Anaphylaxis and delayed hymenoptera in a child with fire ant envenomation

Natural toxins and One Health: a review

Background

The One Health concept considers the interconnectivity, interactions and interdependence of humans, animals and the environment. Humans, animals and other organisms are constantly exposed to a wide range of natural toxins present in the environment. Thus, there is growing concern about the potential detrimental effects that natural toxins could pose to achieve One Health. Interestingly, alkaloids, steroids and bioactive peptides obtained from natural toxins could be used for the development of therapeutic agents.

Methodology

Our literature search focused on the following keywords; toxins, One Health, microbial toxins, mycotoxins, phytotoxins, phycotoxins, insect toxins and toxin effects. Google Scholar, Science Direct, PubMed and Web of Science were the search engines used to obtain primary databases. We chose relevant full-text articles and review papers published in English language only. The research was done between July 2022 and January 2023.

Results

Natural toxins are poisonous substances comprising bioactive compounds produced by microorganisms, invertebrates, plants and animals. These compounds possess diverse structures and differ in biological function and toxicity, posing risks to human and animal health through the contamination of the environment, causing disease or death in certain cases. Findings from the articles reviewed revealed that effects of natural toxins on animals and humans gained more attention than the impact of natural toxins on the environment and lower organisms, irrespective of the significant roles that lower organisms play to maintain ecosystem balance. Also, systematic approaches for toxin control in the environment and utilization for beneficial purposes are inadequate in many regions. Remarkably, bioactive compounds present in natural toxins have potential for the development of therapeutic agents. These findings suggest that global, comprehensive and coordinated efforts are required for improved management of natural toxins through an interdisciplinary, One Health approach.

Conclusion

Adopting a One Health approach is critical to addressing the effects of natural toxins on the health of humans, animals and the environment.

Acute Rhabdomyolysis in a Child with Multiple Suspicious Gene Variants

Rhabdomyolysis is diagnosed with creatinine kinase (CK) elevation beyond 1000 U/L or ten times above the normal upper limit. Severe episodes can be fatal from electrolyte imbalance, acute renal failure, and disseminated intravascular coagulation. A 13-month-old child was admitted with a CK of 82,090 U/L in the setting of respiratory tract infection-related hyperthermia of 106.9° farenheit. His medical history was significant for prematurity, dystonia, and recurrent rhabdomyolysis. His home medications clonazepam, clonidine, and baclofen were continued upon admission. He exhibited uncontrolled dystonia despite treatment for dystonia. Therefore, sedative infusions and forced alkaline diuresis were begun to prevent heme pigment-induced renal injury. Despite these interventions, his CK peaked at 145,920 U/L, which is rarely reported in this age group. The patient also developed pulmonary edema despite diuresis and required mechanical ventilation. Sedative infusions were not enough for dystonia management, and he needed the addition of a neuromuscular blocking infusion. He finally responded to these interventions, and the CK normalized after a month. He required a month of mechanical ventilation and two and a half months of hospitalization and extensive rehabilitation. We were able to avert renal replacement therapy despite pulmonary edema and an estimated glomerular filtration rate nadir of 21 mL/min/1.73 m2 based on the bedside Schwartz formula. He made a complete recovery and was discharged home. His growth and development were satisfactory for two years after that event. His extensive diagnostic workup was negative. Unfortunately, he died from septic and cardiogenic shock with mild rhabdomyolysis two years later. Prompt recognition, early institution of appropriate therapies, identification of underlying disease, and triggering events are pivotal in rhabdomyolysis management. Evidence-based guidelines are needed in this context.

Clinical Characteristics of Allergy to Hymenoptera Stings

OBJECTIVE

The purpose of this study was to evaluate the clinical characteristics of allergy to stings from the Hymenoptera order of insects in a hospital in Thailand.

METHODS

A descriptive retrospective analytical study was carried out in inpatients and outpatients suffering from Hymenoptera stings from 2009 to 2013 in Siriraj Hospital.

RESULTS

Medical records of 386 patients with an allergy to Hymenoptera stings were evaluated. Anaphylaxis was more common in patients younger than 15 years, who comprised 22.3% of patients in this study. The most common sting type was from wasps (58.3%). Eighty-five percent of patients sought medical treatment less than 24 hours after being stung. A systemic reaction and anaphylaxis were found in 9.9% and 4.4% of subjects, respectively. In 17 patients with anaphylaxis, only 11 patients (64.7%) received an epinephrine (adrenaline) injection as treatment, and only 8 (47.1%) received epinephrine autoinjectors or epinephrine-prefilled syringes to prevent a possible subsequent severe reaction. Significantly more patients younger than 15 years received epinephrine for prevention of an allergic reaction than did those older than 15 years (87.5% vs 11.7%, P < 0.001). Antibiotics were given to 43.0% of patients.

CONCLUSIONS

Anaphylaxis from Hymenoptera stings was more common in children than in adults. Only half of the patients visited the emergency room within 1 hour of being stung. Overuse of antibiotics and underuse of epinephrine were found. More information about Hymenoptera stings should be provided to the public, and the use of epinephrine should be encouraged in the case of severe reactions and anaphylaxis.