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Govardhan C, Rn P, D'Souza F. Cerebral Infarction Following a Wasp Sting. Indian J Pediatr 2023:10.1007/s12098-023-04908-y. [PMID: 37919489 DOI: 10.1007/s12098-023-04908-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Chaitra Govardhan
- Department of Pediatrics, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
| | - Poornima Rn
- Department of Pediatrics, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Fulton D'Souza
- Department of Pediatrics, St. John's Medical College Hospital, Bengaluru, Karnataka, India
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Wang Y, Kang H, Jin M, Wang G, Ma W, Liu Z, Xue Y, Li C. Phenotypic and Transcriptomics Analyses Reveal Underlying Mechanisms in a Mouse Model of Corneal Bee Sting. Toxins (Basel) 2022; 14:toxins14070468. [PMID: 35878206 PMCID: PMC9323056 DOI: 10.3390/toxins14070468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Corneal bee sting (CBS) is one of the most common ocular traumas and can lead to blindness. The ophthalmic manifestations are caused by direct mechanical effects of bee stings, toxic effects, and host immune responses to bee venom (BV); however, the underlying pathogenesis remains unclear. Clinically, topical steroids and antibiotics are routinely used to treat CBS patients but the specific drug targets are unknown; therefore, it is imperative to study the pathological characteristics, injury mechanisms, and therapeutic targets involved in CBS. In the present study, a CBS injury model was successfully established by injecting BV into the corneal stroma of healthy C57BL/6 mice. F-actin staining revealed corneal endothelial cell damage, decreased density, skeletal disorder, and thickened corneal stromal. The terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) assay showed apoptosis of both epithelial and endothelial cells. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that cytokine–cytokine interactions were the most relevant pathway for pathogenesis. Protein–protein interaction (PPI) network analysis showed that IL-1, TNF, and IL-6 were the most relevant nodes. RNA-seq after the application of Tobradex® (0.3% tobramycin and 0.1% dexamethasone) eye ointment showed that Tobradex® not only downregulated relevant inflammatory factors but also reduced corneal pain as well as promoted nerve regeneration by repairing axons. Here, a stable and reliable model of CBS injury was successfully established for the first time, and the pathogenesis of CBS and the therapeutic targets of Tobradex® are discussed. These hub genes are expected to be biomarkers and therapeutic targets for the diagnosis and treatment of CBS.
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Affiliation(s)
- Yanzi Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Honghua Kang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Mengyi Jin
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Guoliang Wang
- School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China;
| | - Weifang Ma
- Department of Ophthalmology, No.4 West China Teaching Hospital, Sichuan University, Chengdu 610041, China;
| | - Zhen Liu
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
| | - Yuhua Xue
- School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China;
- Correspondence: (Y.X.); (C.L.); Tel./Fax: +86-592-2189698 (Y.X.)
| | - Cheng Li
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
- Correspondence: (Y.X.); (C.L.); Tel./Fax: +86-592-2189698 (Y.X.)
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Liu Y, Shu H, Long Y, Nie X, Tang H, Tu L, Zhang H, Qiu G, He D, Huang Q, Zhang Q, Qing S, Xu D, Xia H. Development and internal validation of a Wasp Sting Severity Score to assess severity and indicate blood purification in persons with Asian wasp stings. Clin Kidney J 2022; 15:320-327. [PMID: 35145646 PMCID: PMC8825213 DOI: 10.1093/ckj/sfab201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background In recent years, the incidence of wasp sting has increased annually in China. Organ damage and high mortality due to mass wasp envenomation remain major challenges. Timely and appropriate medical intervention can improve survival. However, there are currently no normalized tools for early assessment of severity. Methods The clinical data of wasp sting patients hospitalized from 2011 to 2019 were used as a training set. Logistic regression was used to explore major risk factors for the development of a severe case of wasp sting (SC). The Wasp Sting Severity Score (WSS) was determined considering these risk factors to identify SCs and was tested in a validation dataset that was prospectively collected in 2020. Results The data of 1131 wasp sting patients from 2011 to 2019 were included in the training set. Logistic regression analysis showed that tea-colored urine, number of stings, and lactate dehydrogenase and total bilirubin levels were risk factors for developing an SC. The WSS was developed considering these four risk factors, and the total possible WSS was 20 points. The WSS was tested using the validation dataset, comprising the data of 153 patients, in 2020, and we found that a WSS ≥3 points was an important indication for blood purification, with a sensitivity of 71.9%, specificity of 92.6% and an area under the curve of 0.918 (95% confidence interval 0.873–0.962). Among patients with more than 30 stings, mortality in those who underwent plasma exchange (PE) within 24 h after admission was significantly lower than that in those who did not receive PE treatment (14.3% versus 46.9%, P = 0.003). However, continuous venovenous hemofiltration (CVVH) (P = 0.317) and hemoperfusion (HP) (P = 0.869) did not significantly reduce mortality. Conclusions Patients with WSS scores ≥3 should be considered for blood purification as early as possible in addition to routine treatment. In addition, PE is better than CVVH and HP at reducing mortality in patients suffering from severe wasp stings.
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Affiliation(s)
- Yong Liu
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Hongmei Shu
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Youlin Long
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaoqin Nie
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Hongfu Tang
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Lang Tu
- Department of Critical Care Medicine, Shehong People's Hospital, Sichuan Province, China
| | - Hao Zhang
- Department of Critical Care Medicine, Shehong People's Hospital, Sichuan Province, China
| | - Gang Qiu
- Department of Critical Care Medicine, Pengxi County People's Hospital, Sichuan Province, China
| | - Daihua He
- Department of Critical Care Medicine, Pengxi County People's Hospital, Sichuan Province, China
| | - Qiang Huang
- Department of Critical Care Medicine, Daying County People's Hospital, Sichuan Province, China
| | - Qi Zhang
- Department of Critical Care Medicine, Daying County People's Hospital, Sichuan Province, China
| | - Shuang Qing
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Donglin Xu
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Hongtao Xia
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
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Yang S, Wellington J, Chen J, Regenhardt RW, Chen AY, Li G, Yan Z, Fu P, Hu Z, Chen Y. Cerebral infarction following bee stings: Case report and literature review. Transl Neurosci 2022; 13:163-171. [PMID: 35860807 PMCID: PMC9267306 DOI: 10.1515/tnsci-2022-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background To date, only 25 cases of cerebral infarction following a bee or wasp sting have been reported. Due to its rarity, undefined pathogenesis, and unique clinical features, we report a case of a 62-year-old man with progressive cerebral infarction following bee stings, possibly related to vasospasm. Furthermore, we review relevant literature on stroke following bee or wasp stings. Case presentation A 62-year-old retired male presented with progressive ischemic stroke after bee stings to the ear and face. Initial magnetic resonance imaging of the brain showed small punctate infarcts in the left medulla oblongata. Head and neck computed tomography angiography showed significant stenosis in the basilar artery and occlusion in the left V4 vertebral artery. The patient received intravenous alteplase (0.9 mg/kg) without symptomatic improvement. Digital subtraction angiography later demonstrated additional near occlusion in the left posterior cerebral artery (PCA). Thrombectomy was considered initially but was aborted due to hemodynamic instability. Repeated CT brain after 24 h showed acute infarcts in the left parieto-occipital region and left thalamus. The near occluded PCA was found to be patent again on magnetic resonance angiography (MRA) 25 days later. This reversibility suggests that vasospasm may have been the underlying mechanism. Unfortunately, the patient had persistent significant neurological deficits after rehabilitation one year later. Conclusion Cerebral infarction following bee stings is rare. There are several proposed pathophysiological mechanisms. While the natural course of this phenomenon is not well characterized, early diagnosis and treatment are essential. Furthermore, it is important to establish standardized care procedures for this unique entity.
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Affiliation(s)
- Shuiquan Yang
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Jack Wellington
- School of Medicine, Cardiff University, Wales, United Kingdom
| | - Juanmei Chen
- The Second Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Alex Y Chen
- Department of Neurology, University Hospital, Case Western Reserve University, Cleveland, United States of America
| | - Guilan Li
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Zile Yan
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Pingzhong Fu
- Department of Radiology, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Zhaohui Hu
- Medical Department and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
| | - Yimin Chen
- Department of Neurology and National Advanced Stroke Center, Key Discipline of Traditional Chinese Medicine of Guangdong Province, Foshan Sanshui District People's Hospital, Foshan, Guangdong Province, China
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Karri M, Ramasamy B, Perumal S, Kannan KT. Wasp sting - Causing a fatal menace. Brain Circ 2021; 7:132-134. [PMID: 34189358 PMCID: PMC8191535 DOI: 10.4103/bc.bc_33_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/15/2022] Open
Abstract
Wasp stings are seen routinely in emergency setup, especially in developing countries. They result in varied manifestations, including both local and systemic reactions. Neurological complications, like stroke, are infrequent in the presentation. A 40-year-old healthy male presented with two episodes of generalized tonic-clonic seizures with left dense hemiplegia after 6 h of massive wasp stings. Local manifestations of urticaria, redness, and itching were present over the face, neck, and upper limbs. Magnetic resonance imaging showed massive infarct in the anterior and middle cerebral artery regions with right internal carotid artery thrombosis. An echocardiogram showed severe left ventricular dysfunction with no evidence of clot, and the carotid duplex study was normal. Systemic manifestations such as anaphylactic shock, stroke, and myocarditis are rare, fatal, and life-threatening. We must be aware of these most unusual and possible complications following a hymenopteran sting.
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Affiliation(s)
- Madhavi Karri
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Balakrishnan Ramasamy
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Santhosh Perumal
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Karthik Thamarai Kannan
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Velayutham SS, Abhishek BR, Jeyaraj KM, Sowmini PR, Kumar MS, Sarvanan SV, Mugundhan K. Thrombolysis in ischemic stroke after bee sting: A rare scenario. Ann Indian Acad Neurol 2021; 24:985-986. [PMID: 35359526 PMCID: PMC8965970 DOI: 10.4103/aian.aian_770_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/04/2022] Open
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Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176162. [PMID: 32854269 PMCID: PMC7504193 DOI: 10.3390/ijerph17176162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022]
Abstract
Background: Hymenopteran stings are the most common animal insult injury encountered in the emergency department. With increasing global spread of imported fire ants in recent decades, the rate of Formicidae assault has become a serious problem in many countries. Formicidae-associated injuries gradually increased in Taiwan in recent decades and became the second most common arthropod assault injury in our ED. The present study aimed at comparing the clinical characteristics of Formicidae sting patients with those of the most serious and common group, Vespidae sting patients, in an emergency department (ED) in Taiwan. Methods: This retrospective study included patients who were admitted between 2015 to 2018 to the ED in a local teaching hospital in Taiwan after a Vespidae or Formicidae sting. Cases with anaphylactic reaction were further compared. Results: We reviewed the records of 881 subjects (503 males, 378 females; mean age, 49.09 ± 17.62 years) who visited our emergency department due to Vespidae or Formicidae stings. A total of 538 (61.1%) were categorized into the Vespidae group, and 343 (38.9%) were sorted into the Formicidae group. The Formicidae group had a longer ED length of stay (79.15 ± 92.30 vs. 108.00 ± 96.50 min, p < 0.01), but the Vespidae group had more cases that required hospitalization (1.9% vs. 0.3%, p = 0.04). Antihistamines (76.8% vs. 80.2%, p < 0.01) were more frequently used in the Formicidae group, while analgesics were more frequently used in the Vespidae group (38.1% vs. 12.5%, p < 0.01). The Vespidae group had more local reactions, and the Formicidae group had more extreme, systemic, or anaphylactic allergic reactions. Creatine kinase was significantly higher in the Vespidae group with an anaphylactic reaction. Sting frequency in both groups exhibited the same positive associations with average temperature of the month and weekend days. Conclusion: Formicidae sting patients presented to the ED with higher rate allergic reactions and spent more time in the ED than Vespidae sting patients. However, Vespidae sting patients had more complications and higher rates of admission, especially with anaphylactic reaction. Laboratory data, especially creatine kinase data, were more valuable to check in Vespidae sting patients with an anaphylactic reaction in the ED. Both groups exhibited positive correlations with temperature and a higher rate on weekend days.
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Anastogiannis H, Litsardopoulos P, Anastopoulou GG, Petsas A, Tsigkas G, Kounis NG, Ravani I, Argyriou AA. Irreversible diffuse hypoxic-ischemic encephalopathy, secondary to type I Kounis syndrome. Int J Neurosci 2019; 130:746-748. [PMID: 31814489 DOI: 10.1080/00207454.2019.1702541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We herein describe the unusual case of irreversible diffuse hypoxic-ischemic encephalopathy secondary to type I Kounis syndrome. The patient survived and remained in a vegetative state after being mechanically ventilated in the intensive care unit for long. A brief review of the literature on mechanisms for KS-associated brain injury is also presented.
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Affiliation(s)
| | | | | | - Andreas Petsas
- Intensive Care Unit, Saint Andrew's State General Hospital of Patras, Patras, Greece
| | - Grigorios Tsigkas
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Nicholas G Kounis
- Department of Cardiology, University of Patras Medical School, Patras, Greece
| | - Ifigenia Ravani
- Intensive Care Unit, Saint Andrew's State General Hospital of Patras, Patras, Greece
| | - Andreas A Argyriou
- Department of Neurology, Saint Andrew's State General Hospital of Patras, Patras, Greece
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Reis J. Environmental Risk Factors for Stroke and Cardiovascular Disease. ENCYCLOPEDIA OF CARDIOVASCULAR RESEARCH AND MEDICINE 2018. [PMCID: PMC7150018 DOI: 10.1016/b978-0-12-809657-4.64111-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Besides the classical individual stroke risk factors a new class has appeared, the environmental risk factors. After a review of the evidences demonstrating that air pollution is a potent risk factor (Part 1), we propose an update of other physical, chemical, and biological factors, now considered as risk factors (Part 2). One of the challenges is to precise their specific roles as they can be combined in their noxious impacts (traffic air pollution + noise + weather + infections). This knowledge has practical consequences; From now on, medical advices cannot be limited to individual recommendations but must also deal with environmental public health issues.
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Mirijello A, Pepe G, Zampiello P, Manfrini A. Ischemic Stroke After Wasp Sting: Another Manifestation of Kounis Syndrome? J Emerg Med 2017; 52:e215. [PMID: 28256353 DOI: 10.1016/j.jemermed.2016.09.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Antonio Mirijello
- Department of Emergency Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Gaetano Pepe
- Department of Emergency Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Patrizio Zampiello
- Department of Emergency Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy
| | - Antonio Manfrini
- Department of Emergency Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy
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