança da vacinação contra a COVID-19 em doentes com história de alergia ao veneno de himenópteros referenciados dos Cuidados de Saúde Primários (CSP). Métodos: Estudo observacional retrospectivo com inclusão dos doentes com alergia ao veneno de himenópteros referenciados pelos CSP ao serviço de Imunoalergologia, para estratificação do risco de reações de hipersensibilidade à vacina contra o SARS-CoV-2, entre janeiro e dezembro de 2021. Resultados: No total, incluíram-se 18 doentes, 72% do sexo feminino, média de idades de 61±18 [21-89] anos. Na caracterização do tipo da reação ao veneno de himenópteros, as reações locais exuberantes corresponderam a 33% de todas as reações referidas. Quanto a sintomas sistêmicos de anafilaxia, foram referidos sintomas mucocutâneos (33%), respiratórios (28%), cardiovasculares (33%) e gastrointestinais (11%). A abelha foi o inseto mais frequentemente implicado (61%). Relativamente aos valores de triptase basal, 3 doentes apresentaram níveis acima do cut-off estabelecido de 11,4 ng/mL, tendo indicação formal para iniciar esquema de vacinação em meio hospitalar. Durante o processo vacinal registrou-se um total de 46 administrações em 18 doentes, todas sem intercorrências. Apenas 5 doentes foram vacinados em meio hospitalar, tendo sido os restantes encaminhados para os CSP. Os doentes com mastocitose confirmada ou suspeita foram submetidos à pré-medicação com anti-histamínico anti-H1 e anti- H2, bem como montelucaste, na véspera e no dia da vacinação. Conclusões: A vacinação contra a COVID-19 é segura em doentes com reação de hipersensibilidade ao veneno de himenópteros. O protocolo utilizado mostrou ser eficaz na segregação de doentes entre CSP e cuidados secundários/terciários.

Introduction: Despite numerous reports of hypersensitivity reactions to COVID-19 vaccination, anaphylaxis is rare. Although hypersensitivity reactions to hymenoptera venom are the third most common cause of anaphylaxis in Portugal, they don't appear to enhance the risk of anaphylactic reaction to COVID-19 vaccination. Objectives: To assess the safety of COVID-19 vaccination in patients with a history of hymenoptera venom allergy. Methods: This retrospective observational study included patients with hymenoptera venom allergy referred by primary health care to the Immunoallergology Outpatient Clinic of a tertiary hospital between January and December 2021 to stratify the risk of hypersensitivity reactions to the SARSCoV- 2 vaccine. Results: A total of 18 patients were included: 72% women; mean age 61 (SD, 18 [range 21-89]) years. One-third of all reported reactions to hymenoptera venom were large and local. Topical systemic symptoms of anaphylaxis were mucocutaneous (33%), respiratory (28%), cardiovascular (33%) and gastrointestinal (11%). The honeybee was the most frequently involved hymenoptera species (61%). The basal tryptase levels of 3 patients were above the established cut-off (11.4 ng/mL) and they were formally indicated for vaccination in a hospital setting. Concerning the vaccination process, 46 doses were administered to the 18 patients and no reactions were recorded. Only 5 patients were vaccinated in a hospital environment; the rest were referred to primary health care centers. Patients with confirmed or suspected mastocytosis were premedicated with anti-H1 and anti-H2 antihistamines, as well as montelukast, the day before and on the day of vaccination. Conclusions: COVID-19 vaccination is safe for patients with hypersensitivity to hymenoptera venom. The risk assessment protocol effectively designated patients to primary or secondary/tertiary health care.

Anaphylaxis and systemic mastocytosis caused by Solenopsis invicta stings / Anafilaxia e mastocitose sistêmica ocasionada pela Solenopsis invicta

Indolent systemic mastocytosis is a rare disease characterized by an increased number of mast cells in the bone marrow and other tissues, such as the liver, spleen, lymph nodes, and skin. Patients with indolent systemic mastocytosis and high serum tryptase levels are at risk for Hymenoptera venom-induced anaphylaxis. Hymenoptera venom immunotherapy in patients with specific IgE is safe and effective. While some patients can receive ultra-rush venom immunotherapy with minimal side effects, omalizumab effectively protects against anaphylaxis during the build-up phase.

A mastocitose sistêmica indolente é uma doença rara caracterizada por um número aumentado de mastócitos na medula óssea e em outros tecidos, como fígado, baço, linfonodos e pele. Pacientes com mastocitose sistêmica indolente e altos níveis séricos de triptase correm risco de anafilaxia induzida pelo veneno dos Hymenoptera. A imunoterapia com veneno de himenópteros em pacientes com IgE específica é segura e eficaz. Embora alguns pacientes possam receber imunoterapia com veneno ultrarrápido com efeitos colaterais mínimos, o omalizumabe protegeu efetivamente contra a anafilaxia durante a fase de acúmulo.

Social wasps (Vespidae: Polistinae) in Cerrado and Caatinga conservation units, Minas Gerais, Brazil / Vespas sociais (Vespidae: Polistinae) em unidades de conservação do Cerrado e da Caatinga, Minas Gerais, Brasil

Abstract The Parque Nacional Grande Sertão Veredas, northern Minas Gerais, is located in the Cerrado, a global hotspot, and the literature lacks information about its communities of social wasps, insects that perform numerous services for the functioning of ecosystems. Therefore, this study aimed to conduct an inventory of social wasps (Vespidae: Polistinae) in the Parque Nacional Grande Sertão Veredas, and compare its richness and composition with three other fully protected conservation units in northern Minas Gerais and Vale do Jequitinhonha, Minas Gerais. A total of 41 species of 14 genera of social wasps were recorded, including a new occurrence in the state: Mischocyttarus campestris Raw, 1985. The presence of distinct social wasp communities in the Cerrado and Caatinga conservation units analyzed in this study, reinforces and justifies the creation of these fully protected areas, which ensure the conservation of this biological heritage and the environmental services provided by these taxa, besides providing subsidies for the management and sustainable use of the natural resources of these conservation units.

Resumen O Parque Nacional Grande Sertão Veredas, norte de Minas Gerais, inserido no Cerrado, hotspot mundial, carece de informações sobre a comunidade de vespas sociais, insetos que desempenham inúmeros serviços para o funcionamento dos ecossistemas. Portanto, o objetivo deste estudo foi realizar um inventário de vespas sociais (Vespidae: Polistinae) no Parque Nacional Grande Sertão Veredas, além de comparar sua riqueza e composição com à de outras três Unidades de Conservação de proteção integral no Norte e no Vale do Jequitinhonha no estado de Minas Gerais. Foram registradas 41 espécies de 14 gêneros de vespas sociais, com um novo registro de ocorrência para o estado, Mischocyttarus campestris Raw, 1985. A presença de comunidades distintas de vespas sociais nas Unidades de Conservação no Cerrado e Caatinga, analisadas no presente estudo, reforça e justifica a criação dessas áreas de proteção integral, que assegura a conservação desse patrimônio biológico, bem como os serviços ambientais prestados por esses táxons, além de fornecer subsídios para o manejo e uso sustentável dos recursos naturais dessas Unidades de Conservação.

A reminder of life-threatening reaction of hymenoptera sting cause anaphylaxis shock

The prevalence of hymenoptera sting in general population still high. Large local reaction (LLR) is more common manifestation but can also causeanaphylactic shock and loss of consciousness, or even cardiac or respiratory arrest that all is defined as severe systemic sting reaction (SSR). The risk is generally considered low for future SSR in subjects with LLR but need to be considered and recognized immediately. We reporteda case of 39-year-old women was stung by a wasp when driving motorcycle and presented to emergency room with anaphylactic shock (fulfill the amended NIAID/FAAN criteria). She also stung by wasp 2 years ago and cause her left upper and lower arms became swollen slowly and improved 3 days later after treatment with allergy drugs. Electrocardiography result refer to sinus bradycardia. Significant laboratory result showed hypokalemia (2.9 mmol/l). Patient treated by injecting epinephrine intramuscularly and glucocorticoids to preventing protracted symptoms and biphasic reactions.

Fatal systemic reactions, concurrent of anaphylaxis and systemic toxic reactions to hymenoptera-sting

Hymenoptera-stingcan cause localized and systemic reactions (SR). SRs such asanaphylaxis and systemictoxic reactions (STR). Itis estimated to occur in 3% of adultsand can be life-threatening. Diagnosis is based on clinical manifestations,previous of allergic history, IgE-mediated confirmation and the offending insect identification. Anaphylaxis patients should immediately receive adrenaline intramuscularly, emergency medical attention and other supporting treatment. We report a36-year-old man with fatal SRs, concurrent of anaphylaxis and systemic toxic reaction due to multiple hymenoptera-stings.

First list of parasitoids in flies of medical, veterinary, and forensic importance in Rio Grande do Sul – Brazil / Primeira lista de parasitoides em moscas de importância médica, veterinária e forense no Rio Grande do Sul - Brasil

Necrophagous flies are of great importance for human and animal health. In places where their development occurs, parasitoids can be used as a tool to control these dipterans. In Brazil, the fauna of these parasitoids has been investigated in some regions. However, in Rio Grande do Sul, it is known the occurrence of only one species. Thus, this study aimed to create the first list of parasitoids in flies of medical and veterinary importance in Southern Brazil. Collections took place in the municipality of Pelotas (31º 42' S; 52º 18' W). Three replicates consisting of a 500 g bovine liver chunk placed in a tray were exposed to open air for 20 days. Then pupae were individualized and observed until their emergence. We identified 4,882 adult flies of Calliphoridae, Fanniidae, Muscidae, and Sarcophagidae. 4,040 parasitoids emerged, belonging to eight species, of which Nasonia vitripennis, Spalangia cameroni, Spalangia chontalensis, and Tachinephagus zealandicus are new records in Rio Grande do Sul state. Also, three undescribed species of the genus Aphaereta were collected. In spite of being the first attempt to inventory the fauna of hymenopteran parasitoids, this study may help in the development of management programs of these dipterans in the region.

Moscas necrófagas possuem grande importância para a sanidade humana e animal. Onde estas se desenvolvem ocorrem parasitoides que podem ser utilizados como ferramentas para o controle desses dípteros. No Brasil, a fauna desses parasitoides vem sendo investigada em algumas regiões e no Rio Grande do Sul é conhecida a ocorrência de apenas uma espécie. Portanto, o objetivo deste estudo foi criar a primeira lista de espécies de parasitoides de moscas de importância médica e veterinária ocorrentes no extremo sul do Brasil. As coletas foram realizadas no município de Pelotas (31º 42' S; 52º 18' O). Foram montadas três réplicas de bandejas contendo, cada uma, 500 g de fígado bovino, expostas ao ar livre durante 20 dias. Na sequência, as pupas foram individualizadas e observadas até a emergência. Foram identificados 4.882 adultos pertencentes às famílias Calliphoridae, Fanniidae, Muscidae e Sarcophagidae. Emergiram 4.040 parasitoides, pertencentes a oito espécies, das quais Nasonia vitripennis, Spalangia cameroni, Spalangia chontalensis e Tachinephagus zealandicus são novas ocorrências para o Rio Grande do Sul. Foram coletadas três espécies ainda não descritas do gênero Aphaereta. Apesar de ainda ser um primeiro esforço de inventariar a fauna de himenópteros parasitoides, este estudo pode auxiliar no desenvolvimento de programas de manejos desses dípteros na região.

First list of parasitoids in flies of medical, veterinary, and forensic importance in Rio Grande do Sul Brazil

Abstract Necrophagous flies are of great importance for human and animal health. In places where their development occurs, parasitoids can be used as a tool to control these dipterans. In Brazil, the fauna of these parasitoids has been investigated in some regions. However, in Rio Grande do Sul, it is known the occurrence of only one species. Thus, this study aimed to create the first list of parasitoids in flies of medical and veterinary importance in Southern Brazil. Collections took place in the municipality of Pelotas (31º 42 S; 52º 18 W). Three replicates consisting of a 500 g bovine liver chunk placed in a tray were exposed to open air for 20 days. Then pupae were individualized and observed until their emergence. We identified 4,882 adult flies of Calliphoridae, Fanniidae, Muscidae, and Sarcophagidae. 4,040 parasitoids emerged, belonging to eight species, of which Nasonia vitripennis, Spalangia cameroni, Spalangia chontalensis, and Tachinephagus zealandicus are new records in Rio Grande do Sul state. Also, three undescribed species of the genus Aphaereta were collected. In spite of being the first attempt to inventory the fauna of hymenopteran parasitoids, this study may help in the development of management programs of these dipterans in the region.

Resumo Moscas necrófagas possuem grande importância para a sanidade humana e animal. Onde estas se desenvolvem ocorrem parasitoides que podem ser utilizados como ferramentas para o controle desses dípteros. No Brasil, a fauna desses parasitoides vem sendo investigada em algumas regiões e no Rio Grande do Sul é conhecida a ocorrência de apenas uma espécie. Portanto, o objetivo deste estudo foi criar a primeira lista de espécies de parasitoides de moscas de importância médica e veterinária ocorrentes no extremo sul do Brasil. As coletas foram realizadas no município de Pelotas (31º 42 S; 52º 18 O). Foram montadas três réplicas de bandejas contendo, cada uma, 500 g de fígado bovino, expostas ao ar livre durante 20 dias. Na sequência, as pupas foram individualizadas e observadas até a emergência. Foram identificados 4.882 adultos pertencentes às famílias Calliphoridae, Fanniidae, Muscidae e Sarcophagidae. Emergiram 4.040 parasitoides, pertencentes a oito espécies, das quais Nasonia vitripennis, Spalangia cameroni, Spalangia chontalensis e Tachinephagus zealandicus são novas ocorrências para o Rio Grande do Sul. Foram coletadas três espécies ainda não descritas do gênero Aphaereta. Apesar de ainda ser um primeiro esforço de inventariar a fauna de himenópteros parasitoides, este estudo pode auxiliar no desenvolvimento de programas de manejos desses dípteros na região.

First list of parasitoids in flies of medical, veterinary, and forensic importance in Rio Grande do Sul - Brazil / Primeira lista de parasitoides em moscas de importância médica, veterinária e forense no Rio Grande do Sul - Brasil

Necrophagous flies are of great importance for human and animal health. In places where their development occurs, parasitoids can be used as a tool to control these dipterans. In Brazil, the fauna of these parasitoids has been investigated in some regions. However, in Rio Grande do Sul, it is known the occurrence of only one species. Thus, this study aimed to create the first list of parasitoids in flies of medical and veterinary importance in Southern Brazil. Collections took place in the municipality of Pelotas (31º 42' S; 52º 18' W). Three replicates consisting of a 500 g bovine liver chunk placed in a tray were exposed to open air for 20 days. Then pupae were individualized and observed until their emergence. We identified 4,882 adult flies of Calliphoridae, Fanniidae, Muscidae, and Sarcophagidae. 4,040 parasitoids emerged, belonging to eight species, of which Nasonia vitripennis, Spalangia cameroni, Spalangia chontalensis, and Tachinephagus zealandicus are new records in Rio Grande do Sul state. Also, three undescribed species of the genus Aphaereta were collected. In spite of being the first attempt to inventory the fauna of hymenopteran parasitoids, this study may help in the development of management programs of these dipterans in the region.

Moscas necrófagas possuem grande importância para a sanidade humana e animal. Onde estas se desenvolvem ocorrem parasitoides que podem ser utilizados como ferramentas para o controle desses dípteros. No Brasil, a fauna desses parasitoides vem sendo investigada em algumas regiões e no Rio Grande do Sul é conhecida a ocorrência de apenas uma espécie. Portanto, o objetivo deste estudo foi criar a primeira lista de espécies de parasitoides de moscas de importância médica e veterinária ocorrentes no extremo sul do Brasil. As coletas foram realizadas no município de Pelotas (31º 42' S; 52º 18' O). Foram montadas três réplicas de bandejas contendo, cada uma, 500 g de fígado bovino, expostas ao ar livre durante 20 dias. Na sequência, as pupas foram individualizadas e observadas até a emergência. Foram identificados 4.882 adultos pertencentes às famílias Calliphoridae, Fanniidae, Muscidae e Sarcophagidae. Emergiram 4.040 parasitoides, pertencentes a oito espécies, das quais Nasonia vitripennis, Spalangia cameroni, Spalangia chontalensis e Tachinephagus zealandicus são novas ocorrências para o Rio Grande do Sul. Foram coletadas três espécies ainda não descritas do gênero Aphaereta. Apesar de ainda ser um primeiro esforço de inventariar a fauna de himenópteros parasitoides, este estudo pode auxiliar no desenvolvimento de programas de manejos desses dípteros na região.

From allergy to labial abscess following a bee sting: A Case report

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.

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.

Functional Structure and Patterns of Specialization in Plant-Pollinator Relationships of an Agroecosystem in Valle del Cauca, Colombia / Estructura funcional y patrones de especialización en las relaciones planta-polinizador de un agroecosistema en el valle del cauca, colombia

RESUMEN Los himenópteros son los principales polinizadores de los sistemas agrícolas y juegan un papel clave en la producción de alimentos. Sin embargo, poco se ha estudiado sobre las redes de polinización y la dependencia de las plantas a polinizadores en agroecosistemas tropicales. El objetivo de este estudio fue describir la red de polinizadores asociada a un agroecosistema y evaluar la influencia de los rasgos morfológicos de las especies en la polinización. El estudio se realizó en un agroecosistema en el Valle del Cauca, Colombia. Entre enero y febrero del 2017 se emplearon 96 h de observación y se cuantificaron las interacciones entre polinizadores y flores; se estimó la duración promedio de visita por polinizador, se registró la abundancia floral y se midieron los principales rasgos morfológicos de plantas y polinizadores. En las plantas se midió el largo de la corola, y en los polinizadores, masa corporal y longitud de lengua. En total se identificaron 17 especies de polinizadores que visitaron ocho especies de plantas (cinco agrícolas y tres arvenses). Se encontró que la red es especializada (H2' = 0,8) con un grado de anidamiento bajo (NODF = 10,4), y que las plantas fueron especialistas y dependientes a los polinizadores (75 % spp. d' > 0,7). Además, se encontró que la abundancia floral y la masa corporal de los himenópteros influencian la duración de visita, lo cual podría afectar la calidad de la polinización. Este estudio revela que la especialización ecológica y la complementariedad funcional de los himenópteros influyen en la polinización de agroecosistemas.

ABSTRACT Hymenoptera is the main group of pollinators in agricultural systems and play a key role in food production. However, little is known about pollination networks and the dependence of plants on pollinators in tropical agroecosystems. The objectives of this study were i) to describe the plant-pollinator network associated with an agroecosystem, and ii) to evaluate the influence of morphological traits of the species on pollination. To do so, we conducted the fieldwork in an agroecosystem in Valle del Cauca, Colombia, between January and February 2017. We invested 96 h of observation and quantified interactions between pollinators and flowers; we estimated the average of visit duration per pollinator, the floral abundance, and measured the main morphological traits of plants and pollinators. For plants, we measured the length of corolla, and for pollinators, body mass and tongue length. We found that 17 species of pollinator visited eight plant species (five agricultural plants and three weeds). Our results suggest that the network is specialized (H2' = 0.8), had a low degree of nestedness (NODF = 10.4), and that plants were specialized and highly dependent on pollinators (75 % spp. d' > 0.7). Also, we found that floral abundance and body mass of Hymenoptera influence the length of visit, which might affect the quality of pollination. This study reveals that ecological specialization and functional complementarity of Hymenoptera influence pollination in agroecosystems.

Professor Júlio Croce - uma vida, um legado / Professor Júlio Croce - a life, a legacy

O médico e professor Júlio Croce foi um dos principais alergistas brasileiros. Formado em 1947 pela Faculdade de Medicina da Universidade de São Paulo (FMUSP), foi um dos pioneiros da especialidade de Alergia e Imunopatologia no Brasil. Foi professor da Disciplina de Imunologia Clínica e Alergia da FMUSP e Diretor do Serviço de Alergia e Imunologia do Hospital das Clínicas da USP (HC-FMUSP). Posteriormente, permaneceu como Professor de Mestrado no Programa de Pós-Graduação em Alergia e Imunopatologia na mesma Universidade. Como Diretor do Serviço de Alergia e Imunologia do HC-FMUSP teve grande influência na formação de alergistas que mais tarde se tornaram expoentes da especialidade, não só no Brasil, como em toda América Latina. Tendo formação como clínico e um grande entrosamento com as áreas básicas, dedicou parte de sua vida à pesquisa de alérgenos encontrados no Brasil, marcando a originalidade do seu trabalho. Pesquisou e publicou artigos sobre alérgenos regionais tão variados como ácaros, fungos, insetos, plantas e alimentos. Também se interessou pela relação das alergias com a poluição. Homem de mente aberta e simplicidade no trato, era um verdadeiro diplomata da Alergia. Agregou especialistas do Brasil e do mundo, tendo sido membro fundador de diversas sociedades médicas. Ao acolher residentes e estagiários vindos de todas as partes do Brasil e da América Latina, contribuiu enormemente para a divulgação e o ensino da especialidade de Alergia. Foi homenageado pelas principais sociedades de Alergologia na América Latina, Estados Unidos e Europa. Como testemunhas de uma parte de sua vida, nosso objetivo, ao relembrar sua trajetória, é a de utilizar a pedagogia do exemplo. Prof. Júlio Croce, um exemplo de alergista a ser lembrado e seguido.

Physician and professor Júlio Croce was one of the greatest Brazilian allergists. Graduated in 1947 at the University of São Paulo (USP) Medical School, he was a pioneer in the Allergy and Immunopathology specialty in Brazil. He taught the course of Clinical Immunology and Allergy and was head of the Allergy and Immunology Service at USP Hospital das Clínicas. Later he remained working as a professor at the USP Graduate Program in Allergy and Immunopathology. As head of the Allergy and Immunology Service, he had great influence on the training of allergists who later became specialists in this field not only in Brazil but all over Latin America. Having clinical training and a close relationship with primary care areas, he dedicated part of his life to research on allergens found in Brazil, which marked the originality of his work. He investigated and published articles on several regional allergens including mites, fungi, insects, plants and foods. He was also interested in the relationship between allergies and pollution. He was an open-minded, simple man and a true Allergy diplomat. He brought together experts from Brazil and the world as a founding member of several medical societies. By welcoming residents and trainees from all parts of Brazil and Latin America, he contributed greatly to the dissemination and teaching of the Allergy specialty. He was honored by the leading allergology societies in Latin America, the United States and Europe. As witnesses of part of his life, our aim, in recalling his trajectory, is to use the pedagogy of example. Professor Júlio Croce is an example of allergist to be remembered and emulated.

Mortality due to mass Hymenoptera attacks: A serious but underrecognized public health problem in a mountainous state of India

Most deaths related to Hymenoptera are a result of immediate hypersensitivity reactions causing anaphylaxis to one or few stings. However, if the patient is exposed to a large quantity of the venom due to mass/multiple stings, massive envenomation can cause death in nonallergic individuals. Thirty-nine cases of acute kidney injury (AKI) who followed mass attacks by Hymenoptera were seen over 15 years, with a reference period between 2003 and 2017. AKI was severe; most (85%) of them required dialysis and one-third died. Mass attacks by Hymenoptera have become a serious public health problem in tropics. There is no antivenom, and treatment in such cases is supportive. Early hospitalization is vital to reduce morbidity and mortality.

Falla multiorgánica secundaria a múltiples picaduras de abeja (Apis mellifera). Reporte de caso / Multiorgan failure secondary to multiple bee stings (Apis mellifera). Case report

Resumen Antecedentes: Las picaduras de abejas producen el mayor número de accidentes en muchos países. Se han descrito manifestaciones sistémicas inusuales tras la exposición al veneno de himenópteros. Con menor frecuencia se han documentado complicaciones neurológicas, infarto del miocardio, rabdomiólisis e insuficiencia renal. Este tipo de reacciones alérgicas sistémicas se producen en 0.3-7.5% de la población. Caso clínico: Varón de 39 años, talador, procedente de zona rural de Comayagua, Honduras, con historia de sufrir múltiples picaduras por abeja (Apis mellifera) acompañado de síncope, con trauma en región frontoparietal bilateral, de 3 h de evolución, fue atendido en servicio de salud en Comayagua y trasladado al Hospital Escuela Universitario, donde se continuó manejo por anafilaxia severa y extracción de múltiples aguijones. Posteriormente inició con estridor laríngeo, cianosis y disnea, por lo que se realizó intubación endotraqueal. Al examen físico se identificó edema facial importante, múltiples lesiones y excoriaciones, patrón respiratorio irregular, picaduras generalizadas, y presencia de hipoventilación en ambos campos pulmonares. Glasgow 13/15, hiperalgesia generalizada. Exámenes de laboratorio mostraron reacción leucemoide, neutrofilia severa, hiperhemoglobinemia, aumento de azoados, enzimas hepáticas elevadas, hipoalbuminemia, trastornos hidroelectrolíticos y acidosis mixta. Posteriormente progresó a rabdomiólisis y falla multiorgánica (hemodinámica, ventilatoria, renal), y falleció 48 h después de su ingreso. Conclusión: El número de picaduras y la cantidad de veneno inoculado son factores predictores de alta mortalidad y baja sobrevida. El traslado de forma oportuna y el manejo multidisciplinario son fundamentales para determinar un buen pronóstico en estos pacientes.

Abstract Background: Bee stings produce the greatest number of accidents in many countries. Unusual systemic manifestations have been described after exposure to Hymenoptera venom. Less frequently, neurological complications, myocardial infarction, rhabdomyolysis and renal failure have been documented. This type of systemic allergic reactions occur in 0.3-7.5% of the population. Case report: A 39-year- old male, logger, from the rural área of Comayagua, Honduras, had a history of suffering multiple bee stings (Apis mellifera) with a syncopal episode, trauma in parietal-forehead bilateral region and 3 hours of evolution. He was treated at a health service in Comayagua and transferred to the University School Hospital, where treatment was continued due to severe anaphylaxis and extraction of multiple stings. Later he began with stridor, cianosis and dyspnea, so endotracheal intubation was performed. Physical examination revealed significant facial edema, multiple lesions and excoriations, irregular respiratory pattern, generalized stings, and the presence of hypoventilation in both lung fields. Glasgow 13/15, generalized hyperalgesia. Laboratory tests showed leukemoid reaction, severe neutrophilia, hyperhemoglobinemia, increased nitrogen levels, elevated liver enzymes, hypoalbuminemia, hydroelectrolytic disorders and mixed acidosis. He later progressed to multiorgan failure and rhabdomyolysis (hemodynamics, ventilatory, renal), and died 48 hours after admission. Conclusion: The number of bites and the amount of poison inoculated are predictive factors of high mortality and low survival. The transfer in a timely manner and multidisciplinary management are essential to determine a good prognosis in these patients.

Hymenoptera stings in Brazil: a neglected health threat in Amazonas State

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.

FORMIGAS E VESPAS COMO PROBLEMA DE SAÚDE PÚBLICA / ANTS AND WASPS AS A PUBLIC HEALTH PROBLEM / LAS HORMIGAS Y AVISPAS COMO UN PROBLEMA DE SALUD PÚBLICA

Os acidentes com os himenópteros são poucos incidentes no Brasil e normalmente possuem evolução benigna, no entanto casos graves com evolução para choque anafilático e óbito já foram registrados. Neste contexto torna-se primordial a construção de conhecimentos sobre esse risco de acidentes e gravidades, principalmente no que tange a população, para identificar os riscos e procurar os serviços de saúde precocemente, assim como para os profissionais de saúde, para que estejam preparados para propiciar uma assistência de qualidade. Ainda é primordial a discussão acerca da efetivação das notificações das ocorrências, pois assim os acidentes com vespas e formigas serão registrados promovendo o conhecimento sobre a real dimensão do problema no país.

Accidents with hymenoptera are few incidents in Brazil and usually have benign evolution, however severe cases with evolution to anaphylactic shock and death have already been recorded. In this context, it is essential to build knowledge about this risk of accidents and seriousness, especially with regard to the population to identify the risk and to seek health services early, both for health professionals, so that they are prepared to Quality assistance. It is still essential to discuss the effectiveness of the notifications of the occurrences, as thus the accidents with wasps and ants will be registered, promoting the knowledge about the real dimension of the problem in the country.

Os acidentes com os himenópteros son pocos incidentes no Brasil y normalmente la evolución benigna, no obstante graves casos con la evolución de la anestesia y el óbito ya se registró. Este contexto se convierte en primordial en la construcción de conocimientos sobre el riesgo de las enfermedades y las gravedad, principalmente en la búsqueda de la población para identificar el riesgo y la búsqueda de los servicios de salud precocemente, tanto para los profesionales de la salud, Asistencia de calidad Ainda é primordial una discusión acerca de la efectividad de las notificaciones de las sucesiones, así como los acidentes con las vespas y las formigas.

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.

Inmunoterapia con alérgenos: mecanismos de acción, impacto terapéutico y socioeconómico Consenso de la Asociación Colombiana de Alergias, Asma e Inmunología / Allergen immunotherapy: Mechanisms of action, and therapeutic and socioeconomic impact Consensus of the Asociación Colombiana de Alergia, Asma e Imunología

Las alergias constituyen un conjunto de enfermedades de gran prevalencia. Cuando los procesos alérgicos no se controlan, pueden poner en peligro la salud e, incluso, la vida de los pacientes y, además, su efecto económico y social es considerable. El objetivo de esta revisión es presentar un consenso práctico de la información científica disponible sobre el empleo de la inmunoterapia en las enfermedades alérgicas con la colaboración de varios institutos y universidades de Colombia, por solicitud de la Asociación Colombiana de Alergia, Asma e Inmunología. La revisión incluyó aspectos prácticos presentados desde el punto de vista de médicos generales, alergólogos, inmunólogos, internistas y pediatras con experiencia en el campo de las alergias. Con base en la evidencia científica actual a nivel nacional e internacional, se describió de forma detallada en qué consiste la inmunoterapia, sus indicaciones, contraindicaciones y sus beneficios para la salud, así como en el ámbito socioeconómico. Se concluyó que la inmunoterapia es efectiva y segura, y que, además, puede reducir sustancialmente el costo del tratamiento global de los pacientes alérgicos.

Allergies comprise a set of highly prevalent diseases. When allergic processes are not controlled, they can endanger patients´ health and lives, and have an important economic and social impact. The aim of this paper is to present a practical consensus of the scientific evidence on the use of immunotherapy in allergic diseases. A collaborative review made by various institutes and universities in Colombia was carried out upon request of the Asociación Colombiana de Alergia, Asma e Imunología , led by general practitioners, allergists, immunologists, internists and paediatricians with experience in the field of allergies. As a result, based on current national and international scientific evidence, we describe in detail what immunotherapy is about, its indications, contraindications and its economic and health benefits. Conclusions show immunotherapy as a clinically effective and safe treatment, which can substantially reduce the cost of the overall treatment of allergic patients.

<b>Five Cases of Hymenoptera Stings and Centipede Bites Treated with Ourengedokuto and </b><b>Inchingoreisan</b> / 日本東洋医学雑誌

<p>We report five cases of painful swelling caused by hymenoptera stings and centipede bites treated with <i>ourengedokuto </i>and <i>inchingoreisan </i>soon after the time of injury. The first case was a 70-year-old male. He was stung by a hornet on the left hand 30 minutes prior. The second case was a 45-year-old male. He was stung by a hornet on the left face 20 minutes prior. The third case was a 55-year-old male. He was stung by a hornet on the left lower thigh 10 minutes prior. The fourth case was a 39-year-old male. He was stung by a hornet on the right thigh 60 minutes prior. The fifth case was a 35-year-old male. He was bitten by a centipede on the right first toe 20 minutes prior. All cases received Kampo therapies immediately and continued them every few hours. In all cases, their pain, redness and swelling at the site of injury were relieved by the next day. We consider Kampo therapies can contribute to the healing of hymenoptera stings and centipede bites at an early stage.</p>