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Muacevic A, Adler JR, Acharya S, Kumar S, Sawant R. Acute Ischemic Stroke Post Honeybee Sting: A Rare Case Report. Cureus 2022; 14:e31851. [PMID: 36579284 PMCID: PMC9792332 DOI: 10.7759/cureus.31851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/24/2022] [Indexed: 11/25/2022] Open
Abstract
Stings by bees or wasps are frequent worldwide. From minor urticaria to severe anaphylaxis, allergic symptoms are typically present. Various reports of unexpected reactions to bee stings affecting the neurological, renal, cardiac, pulmonary, and ocular systems have been published. Here, we present a rare instance of subacute bee sting syndrome that resulted in an ischemic stroke over a 24-hour period.
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Turner K, Boyd C, Rossi G, Sharp CR, Claus MA, Francis A, Smart L. Allergy, inflammation, hepatopathy and coagulation biomarkers in dogs with suspected anaphylaxis due to insect envenomation. Front Vet Sci 2022; 9:875339. [PMID: 36003410 PMCID: PMC9393546 DOI: 10.3389/fvets.2022.875339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare concentrations of biomarkers of; allergy [mast cell tryptase (MCT) and histamine], inflammation [interleukin (IL)-6,-10, and-18, CXCL8, CCL2, keratinocyte chemoattractant (KC), C-reactive protein (CRP)], endothelial glycocalyx shedding (hyaluronan), coagulation [prothrombin time, activated partial thromboplastin time, fibrinogen concentration, and von Willebrand Factor antigen, protein C (PC) and antithrombin (AT) activity], and hepatopathy [alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and total bilirubin] between dogs with anaphylaxis after suspected insect exposure, dogs with critical illness, and healthy dogs. Design This was a single center prospective clinical observational comparative biomarker study that included 25 dogs with anaphylaxis (evidence of insect exposure, acute dermatological signs, and other organ involvement), 30 dogs with other critical illness, and 20 healthy dogs. Differences across groups in biomarker concentrations were tested using one-way ANOVA or Kruskal-Wallis test, with significant P values (<0.05) reported for pairwise differences detected by post-hoc tests. Logistic regression models were used to calculate the area under the receiver operator characteristic curve (AUROC) for discrimination between anaphylaxis and non-anaphylactic illness. Results Histamine concentration was significantly higher in the anaphylaxis group than the healthy (P < 0.001) and critically ill groups (P < 0.001), whereas no differences in MCT were detected amongst groups. Biomarker concentrations that were increased relative to healthy dogs in both the anaphylaxis and critically ill groups included IL-10 (P < 0.001 and P = 0.007, respectively), CCL2 (P = 0.007 and P < 0.001, respectively) and AST (both P < 0.001), whereas only the critically ill group had significantly increased CRP (P < 0.001), IL-6 (P < 0.001), KC (P < 0.001), ALP (P < 0.001), and fibrinogen (P = 0.016) concentrations, compared to the healthy group. Only dogs with anaphylaxis had significantly higher hyaluronan (P = 0.021) and ALT (P = 0.021) concentrations, and lower PC (P = 0.030) and AT (P = 0.032) activities, compared to healthy dogs. Both CRP and histamine concentration showed good discrimination between anaphylaxis and other critical illness, with an AUROC of 0.96 (95% CI 0.91-1) and 0.81 (95% CI 0.69-0.93), respectively. Conclusions This preliminary study in dogs with anaphylaxis after suspected insect exposure, found evidence of an early innate immune response, glycocalyx shedding and anticoagulant consumption. Both CRP and histamine showed potential clinical utility for differentiation between anaphylaxis and other critical illness.
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Affiliation(s)
- Kate Turner
- Emergency and Critical Care Department, School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | - Corrin Boyd
- Emergency and Critical Care Department, School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | - Gabriele Rossi
- Veterinary Pathology Department, School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | - Claire R. Sharp
- Emergency and Critical Care Department, School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
- Harry Butler Institute, Murdoch University, Perth, WA, Australia
| | - Melissa A. Claus
- Emergency and Critical Care Department, School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
| | - Abbie Francis
- Telethon Kids Cancer Centre, Telethon Kids Institute, Nedlands, WA, Australia
- Discipline of Pediatrics, Medical School, The University of Western Australia, Nedlands, WA, Australia
| | - Lisa Smart
- Emergency and Critical Care Department, School of Veterinary Medicine, Murdoch University, Perth, WA, Australia
- Emergency and Critical Care Department, Small Animal Specialist Hospital, North Ryde, NSW, Australia
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Turner K, Boyd C, Stander N, Smart L. Clinical characteristics of two-hundred thirty-two dogs (2006-2018) treated for suspected anaphylaxis in Perth, Western Australia. Aust Vet J 2021; 99:505-512. [PMID: 34541658 DOI: 10.1111/avj.13114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 05/28/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the clinical features of dogs treated for suspected anaphylaxis in Perth, Western Australia. DESIGN Single-centre observational case series with retrospective and prospective phases. METHODS This was a two-phase study of dogs with clinical suspicion of anaphylaxis presenting to the emergency service of a university teaching hospital. Dogs required evidence of, and appropriate treatment of, a type 1 hypersensitivity reaction as well as two or more organs affected (or cardiovascular signs alone) to be included. Phase 1 includes retrospective case series of 186 dogs (March 2006-December 2018). Phase 2 includes prospective descriptive case series of 46 dogs (October 2017-July 2018) focused on clinical signs. RESULTS In phase 1, 88 (47%) dogs had evidence of insect exposure prior to the acute event. One hundred forty (75%) dogs had dermatological signs, 141 (76%) had gastrointestinal signs and 129 (69%) had cardiovascular signs. Ninety-two (49%) dogs had vasoconstrictive shock (5 with bradycardia), 24 (13%) had vasodilatory shock, 8 (4%) had mixed vasodilatory and vasoconstrictive shock and 5 (3%) had unclassifiable shock. On focused abdominal ultrasound, 42 of 71 (59%) dogs had gallbladder wall oedema and 3 of 71 (4%) dogs had peritoneal free fluid. In phase 2, the distributions of insect exposure, organ dysfunction and sonographic abnormalities were similar to phase 1. CONCLUSION Dogs presenting with suspected anaphylaxis showed a broad range of presentations. Dermatological signs were absent in a proportion of dogs, vasoconstrictive shock was more frequent than vasodilatory and unique features of shock were identified. This study highlights the challenges of diagnosis based on presenting features alone.
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Affiliation(s)
- K Turner
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - C Boyd
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
| | - N Stander
- Vet Imaging Specialists, The Animal Hospital at Murdoch University, Perth, Western Australia, Australia
| | - L Smart
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Western Australia, Australia
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Colthurst SMM, Simcock JO, Kisielewicz C, Hodge P, Rowan C. Spontaneous haemoperitoneum with extravasation of contrast medium on CT due to bee sting vasculitis in a dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Conor Rowan
- VetCT Cambridge UK
- University of Veterinary Medicine Vienna Austria
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Lai D, Tian Y, Zhang J, Weng CF. Hyperendogenous Heparinization Suggests a Guideline for the Management of Massive Wasp Stings in Two Victims. Wilderness Environ Med 2021; 32:344-350. [PMID: 34294538 DOI: 10.1016/j.wem.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/18/2021] [Accepted: 02/26/2021] [Indexed: 10/20/2022]
Abstract
Bees and wasps (order Hymenoptera) are commonly encountered worldwide and often deliver defensive stings when in contact with humans. Massive envenomation resulting from >50 stings causes a toxic reaction and life-threatening complications that typically result in rhabdomyolysis and disseminated intravascular coagulation. Two male patients who were stung over 80 times by wasps experienced severe coagulation abnormality. Consecutive examination by thromboelastography (TEG) guided by heparinase treatment during their hospitalization evidenced heparin-like coagulation dysfunction despite no clinical use of heparin-like substances. Numerous tests were also conducted to confirm whether the coagulation abnormalities could be attributed to hyperendogenous heparinization and allergic reaction, rhabdomyolysis, and vascular endothelial cell injury without apparent disseminated intravascular coagulation, which might all be affected by the production of endogenous heparin. The reduced coagulation potential caused by hyperendogenous heparinization was associated with the binding of antithrombin and the activation of fibrinolysis. In addition, TEG-identified coagulopathy was moderated using protamine for heparin neutralization. The massively envenomed patients survived and were discharged after completion of medical care. We also review clinical manifestations from other published case reports, including topical treatment. Our study provides clinical evidence and guidance for diagnosis via TEG and appropriate intervention with protamine for patients with massive wasp envenomation.
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Affiliation(s)
- Dong Lai
- Department of Transfusion, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Intensive Care Unit, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Department of Clinical Medicine, Xiamen Medical College, Xiamen, China
| | - Yan Tian
- Department of Transfusion, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Department of Clinical Medicine, Xiamen Medical College, Xiamen, China
| | - Jie Zhang
- Department of Transfusion, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China; Intensive Care Unit, the Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Ching-Feng Weng
- Department of Physiology, School of Basic Medical Science, Xiamen Medical College, Xiamen, China.
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CLINICAL OBSERVATIONS OF BEE ENVENOMATION IN TOUCANS. J Zoo Wildl Med 2021; 52:787-794. [PMID: 34130427 DOI: 10.1638/2020-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/21/2022] Open
Abstract
There are numerous reports on envenomation, even fatal, secondary to bee attacks in humans and other mammals. In birds, reports on those incidents are scarce and there are none regarding honeybee (Apis mellifera) stings in toucans. In the first case presented, an adult female red-breasted toucan (Ramphastos dicolorus) received at least five bee stings in the periophthalmic area. Within 5 h the bird was lethargic and dehydrated. The urates were yellowish. Three days later the bird showed a moderate anemia, but no changes in the leukocyte count, beyond an elevated heterophil: lymphocyte ratio. Blood chemistry showed hyperglycemia, hypoalbuminemia and elevated aspartate aminotransferase and creatine kinase. Alterations in electrolyte values were also noted. Fourteen days later bile acid elevation was observed. Hematocrit levels normalized after 2 wk. A second incident involved a breeding pair of toco toucans (Ramphastos toco). While the female toco toucan received 10 stings and showed mild clinical manifestations, the male toco toucan was more severely attacked, receiving 40 stings, and died overnight. Despite the relative gravity of the attack (in terms of number of stingers in relation to body weight) both surviving birds recovered in less than 2 wk. To the authors' knowledge, fatal bee envenomation in birds has been reported only in pigeons and macaws. The findings described in this report suggest that toucans are less sensitive to bee venom when compared with pigeons and may have higher tolerance to bee venom compared with mammals. Honeybee envenomation must be considered a potential threat when considering toucan husbandry in zoos and collections.
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The anticoagulant effect of Apis mellifera phospholipase A 2 is inhibited by CORM-2 via a carbon monoxide-independent mechanism. J Thromb Thrombolysis 2020; 49:100-107. [PMID: 31679116 DOI: 10.1007/s11239-019-01980-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Bee venom phospholipase A2 (PLA2) has potential for significant morbidity. Ruthenium (Ru)-based carbon monoxide releasing molecules (CORM) inhibit snake venoms that are anticoagulant and contain PLA2. In addition to modulating heme-bearing proteins with carbon monoxide, these CORM generate reactive Ru species that form adducts with histamine residues resulting in changes in protein function. This study sought to identify anticoagulant properties of bee venom PLA2 via catalysis of plasma phospholipids required for thrombin generation. Another goal was to determine if Ru-based CORM inhibit bee venom PLA2 via carbon monoxide release or via potential binding of reactive Ru species to a key histidine residue in the catalytic site of the enzyme. Anticoagulant activity of bee venom PLA2 was assessed via thrombelastography with normal plasma. Bee venom PLA2 was then exposed to different CORM and a metheme forming agent and anticoagulant activity was reassessed. Using Ru, boron and manganese-based CORM and a metheme forming agent, it was demonstrated that it was unlikely that carbon monoxide interaction with a heme group attached to PLA2 was responsible for inhibition of anticoagulant activity by Ru-based CORM. Exposure of PLA2 to a Ru-based CORM in the presence of histidine-rich human albumin resulted in loss of inhibition of PLA2. Ru-based CORM likely inhibit bee venom PLA2 anticoagulant activity via formation of reactive Ru species that bind to histidine residues of the enzyme.
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de Roodt AR, Lanari LC, Lago NR, Bustillo S, Litwin S, Morón-Goñi F, Gould EG, van Grootheest JH, Dokmetjian JC, Dolab JA, Irazú L, Damin CF. Toxicological study of bee venom (Apis mellifera mellifera) from different regions of the province of Buenos Aires, Argentina. Toxicon 2020; 188:27-38. [PMID: 33007351 DOI: 10.1016/j.toxicon.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/31/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
Samples of Apis mellifera mellifera venom from different hives in two regions of the Buenos Aires province and its pool were analyzed for their lethal potency, myotoxic, defibrinogenating, hemolytic and inflammatory-edematizing activity and for the histological alterations they produce in the heart, lungs, kidneys, skeletal muscle and liver of mice. In vitro studies focused on the venom's hemolytic activity in different systems and species (horse, man, sheep and rabbit), the cytotoxicity in cellular lines, and on the proteolytic and coagulant activity in plasma and fibrinogen. Hemolytic activity, either observed in vitro or in vivo, showed similar toxicity levels for all samples. Erythrocytes of different species varied in their sensitivity to the venom pool, equines being the most sensitive and sheep the most resistant to direct hemolytic action. Local and systemic myotoxicity was evidenced by either the elevation of serum creatine kinase and/or histopathological lesions, observed in different muscles. All samples caused significant pathological alterations; pulmonary, cardiac, renal and skeletal muscle lesions were substantive and can be related to the pathophysiological mechanisms of envenomation. The venoms from different apiaries and regions of the Buenos Aires province showed very similar toxicological characteristics. These results suggest that severity of envenomation in case of a swarming could therefore be more related to the number of bees than to the differential toxicity of the venom from different regions of the province. This is the first study on the toxicity and toxicological characteristics of Apis mellifera venom in Argentina.
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Affiliation(s)
- Adolfo R de Roodt
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Argentina; Primera Cátedra de Toxicología, Facultad de Medicina, Universidad de Buenos Aires, Argentina; Centro de Patología Experimental y Aplicada, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
| | - Laura C Lanari
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Argentina
| | - Néstor R Lago
- Centro de Patología Experimental y Aplicada, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Soledad Bustillo
- Grupo de Investigaciones Biológicas y Moleculares (GIByM) - IQUIBA, Universidad Nacional del Nordeste, Corrientes, Argentina
| | - Silvana Litwin
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Argentina
| | - Fernando Morón-Goñi
- Primera Cátedra de Toxicología, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | | | - Jantine H van Grootheest
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Argentina
| | - José Ch Dokmetjian
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Argentina
| | - Jorge A Dolab
- Instituto Nacional de Producción de Biológicos, ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Argentina
| | - Lucía Irazú
- Instituto Nacional de Enfermedades Infecciosas - ANLIS "Dr. Carlos G. Malbrán", Ministerio de Salud, Argentina
| | - Carlos F Damin
- Primera Cátedra de Toxicología, Facultad de Medicina, Universidad de Buenos Aires, Argentina
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Veado HC, Conceição RS, Nogueira K, Fino TCM, Silva AS, Castro MB, Soto-Blanco B, Câmara ACL. Massive Africanized honeybee stings in two hair sheep and a mare. Toxicon 2020; 177:35-40. [PMID: 32056832 DOI: 10.1016/j.toxicon.2020.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
The findings of massive Africanized honeybee stings in two hair sheep and a mare are reported. One sheep died 15 h after attack, and the survivors developed skin necrosis on the sting sites. Pathological evaluation revealed necrosis in the dermis, degeneration of the tubular epithelial cells, and multifocal hemorrhages in heart and spleen. The massive attack by Africanized honeybees induced lesions in the skin, heart, muscles, kidneys, and lungs.
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Affiliation(s)
- Henrique C Veado
- Large Animal Veterinary Teaching Hospital, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Galpão 4, Granja do Torto, Brasília, DF 70636-200, Brazil
| | - Raffaela S Conceição
- Large Animal Veterinary Teaching Hospital, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Galpão 4, Granja do Torto, Brasília, DF 70636-200, Brazil
| | - Kaique Nogueira
- Large Animal Veterinary Teaching Hospital, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Galpão 4, Granja do Torto, Brasília, DF 70636-200, Brazil
| | - Tayná Cardim M Fino
- Large Animal Veterinary Teaching Hospital, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Galpão 4, Granja do Torto, Brasília, DF 70636-200, Brazil
| | - Anahi S Silva
- Veterinary Pathology Laboratory, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Via L4 Norte s/n, Asa Norte, Brasília, DF 70910-970, Brazil
| | - Marcio B Castro
- Veterinary Pathology Laboratory, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Via L4 Norte s/n, Asa Norte, Brasília, DF 70910-970, Brazil
| | - Benito Soto-Blanco
- Department of Veterinary Clinics and Surgery, Veterinary College, Universidade Federal de Minas Gerais, Avenida Presidente Antônio Carlos 6627, Belo Horizonte, MG 31275-013, Brazil
| | - Antonio Carlos Lopes Câmara
- Large Animal Veterinary Teaching Hospital, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Galpão 4, Granja do Torto, Brasília, DF 70636-200, Brazil.
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Perez-Riverol A, Lasa AM, Dos Santos-Pinto JRA, Palma MS. Insect venom phospholipases A1 and A2: Roles in the envenoming process and allergy. INSECT BIOCHEMISTRY AND MOLECULAR BIOLOGY 2019; 105:10-24. [PMID: 30582958 DOI: 10.1016/j.ibmb.2018.12.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/10/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
Insect venom phospholipases have been identified in nearly all clinically relevant social Hymenoptera, including bees, wasps and ants. Among other biological roles, during the envenoming process these enzymes cause the disruption of cellular membranes and induce hypersensitive reactions, including life threatening anaphylaxis. While phospholipase A2 (PLA2) is a predominant component of bee venoms, phospholipase A1 (PLA1) is highly abundant in wasps and ants. The pronounced prevalence of IgE-mediated reactivity to these allergens in sensitized patients emphasizes their important role as major elicitors of Hymenoptera venom allergy (HVA). PLA1 and -A2 represent valuable marker allergens for differentiation of genuine sensitizations to bee and/or wasp venoms from cross-reactivity. Moreover, in massive attacks, insect venom phospholipases often cause several pathologies that can lead to fatalities. This review summarizes the available data related to structure, model of enzymatic activity and pathophysiological roles during envenoming process of insect venom phospholipases A1 and -A2.
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Affiliation(s)
- Amilcar Perez-Riverol
- Center of the Study of Social Insects, Department of Biology, Institute of Biosciences of Rio Claro, São Paulo State University (UNESP), Rio Claro, SP, 13500, Brazil
| | - Alexis Musacchio Lasa
- Center for Genetic Engineering and Biotechnology, Biomedical Research Division, Department of System Biology, Ave. 31, e/158 and 190, P.O. Box 6162, Cubanacan, Playa, Havana, 10600, Cuba
| | - José Roberto Aparecido Dos Santos-Pinto
- Center of the Study of Social Insects, Department of Biology, Institute of Biosciences of Rio Claro, São Paulo State University (UNESP), Rio Claro, SP, 13500, Brazil
| | - Mario Sergio Palma
- Center of the Study of Social Insects, Department of Biology, Institute of Biosciences of Rio Claro, São Paulo State University (UNESP), Rio Claro, SP, 13500, Brazil.
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Abstract
Bee venom is a blend of biochemicals ranging from small peptides and enzymes to biogenic amines. It is capable of triggering severe immunologic reactions owing to its allergenic fraction. Venom components are presented to the T cells by antigen-presenting cells within the skin. These Th2 type T cells then release IL-4 and IL-13 which subsequently direct B cells to class switch to production of IgE. Generating venom-specific IgE and crosslinking FcεR1(s) on the surface of mast cells complete the sensitizing stage in allergic individuals who are most likely to experience severe and even fatal allergic reactions after being stung. Specific IgE for bee venom is a double-edged sword as it is a powerful mediator in triggering allergic events but is also applied successfully in diagnosis of the venom allergic patient. The healing capacity of bee venom has been rediscovered under laboratory-controlled conditions using animal models and cell cultures. The potential role of enzymatic fraction of bee venom including phospholipase A2 in the initiation and development of immune responses also has been studied in numerous research settings. Undoubtedly, having insights into immunologic interactions between bee venom components and innate/specific immune cells both locally and systematically will contribute to the development of immunologic strategies in specific and epitope-based immunotherapy especially in individuals with Hymenoptera venom allergy.
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Caldwell DJ, Petras KE, Mattison BL, Wells RJ, Heffelman VL. Spontaneous hemoperitoneum and anaphylactic shock associated with Hymenoptera envenomation in a dog. J Vet Emerg Crit Care (San Antonio) 2018; 28:476-482. [PMID: 30102015 DOI: 10.1111/vec.12751] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/17/2016] [Accepted: 11/29/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the clinical presentation of a dog with spontaneous hemoperitoneum associated with anaphylactic shock from Hymenoptera envenomation. CASE SUMMARY An 8-year-old female neutered Beagle presented as an emergency for acute onset of collapse, hematemesis, and hematochezia. The dog was tachycardic, tachypneic, and hypotensive. Initial assessment revealed a hemoperitoneum with documentation of a nonclotting sanguineous peritoneal effusion with PCV 81% and total protein concentration 65 g/L (6.5 g/dL). No obvious masses were appreciated ultrasonographically during original presentation and cytology of the peritoneal effusion was unremarkable. Peripheral PCV was 67% and total plasma protein concentration was 72 g/L (7.2 g/dL). A bee stinger was located in the right upper lip after presentation and was postulated to be the inciting trigger for the abdominal hemorrhage and shock. The patient was medically stabilized and ultimately made an uneventful recovery. Abdominal ultrasound performed 3 days after discharge revealed a single 0.85 cm hyperechoic liver nodule. Follow-up evaluation at 6 and 18 months after presentation documented a normal physical examination, unremarkable thoracic radiographs, and no change in the original hyperechoic liver nodule. NEW OR UNIQUE INFORMATION PROVIDED This report details an unusual clinical presentation of anaphylactic shock due to Hymenoptera envenomation in a dog. To the authors' knowledge, spontaneous hemoperitoneum associated with anaphylaxis and bee envenomation has not been documented in the veterinary literature.
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Affiliation(s)
- Dana J Caldwell
- Arizona Veterinary Emergency & Critical Care Center, Gilbert, AZ, 85233
| | - Kaelyn E Petras
- Arizona Veterinary Emergency & Critical Care Center, Gilbert, AZ, 85233
| | - Brandi L Mattison
- Arizona Veterinary Emergency & Critical Care Center, Gilbert, AZ, 85233
| | - Raegan J Wells
- Arizona Veterinary Emergency & Critical Care Center, Gilbert, AZ, 85233
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Farhat E, Tegg E, Mohammed S, Grzechnik E, Favaloro EJ. Not as sweet as honey: A rare case of an apparent factor V "inhibitor" in association with bee sting anaphylaxis. Am J Hematol 2018; 93:965-970. [PMID: 29675861 DOI: 10.1002/ajh.25121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Elisabeth Farhat
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
| | - Elizabeth Tegg
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
| | - Soma Mohammed
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
| | - Elzbieta Grzechnik
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
| | - Emmanuel J. Favaloro
- Haematology, Institute of Clinical Pathology and Medical Research (ICPMR), NSW Health Pathology, Westmead Hospital; Westmead NSW Australia
- Sydney Centres for Thrombosis and Haemostasis; Westmead NSW Australia
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A functional and thromboelastometric-based micromethod for assessing crotoxin anticoagulant activity and antiserum relative potency against Crotalus durissus terrificus venom. Toxicon 2018; 148:26-32. [PMID: 29654870 DOI: 10.1016/j.toxicon.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 11/20/2022]
Abstract
The assessment of the capacity of antivenoms to neutralize the lethal activity of snake venoms still relies on traditional rodent in vivo lethality assay. ED50 and LD50 assays require large quantities of venoms and antivenoms, and besides leading to animal suffering. Therefore, in vitro tests should be introduced for assessing antivenom neutralizing capacity in intermediary steps of antivenom production. This task is facilitated when one key lethal toxin is identified. A good example is crotoxin, a β-neurotoxin phospholipase A2-like toxin that presents anticoagulant activity in vitro and is responsible for the lethality of venoms of Crotalus durissus snakes. By using rotational thromboelastometry, we reported recently one sensitive coagulation assay for assessing relative potency of the anti-bothropic serum in neutralizing procoagulant activity of Bothrops jararaca venom upon recalcified factor-XII-deficient chicken plasma samples (CPS). In this study, we stablished conditions for determining relative potency of four batches of the anti-crotalic serum (ACS) (antagonist) in inactivating crotoxin anticoagulant activity in CPS (target) simultaneously treated with one classical activator of coagulation (agonists). The correlation coefficient (r) between values related the ACS potency in inactivating both in vitro crotoxin anticoagulant activity and the in vivo lethality of whole venom (ED50) was 0.94 (p value < 0.05). In conclusion, slowness in spontaneous thrombin/fibrin generation even after recalcification elicit time lapse sufficient for elaboration of one dose-response curve to pro- or anti-coagulant agonists in CPS. We propose this methodology as an alternative and sensitive assay for assessing antivenom neutralizing ability in plasma of immunized horses as well as for in-process quality control.
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Stack K, Pryor L. Significant Traumatic Intracranial Hemorrhage in the Setting of Massive Bee Venom-Induced Coagulopathy: A Case Report. Wilderness Environ Med 2016; 27:405-8. [PMID: 27427329 DOI: 10.1016/j.wem.2016.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/23/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
Bees and wasps of the Hymenoptera order are encountered on a daily basis throughout the world. Some encounters prove harmless, while others can have significant morbidity and mortality. Hymenoptera venom is thought to contain an enzyme that can cleave phospholipids and cause significant coagulation abnormalities. This toxin and others can lead to reactions ranging from local inflammation to anaphylaxis. We report a single case of a previously healthy man who presented to the emergency department with altered mental status and anaphylaxis after a massive honeybee envenomation that caused a fall from standing resulting in significant head injury. He was found to have significant coagulopathy and subdural bleeding that progressed to near brain herniation requiring emergent decompression. Trauma can easily occur to individuals escaping swarms of hymenoptera. Closer attention must be paid to potential bleeding sources in these patients and in patients with massive bee envenomation.
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Affiliation(s)
- Kelsey Stack
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Lindsey Pryor
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY.
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Abdulsalam MA, Ebrahim BE, Abdulsalam AJ. Immune thrombocytopenia after bee venom therapy: a case report. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:107. [PMID: 27015661 PMCID: PMC4807563 DOI: 10.1186/s12906-016-1091-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
Background Immune thrombocytopenia (ITP) is a hematological disorder with an isolated decrease in number of circulating platelets. Bee venom therapy (BVT) is a form of alternative medicine. It is still being practiced in the Middle East and other parts of Asia. In BVT, acupuncture points are used to inject diluted bee venom into the body. The pharmacological basis behind BVT is not fully understood. However, it has been used to treat various medical conditions such as arthritis and low back pain. On the other hand there have been a number of reported complications of BVT use such as ITP. We present a case report on ITP after BVT. Case presentation A 61 year old lady presented with gum bleeding and ecchymosis and found to have isolated thrombocytopenia (platelet count of 9 × 109/L) after receiving four direct bee sting sessions. There was no evidence of any other risk factors of ITP. Conclusion Bee venom components and toxicity may be associated with thrombocytopenia as a complication. Further research is needed to postulate guidelines and protocol for BVT. In the meantime, monitoring of the practice of BVT should be made, with an emphasis on patient education regarding the safety profile and associated risks compared to the gained benefits.
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Ryu HY, Yoo MS, Park JY, Choi JW, Ryu SK, Kim S, Lee SJ, Kim YB. Lower limb ischemia after bee sting. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.2.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hee Yun Ryu
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Min Seok Yoo
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Ji Young Park
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Sung Kee Ryu
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Seunghwan Kim
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Se Jin Lee
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Young Bin Kim
- Division of Cardiology, Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
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Picart J, Basty M, Martinet O, Reboux AH, Combes X. [Mass envenomation by honeybees with mucous membranes stings]. Presse Med 2015; 44:1075-6. [PMID: 26337361 DOI: 10.1016/j.lpm.2015.07.016] [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: 04/21/2015] [Revised: 07/01/2015] [Accepted: 07/08/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Jeanne Picart
- CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service des urgences, SMUR et SAMU 974, Bellepierre, 97405 Saint-Denis cedex, Réunion.
| | - Marielle Basty
- CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service des urgences, SMUR et SAMU 974, Bellepierre, 97405 Saint-Denis cedex, Réunion
| | - Olivier Martinet
- CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service de réanimation polyvalente, 97405 Saint-Denis cedex, Réunion
| | - Anne-Hélène Reboux
- CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service de néphrologie, 97405 Saint-Denis cedex, Réunion
| | - Xavier Combes
- CHU de la Réunion, université de la Réunion, hôpital Félix-Guyon, service des urgences, SMUR et SAMU 974, Bellepierre, 97405 Saint-Denis cedex, Réunion
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Allergy to Hematophagous Arthropods Bites. CURRENT DERMATOLOGY REPORTS 2014. [DOI: 10.1007/s13671-013-0065-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Critters and creatures can strike fear into anyone who thinks about dangerous animals. This article focuses on the management of the most common North American scorpion, arachnid, hymenoptera, and snake envenomations that cause clinically significant problems. Water creatures and less common animal envenomations are not covered in this article. Critical care management of envenomed patients can be challenging for unfamiliar clinicians. Although the animals are located in specific geographic areas, patients envenomed on passenger airliners and those who travel to endemic areas may present to health care facilities distant from the exposure.
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Jung JW, Jeon EJ, Kim JW, Choi JC, Shin JW, Kim JY, Park IW, Choi BW. A fatal case of intravascular coagulation after bee sting acupuncture. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 4:107-9. [PMID: 22379607 PMCID: PMC3283792 DOI: 10.4168/aair.2012.4.2.107] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 09/28/2011] [Accepted: 10/04/2011] [Indexed: 11/24/2022]
Abstract
Bee stings can cause severe adverse reactions, leading to anaphylaxis, cardiovascular collapse, and death. In some cases, bee venom also induces disseminated intravascular coagulation (DIC). However, to our knowledge, there has been no fatal case of intravascular coagulation accompanied by anaphylaxis caused by bee sting acupuncture. Here, we report a fatal case of a 65-year-old woman with DIC, following anaphylactic shock after bee sting acupuncture. This case emphasizes that practitioners should consider anaphylaxis followed by coagulation abnormalities when a patient's vital signs are unstable after bee sting acupuncture.
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Affiliation(s)
- Jae Woo Jung
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Prado M, Solano-Trejos G, Lomonte B. Acute physiopathological effects of honeybee (Apis mellifera) envenoming by subcutaneous route in a mouse model. Toxicon 2010; 56:1007-17. [PMID: 20638400 DOI: 10.1016/j.toxicon.2010.07.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Revised: 07/08/2010] [Accepted: 07/08/2010] [Indexed: 11/20/2022]
Abstract
Bee stings are a health concern in the Americas, where fatal envenomings due to massive attacks by Africanized honeybees have been documented in the last decades. Most studies on the toxic effects of honeybee venom in experimental animals have been performed using the intravenous or intraperitoneal injection routes. The aim of this study was to develop a mouse model that would better resemble a massive honeybee attack by using the subcutaneous (s.c.) route to induce a severe, sublethal systemic envenoming. An array of acute venom effects were characterized, including biochemical, hematological, histological, and inflammatory alterations, after the s.c. injection of 0.5 median lethal dose of venom. Rapid increases in serum alanine (ALT) and aspartate (AST) transaminases, creatinine, urea nitrogen, uric acid, sodium and chloride electrolytes, and creatine kinase (CK) were recorded, indicating damage to liver, kidneys, and skeletal muscle. Also, coagulation disturbances (fibrinogen decrease, and moderate delay in prothrombin and partial thromboplastin times) were demonstrated. Circulating platelet and leukocyte numbers remained unaltered, but a hemoconcentration effect (hematocrit and hemoglobin increase) was observed. This effect might be related to the marked edema induced by the venom. In addition, this inflammatory response included a systemic increase in cytokines (IL-1 beta, IL-6, TNF-alpha), together with an elevation of serum malondialdehyde and nitric oxide. The myotoxic effects of venom, melittin, and phospholipase A(2) were demonstrated after injection by s.c. route. No synergistic myotoxicity between melittin and PLA(2) was observed. Moreover, these two components, when injected at equivalent concentrations to those present in venom, induced a lower increase in serum CK than venom, suggesting that other components also contribute to its strong systemic toxicity towards skeletal muscle. The model here presented may be useful in preclinical studies to assess therapeutic antivenoms developed to cope with the problem of massive bee attacks.
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Affiliation(s)
- Mónica Prado
- Instituto Clodomiro Picado, Facultad de Microbiología, Universidad de Costa Rica, San José, Costa Rica
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23
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Tsai CL, Fang CC, Chen WJ, Dierberg K. Hornet Sting-Induced Toxic Hepatitis. Clin Toxicol (Phila) 2008. [DOI: 10.1081/clt-50386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lovecchio F, Cannon RD, Algier J, Ruha AM, Curry SC, Wallace KL, Graeme KA. Bee swarmings in children. Am J Emerg Med 2007; 25:931-3. [PMID: 17920979 DOI: 10.1016/j.ajem.2007.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 02/08/2007] [Indexed: 10/22/2022] Open
Abstract
UNLABELLED Africanized honeybees (Apis mellifera scutellata) are now found in the southern and southwestern United States. Swarmings can result in hundreds to thousands of stings delivering a venom load capable of producing multisystem organ failure and death. The literature on mass envenomations is scarce, being limited to case reports and case series. There are no prospective studies on mass envenomations in children. METHODS All patients were admitted to our toxicology service, and all stingers were counted. Laboratory data and clinical assessments were obtained at baseline, 8, and 16 hours after presentation. RESULTS Nineteen patients with a median age of 3.6 years and a median of 2.64 stings per kilogram (range, 1-4.5) were enrolled. Fifteen children had vomiting. Only a mild increase in creatine kinase was seen. None developed coagulopathy or renal insufficiency. CONCLUSION Envenomations of up to 4.5 stings per kilogram resulted in only mild systemic illness. Vomiting does not portend involvement of other organ systems.
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Affiliation(s)
- Frank Lovecchio
- Department of Medical Toxicology and Banner Good Samaritan Regional Poison Center, Phoenix, AZ, USA.
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25
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Oliveira EC, Pedroso PMO, Meirelles AEWB, Pescador CA, Gouvêa AS, Driemeier D. Pathological findings in dogs after multiple Africanized bee stings. Toxicon 2007; 49:1214-8. [PMID: 17383705 DOI: 10.1016/j.toxicon.2007.01.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 01/30/2007] [Accepted: 01/31/2007] [Indexed: 11/22/2022]
Abstract
This retrospective study included 19 dogs that died by intoxication due to multiple Africanized bee stings. Bee accidents occurred in rural and urban areas of the Rio Grande do Sul state, southern Brazil. Although bee stings were associated with edema and hyperemia in several regions of the body, head and neck were the most commonly and massively affected areas. Stingers and bees were also observed in the digestive tract. Dark-colored kidneys, dark-red urine, splenomegaly, and dark red lungs were the main gross changes. Histologically, all the dogs had kidney tubular degeneration and necrosis, which were associated with tubular pigment accumulation in most cases. Other lesions included muscular necrosis, hemorrhage in different organs, marked congestion of the spleen and pulmonary edema and congestion.
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Affiliation(s)
- Eduardo C Oliveira
- Department of Veterinary Clinical Pathology, Faculty of Veterinary Medicine, Federal University of Rio Grande do Sul (UFRGS), Avenida Bento Gonçalves 9090, CEP 91540-000, Brazil
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Kouamé EK, Brouh Y, Boua N. Envenimation massive par un essaim d'abeilles chez un nourrisson. Arch Pediatr 2004; 11:1333-5. [PMID: 15519831 DOI: 10.1016/j.arcped.2004.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2003] [Accepted: 06/18/2004] [Indexed: 11/18/2022]
Abstract
The authors report the case of an infant who survived a massive poisoning of honey bees (>350 bees stings) in 2002. The infant presented convulsions, anaemia, renal failure and haematuria. The main treatment consisted in administration of adrenaline. Systematic and early administration of this drug has limited the severe clinical picture despite massive attack.
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Affiliation(s)
- E K Kouamé
- Service d'anesthésie-réanimation, CHU de Bouaké, Bouaké, République de Côte-d'Ivoire.
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Abstract
Coconut water (CNW) can be used as short-term intravenous hydration and resuscitation fluid. We investigated the influence of coconut water on plasma coagulation in vitro. Either CNW or physiological saline (PS) was added to citrated plasma of 8 healthy volunteers. Coagulation capability of diluted plasma was evaluated by thrombelastography (TEG). Replacement of up to 50 % of citrated plasma by CNW or PS did not influence initiation of coagulation as indicated by split point and reaction time, respectively. Strength of fibrin clot as expressed by maximum amplitude (MA) of TEG recording dose dependently declined in both groups. Replacing 50 % of citrated plasma by CNW or PS reduced MA by 39% and 32%, respectively. The influence of coconut water on hemostasis as assessed by TEG does not differ from the effect caused by an identical volume of PS.
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Affiliation(s)
- S Pummer
- Department of Pharmacology & Toxicology, University of Heidelberg at Mannheim, Mannheim, Germany
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