A Rare Case of Micro-Angiopathic Hemolytic Anemia Due to Envenoming by Giant Asian Honey Bee (Apis dorsata).

Giant Asian honey bee sting envenoming is a recognized cause of morbidity and mortality in rural Sri Lanka. Mass envenoming causes clinical effects, either as allergic and anaphylactic reactions or bee sting toxin-induced multiorgan damage. We report a patient who had mass envenoming from more than 1000 stingers who subsequently developed hematologic features suggestive of thrombotic microangiopathy-related hemolytic anemia. The transient acute kidney injury and acute hepatic failure seen in the patient were also considered to be secondary to thrombotic microangiopathy. A normal clotting profile and a high proportion of schistocytes in blood film ruled out disseminated intravascular coagulation as the underlying cause of the microangiopathic hemolytic anemia. The normal platelet count raised the possibility of a "partial" thrombotic microangiopathy, as has previously been reported in association with Shiga toxin-related hemolytic uremic syndrome and hump-nosed pit viper envenoming. Venom-induced direct toxicity on red cells was another possible explanation for the hemolysis, but the high proportion of schistocytes made it less likely. The place of therapeutic plasma exchange for venom-associated thrombotic microangiopathy is controversial. The patient recovered with symptomatic treatment and meticulous fluid management, without needing therapeutic plasma exchange as an adjunct treatment.

Evaluation of Development Datasets for Hermetia illucens (L.) (Diptera: Stratiomyidae) for Estimating the Time of Placement of Human and Swine Remains in Texas, USA.

A basic tenet of forensic entomology is development data of an insect can be used to predict the time of colonization (TOC) by insect specimens collected from remains, and this prediction is related to the time of death and/or time of placement (TOP). However, few datasets have been evaluated to determine their accuracy or precision. The black soldier fly, Hermetia illucens (L.) (Diptera: Stratiomyidae) is recognized as an insect of forensic importance. This study examined the accuracy and precision of several development datasets for the black soldier fly by estimating the TOP of five sets of human and three sets of swine remains in San Marcos and College Station, TX, respectively. Data generated from this study indicate only one of these datasets consistently (time-to-prepupae 52%; time-to-eclosion 75%) produced TOP estimations that occurred within a day of the actual TOP of the remains. It is unknown if the precolonization interval (PreCI) of this species is long, but it has been observed that the species can colonize within 6 d after death. This assumption remains untested by validation studies. Accounting for this PreCI improved accuracy for the time-to-prepupae group, but reduced accuracy in the time-to-eclosion group. The findings presented here highlight a need for detailed, forensic-based development data for the black soldier fly that can reliably and accurately be used in casework. Finally, this study outlines the need for a basic understanding of the timing of resource utilization (i.e., duration of the PreCI) for forensically relevant taxa so that reasonable corrections may be made to TOC as related to minimum postmortem interval (mPMI) estimates.

First Reported Case of Fatal Stinging by the Large Carpenter Bee Xylocopa tranquebarica.

In the order Hymenoptera, bees, hornets, and wasps are well-known stinging insects whose envenoming can be fatal. Their stinging attacks are common in rural and forested areas of Sri Lanka. However, fatal stinging by the large-bodied carpenter bees is unreported. We report the first known case of a fatal sting by the large carpenter bee, Xylocopa tranquebarica, in a forested area in Puttalam (North Western Province) in the dry zone of Sri Lanka. A 59-year-old healthy male manual laborer accompanied by a fellow worker had been fixing a fence on a coconut estate bordering a forested area when a flying insect emerged from a dead tree trunk and stung him on his face. His coworker, who was watching the incident, killed the insect. The victim complained of immediate intense pain in the face and collapsed on the ground just after resuming work after 10 minutes of resting. He was found dead on admission to the hospital 90 minutes later. Autopsy showed normal coronary arteries and heart, but the lungs were slightly congested and contained secretions in the bronchi. Acute anaphylaxis was the most likely cause of death. This case presents the habitat, morphology, attack pattern, and the medical importance of large carpenter bees.