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Zhang X, Feng Y, Wang K, Qiu T, Zhou J, Che G, Chen S, Ji Y. The association between procalcitonin and acute kidney injury in patients stung by wasps. Front Physiol 2023; 14:1199063. [PMID: 37700759 PMCID: PMC10493320 DOI: 10.3389/fphys.2023.1199063] [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: 04/02/2023] [Accepted: 08/15/2023] [Indexed: 09/14/2023] Open
Abstract
Introduction: The aim of this study was to investigate the status of serum procalcitonin (PCT) in patients stung by wasps and evaluate the association between PCT levels and acute kidney injury (AKI). Methods: Patients stung by wasps admitted to two tertiary hospitals between January 2017 and December 2020 were screened for enrollment. We evaluated serum PCT levels on admission in patients stung by wasps. The patients were divided into an AKI group and a non-AKI group. A logistic regression model was used to analyze the association between PCT status and AKI. The performance of PCT concentrations in predicting the occurrence of AKI was evaluated by the area under the receiver operating characteristic curve (AUROC). Results: A total of 138 patients were enrolled, and 66 patients suffered AKI. PCT levels were elevated in 78.99% of patients stung by wasps. Nearly half of the patients (47.83%) developed AKI. PCT levels were correlated with creatinine levels on admission (r = 0.787, 95% CI: 0.713-0.844). PCT levels in patients with AKI were higher than those in patients without AKI (p < 0.001). After adjustment for covariates, PCT levels on admission were independently associated with AKI (OR: 1.575, 95% CI: 1.071-2.317, p = 0.021). The AUROC of PCT levels on admission was 0.837 (95% CI, 0.771-0.902, p < 0.001). A PCT level of 0.57 μg/L was the cutoff for maximizing the Youden index; the specificity was 79.45%, and the sensitivity was 73.43%. Conclusion: Serum PCT levels may be a potential biomarker of AKI in patients stung by wasps.
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Affiliation(s)
- Xuepeng Zhang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yunxia Feng
- Department of Nephrology, Mianyang Central Hospital, University of Electronic Science and Technology of China, Mianyang, China
| | - Kai Wang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Tong Qiu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jiangyuan Zhou
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Siyuan Chen
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Ji
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, China
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Liu R, Zhan Z, Ran E, Yi Y. Hybrid Blood Purification in the Treatment of Multiple Organ Dysfunction Syndrome Following a Wasp Attack. Wilderness Environ Med 2022; 33:406-411. [PMID: 36216672 DOI: 10.1016/j.wem.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
Severe wasp sting symptoms can progress rapidly, often causing multiple organ dysfunction syndrome (MODS) and, in some cases, even death. Early and comprehensive treatment is needed to avoid these outcomes. Here, we report the case of a patient with MODS due to severe wasp stings. The patient received conventional treatment combined with glucocorticoids, plasma exchange, hemoperfusion, and continuous renal replacement therapy and had a successful recovery. MODS is a serious potential complication of wasp stings. Early local wound treatment, antiallergy interventions, antishock therapy, fluid replacement, glucocorticoid administration, and blood purification treatments are required to treat MODS secondary to wasp stings. Our results suggest that a hybrid blood purification method involving plasma exchange combined with hemoperfusion and continuous renal replacement therapy is more clinically effective than the single blood purification method. Early use of high-dose glucocorticoids combined with a hybrid blood purification treatment method had a positive effect in managing our patient and may improve the prognosis of other patients with MODS.
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Affiliation(s)
- Rongzhi Liu
- Department of Nephrology, Suining Central Hospital, Sichuan Province, China
| | - Zhipeng Zhan
- Department of Nephrology, Suining Central Hospital, Sichuan Province, China
| | - Enrong Ran
- Department of Nephrology, Suining Central Hospital, Sichuan Province, China
| | - Yanxia Yi
- Department of Nephrology, Suining Central Hospital, Sichuan Province, China.
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Ruwanpathirana P, Priyankara D. Clinical manifestations of wasp stings: a case report and a review of literature. Trop Med Health 2022; 50:82. [PMID: 36307881 PMCID: PMC9615201 DOI: 10.1186/s41182-022-00475-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Wasp stinging, a neglected tropical entity can have a myriad of local and systemic effects. We present a case of multi-organ injury following multiple wasp stings and a review of literature on the systemic manifestations of wasp stings.
Case presentation A 48-year-old Sri Lankan male who suffered multiple wasp stings, developed an anaphylactic shock with respiratory failure, which was treated with adrenaline and mechanical ventilation. Within the next 2 days the patient developed acute fulminant hepatitis, stage III acute kidney injury, rhabdomyolysis, haemolysis and thrombocytopenia. The patient was treated in the intensive care unit with ionopressors and continuous renal replacement therapy (CRRT). Haemoadsorbant therapy was used in adjunct with CRRT. There was a gradual recovery of the organ functions over the 1st week. However, the patient succumbed to fungal sepsis on the 16th day despite treatment. We conducted a literature review to identify the various clinical manifestations of wasp stinging. Wasp venom contains enzymes, amines, peptides and other compounds. These proteins can cause type 1 hypersensitive reactions ranging from local skin irritation to anaphylactic shock. Furthermore, the toxins can cause direct organ injury or delayed hypersensitivity reactions. The commonly affected organs are the kidneys, liver, and muscles. The effect on the haematological system manifests as coagulopathy and/or cytopenia. The heart, nervous system, lungs, intestines and skin can be affected rarely. Treatment is mainly supportive. Conclusion In conclusion, wasp envenomation can result in multi-organ injury and attention should be paid in doing further research and establishing evidence-based treatment practices.
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Affiliation(s)
- Pramith Ruwanpathirana
- Medical Intensive Unit, National Hospital Sri Lanka, 435/11, Thimbirigasyaya Road, Colombo 05, Sri Lanka.
| | - Dilshan Priyankara
- Medical Intensive Unit, National Hospital Sri Lanka, 435/11, Thimbirigasyaya Road, Colombo 05, Sri Lanka
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Feng X, Xu B, Huang Y. The complete mitochondrial genome of a medical important wasp, Vespa magnifica (Hymenoptera, Vespidae). Mitochondrial DNA B Resour 2022; 7:93-95. [PMID: 34993323 PMCID: PMC8725949 DOI: 10.1080/23802359.2021.1981163] [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] [Indexed: 11/30/2022] Open
Abstract
Vespa magnifica (Smith) is an aggressive social wasp species of Vespidae family. This species is of medical importance for its dangerous sting, traditional medicinal use and valuable venom components. Here, a complete mitogenome of V. magnifica was presented. It was 16,730 bp in length with nucleotide composition of AT: 79.4% and CG: 20.6%. In total, 13 protein-coding genes (PCGs), 22 transfer RNA, and two ribosomal RNA genes were annotated in this mitogenome. Phylogenetic analysis was performed using V. magnifica with 20 other species of Vespidae. The result indicated those species of genus Vespa fell into a paraphyletic group. Moreover, the Vespa species with large body size were clustered into a clade. This mitogenome resource can contribute to further phylogenetic and taxonomic study on genus Vespa.
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Affiliation(s)
- Xi Feng
- Changsha Hospital of Hunan Normal University, Changsha, China.,The Fourth Hospital of Changsha, Changsha, China.,Institute of Emergency and Critical Care Medicine of Changsha, Changsha, China
| | - Binqiang Xu
- Changsha Hospital of Hunan Normal University, Changsha, China.,The Fourth Hospital of Changsha, Changsha, China.,Institute of Emergency and Critical Care Medicine of Changsha, Changsha, China
| | - Yan Huang
- Changsha Hospital of Hunan Normal University, Changsha, China.,The Fourth Hospital of Changsha, Changsha, China.,Institute of Emergency and Critical Care Medicine of Changsha, Changsha, China
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Meher B, Pati S, Panda I, Naik S. Acute kidney injury following multiple wasp stings: A case report. JOURNAL OF PEDIATRIC CRITICAL CARE 2022. [DOI: 10.4103/jpcc.jpcc_62_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ou WF, Huang WH, Chiu HF, Mao YC, Wen MC, Chen CH, Hung SJ, Wu MJ, Wu CL, Chao WC. Clinical manifestation of multiple wasp stings with details of whole transcriptome analysis: Two case reports. Medicine (Baltimore) 2021; 100:e24492. [PMID: 33530269 PMCID: PMC7850695 DOI: 10.1097/md.0000000000024492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/28/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Multiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings. PATIENT CONCERNS Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps (Vespa basalis). DIAGNOSIS Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings. INTERVENTIONS Both 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17. OUTCOMES Both patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2. CONCLUSION In conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.
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Affiliation(s)
| | | | - Hsien-Fu Chiu
- Division of Nephrology, Department of Internal Medicine
| | - Yan-Chiao Mao
- Division of Clinical Toxicology, Department of Emergency Medicine
| | - Mei-Chin Wen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine
- Department of Life Science, Tunghai University
| | - Sheng-Jou Hung
- Department of Medical Research, Taichung Veterans General Hospital
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine
- School of Medicine, Chung Shan Medical University
- Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University
- Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University
| | - Chieh-Liang Wu
- Department of Critical Care Medicine, Taichung Veterans General Hospital
- Department of Industrial Engineering and Enterprise Information
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital
- Department of Computer Science, Tunghai University, Taichung, Taiwan
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Herrera C, Leza M, Martínez-López E. Diversity of compounds in Vespa spp. venom and the epidemiology of its sting: a global appraisal. Arch Toxicol 2020; 94:3609-3627. [PMID: 32700166 DOI: 10.1007/s00204-020-02859-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 05/04/2020] [Indexed: 12/23/2022]
Abstract
Poisonous animals imply a risk to human life, because their venom is a complex mixture of low molecular weight components, peptides and proteins. Hornets use the venom for self-defence, to repel intruders and to capture prey, but they can cause poisoning and allergic reactions to people. In particular, they seem to be a health problem in the countries where they are native due to their sting, which in the most severe cases can lead to severe or fatal systemic anaphylaxis. But this situation is being an emerging problem for new countries and continents because hornet incursions are increasing in the global change scenario, such as in Europe and America. Furthermore, 55 detailed cases of hornet sting were found in 27 papers during the current review where 36.4% died due to, mainly, a multi-organ failure, where renal failure and liver dysfunction were the most common complications. Moreover, the great taxonomic, ecological diversity, geographical distribution and the wide spectrum of pathophysiological symptoms of hornets have been the focus of new research. Considering this, the present systematic review summarizes the current knowledge about the components of Vespa venom and the epidemiology of its sting to serve as reference for the new research focused on the development of techniques for diagnosis, new drugs and treatments of its sting.
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Affiliation(s)
- Cayetano Herrera
- Department of Biology (Zoology), University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Mar Leza
- Department of Biology (Zoology), University of the Balearic Islands, Palma, Balearic Islands, Spain.
| | - Emma Martínez-López
- Area of Toxicology, Department of Health Sciences, Faculty of Veterinary Medicine, University of Murcia, 30100, Murcia, Spain.,Toxicology and Risk Assessment Group, Biomedical Research Institute of Murcia (IMIB-Arrixaca), University of Murcia, 30100, Murcia, Spain
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8
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Risk factors of acute kidney injury induced by multiple wasp stings. Toxicon 2020; 182:1-6. [PMID: 32387349 DOI: 10.1016/j.toxicon.2020.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 12/22/2022]
Abstract
In Asia, acute kidney injury (AKI) induced by wasp stings is common; however, the pathophysiological mechanisms involved remain unclear. To evaluate the mechanisms associated with AKI induced by wasp stings, we conducted a retrospective cohort study that assessed blood and urinary samples from 112 patients with hospital admissions resulting from wasp stings. These samples were divided into those with AKI and without AKI as described in the Kidney Disease Improving Global Outcomes (KDIGO) database. Of the patients, 48.2% presented with an elevated number of leukocytes (median 19.9 vs. 15.8 × 109/L), serum creatinine (median 122.0 vs. 66.0 μmol/L), alanine aminotransferase (ALT) (median 176 vs. 32 U/L), aspartate aminotransferase (AST) (median 402 vs. 37 U/L), lactate dehydrogenase (LDH) (median 3076.0 vs. 300.0 U/L), creatine kinase (CK) (median 9990.0 vs. 261.0 U/L), creatine kinase myocardial band (CK-mb) (median 200.0 vs. 29.5 U/L), activated partial thromboplastin time (APTT) (median 70.0 vs. 42.5s), prothrombin time (PT) (median 15.0 vs. 12.5s), myoglobin (median 2200.0 vs. 78.0 ng/mL), proteinuria (51.9% vs. 17.2% ≥ 1+), and urinary monocyte chemotactic protein-1 (MCP-1) (median 432.0 vs. 177.0 pg/mL), and subsequently developed AKI. As determined by multivariate logistic regression analysis, elevated leukocytes (>10 × 109/L) [OR 1.12 (95% CI 1.02-1.23)], high myoglobin (>1200 ng/mL) [OR 18.51 (95% CI 1.51-132.27)], and high urinary MCP-1 (>200 pg/mL) [OR 5.42 (95% CI 1.27-30.39)] on admission were independent risk factors for AKI. At admission, baseline values for ALT, aspartate aminotransferase (AST), LDH, CK-mb, APTT, PT, and proteinuria were higher for those who later died as well as for those who developed end-stage renal disease (ESRD). No patients without AKI died or developed ESRD. The present study explored the pathophysiology of AKI induced by wasp stings based on the findings of risk factors as well as factors related to outcomes. An understanding of AKI induced by wasp stings allows better treatment options and clinical management for wasp stings patients.
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Gong J, Yuan H, Gao Z, Hu F. Wasp venom and acute kidney injury: The mechanisms and therapeutic role of renal replacement therapy. Toxicon 2019; 163:1-7. [PMID: 30880185 DOI: 10.1016/j.toxicon.2019.03.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 01/02/2023]
Abstract
Stinging accidents involving wasp venom are a notable cause of acute kidney injury (AKI) in Asia. However, very little attention has been paid to the understanding of the mechanisms involved in this type of AKI. The aims of this review are to explore the evidence for the mechanisms and the therapeutic role of renal replacement therapy of wasp venom and AKI. A systematic literature search was conducted using PubMed for the association among wasp venom and AKI. Wasp venom is a complex mixture of biologically active components, including enzymes, amines, and peptides. Wasp venom may induce local anaphylaxis reactions as well as systemic reactions such as AKI. AKI may develop as a result of direct nephrotoxic effects of the venom or secondary intravascular hemolysis and/or rhabdomyolysis. Histopathological features of renal biopsies predominantly include acute tubular necrosis and acute interstitial nephritis. Renal replacement therapy, which includes intermittent hemodialysis, hemoperfusion, plasmapheresis, continuous renal replacement therapy, and peritoneal dialysis, has been used to treat severe AKI cases induced by wasp stings. Continuous renal replacement therapy appears to provide more benefit than intermittent hemodialysis in the treatment of wasp sting-induced AKI. In this review, we summarize the existing evidence of the mechanisms and treatment for venom-induced AKI, with a particular emphasis on the role of renal replacement therapy in the management of severe AKI following massive wasp stings.
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Affiliation(s)
- Jianhua Gong
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China
| | - Hai Yuan
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China
| | - Zhao Gao
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China
| | - Fengqi Hu
- Department of Nephrology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441000, Hubei, China.
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Vikrant S, Jaryal A, Gupta D, Parashar A. Epidemiology and outcome of acute kidney injury due to venomous animals from a subtropical region of India. Clin Toxicol (Phila) 2018; 57:240-245. [PMID: 30306815 DOI: 10.1080/15563650.2018.1513526] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM To study the epidemiology and outcome of acute kidney injury (AKI) caused by venomous animals. METHODS A retrospective study of patients admitted at Indira Gandhi Medical College Hospital, Shimla, with AKI due to venomous animals over a period of 15 years (January 2003-December 2017). Medical records were evaluated for patient information on demographic factors, clinical characteristics, complications, and outcome. Outcomes of requirement for intensive care unit (ICU) support, treatment with dialysis, survival, and mortality were analyzed. The survival and non-survival groups were compared to see the difference in the demographic factors, laboratory results, clinical characteristics, and complications. RESULTS One hundred and eighty-one patients were diagnosed with AKI caused by venomous creatures. Mean age was 44 ± 15.4 years, and the majority (54.1%) was women. Snakebite (77.9%) and wasp stings (19.9%) were the leading causes of AKI. Clinical details were available in 148 patients. The median duration of arrival at hospital was two days. 81.8% had oliguria, and 54.7% had a history of hematuria or having passed red or brown colored urine. The hematological and biochemical laboratory abnormalities were as follows: anemia (75%), leukocytosis (75.7%), hyperkalemia (35.8%), severe metabolic acidosis (46.6%), hepatic dysfunction (54.7%), hemolysis (85.8%), and rhabdomyolysis (65.5%). Main complications were as follows: gastrointestinal bleed (9.5%), seizure/encephalopathy (10.8%), and pneumonia/acute respiratory distress syndrome (ARDS) (11.5%). 82.3% of the patients required dialysis. 154 (85.1%) patient survived, and 27 (14.9%) patients died. As compared to the survival group, the white blood cell count, serum bilirubin, aspartate aminotransferase, alanine aminotransferase, creatine kinase, and lactate dehydrogenase were significantly higher, and serum albumin levels were significantly lower in patients who died. The proportion of patients with leukocytosis, hyperkalemia, metabolic acidosis, pneumonia/ARDS, seizure/encephalopathy, need for ICU support, and dialysis was significantly higher in patients who died. CONCLUSIONS Snakebite and multiple Hymenoptera stings (bees and wasps) were the leading causes of AKI due to venomous animals. AKI was severe, a high proportion required dialysis, and the mortality was high.
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Affiliation(s)
- Sanjay Vikrant
- a Department of Nephrology , Indira Gandhi Medical College , Shimla , India
| | - Ajay Jaryal
- a Department of Nephrology , Indira Gandhi Medical College , Shimla , India
| | - Dalip Gupta
- b Medicine , Indira Gandhi Medical College , Shimla , India
| | - Anupam Parashar
- c Community Medicine , Indira Gandhi Medical College , Shimla , India
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Sun Y, Yang J, Sun Y, Chen P, Yao W, Meng Z, Xiao M, Qian X. Interleukin-6 Gene Polymorphism and the Risk of Systemic Inflammatory Response Syndrome Caused by Wasp Sting Injury. DNA Cell Biol 2018; 37:967-972. [PMID: 30265566 DOI: 10.1089/dna.2018.4156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Previous studies have shown that serum levels of interleukin-6 (IL-6), which plays an important role in the development of systemic inflammatory response syndrome (SIRS), is significantly increased in wasp sting patients. However, the association between IL-6 gene variants and the risk of SIRS development in these patients is not clearly understood. In this study, we investigated the association between IL-6 gene polymorphism in the promoter region and the risk of SIRS in wasp sting patients. A total of 160 patients were divided into SIRS group and non-SIRS group (control), and evaluated for polymorphisms in IL-6 (-174G/C, -572G/C, -597G/A, and -634C/G), using DNA sequencing. The IL-6 serum levels were assessed using an enzyme-linked immunosorbent assay. Risk factors were analyzed by logistic regression analysis. We found that the IL-6 serum level was significantly higher in the SIRS group than in the control group (p < 0.001). A significant association was observed in the genotypic distribution of the IL-6 - 572G allele in the SIRS group, when compared with the control group [OR = 3.909 (1.906-8.019), p < 0.001], and SIRS is more likely to occur in wasp sting patients with more than 10 stings. Thus, the IL-6 - 572G allele and more than 10 stings can be used as predictors of risk of SIRS development in wasp sting patients.
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Affiliation(s)
- Yuhui Sun
- 1 Department of Emergency Medicine, Institute of Respiratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jingning Yang
- 2 Department of Immunology, School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China
| | - Yuwen Sun
- 1 Department of Emergency Medicine, Institute of Respiratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Ping Chen
- 1 Department of Emergency Medicine, Institute of Respiratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Wei Yao
- 1 Department of Emergency Medicine, Institute of Respiratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Zhongji Meng
- 3 Institute of Biomedical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Min Xiao
- 1 Department of Emergency Medicine, Institute of Respiratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Xin Qian
- 4 Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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12
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Clinical consequences of toxic envenomations by Hymenoptera. Toxicon 2018; 150:96-104. [PMID: 29782951 DOI: 10.1016/j.toxicon.2018.05.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 11/21/2022]
Abstract
Many familiar Hymenoptera are brightly colored and can sting painfully-thus, their threat and clinical importance may be exaggerated. Most stinging insects only sting to defend themselves or their colonies from predators. The clinical nature of Hymenoptera envenomations contrasts that of other venomous animals, including other arthropods, primarily because allergic reaction, not direct intoxication, is the usual main concern. This review focuses mainly on the clinical features of direct toxicity to Hymenoptera envenomations, which can induce a high incidence of acute renal failure, liver failure, multiple organ failures, and death. Toxic mass envenomations by honeybees usually entail many hundreds or more stings per victim. In contrast to honeybee toxic envenomations, hornet sting envenomations can be clinically threatening with only 20-200 stings needed to cause kidney and other organ failures. Many lethal envenomations by honeybees occur in rural areas in the New World and Africa and are not recorded or documented. In contrast, deaths by hornets occur mainly to Asia. The most frequent and important envenomating taxa are honeybees, hornets, yellowjacket wasps, paper wasps, fire ants, and jack jumper ants. Occasional envenomating taxa include bumblebees, bullet ants, harvester ants, solitary wasps, solitary bees, and various ants of lesser clinical importance. Envenomations by Hymenoptera usually can be avoided if one considers that bees, wasps and ants "view" us as potential threats or predators, and that with information about the biology of stinging Hymenoptera, humans can minimize adverse incidents.
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Acute Pancreatitis and Rhabdomyolysis with Acute Kidney Injury following Multiple Wasp Stings. Case Rep Nephrol 2017; 2017:8596981. [PMID: 28706746 PMCID: PMC5494575 DOI: 10.1155/2017/8596981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/05/2017] [Accepted: 05/23/2017] [Indexed: 12/02/2022] Open
Abstract
Multiple wasp stings can induce multiple organ dysfunction by toxic reactions. However, acute pancreatitis is a rare manifestation in wasp sting injury. A 74-year-old woman visited the emergency department by anaphylactic shock because of multiple wasp stings. Acute kidney injury, rhabdomyolysis, hepatotoxicity, and coagulopathy were developed next day. Serum amylase and lipase were elevated and an abdominal computed tomography revealed an acute pancreatitis. Urine output was recovered after 16 days of oliguria (below 500 ml/day). Her kidney, liver, and pancreas injury gradually improved after sessions of renal replacement therapy.
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Dhanapriya J, Dineshkumar T, Sakthirajan R, Shankar P, Gopalakrishnan N, Balasubramaniyan T. Wasp sting-induced acute kidney injury. Clin Kidney J 2016; 9:201-4. [PMID: 26985369 PMCID: PMC4792632 DOI: 10.1093/ckj/sfw004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 01/11/2016] [Indexed: 12/05/2022] Open
Abstract
Background Wasp stings are a common form of envenomation in tropical countries, especially in farmers. The aim of this study was to document the clinical presentation, treatment and outcomes of patients with acute kidney injury (AKI) due to multiple wasp stings in a tertiary care hospital. Methods We conducted a retrospective observational study of patients with multiple wasp stings and AKI at the Department of Nephrology between July 2011 and August 2015. The clinical features, laboratory data, treatment details and outcomes were noted. Results A total of 11 patients were included. All were from rural areas. All of them were males with age ranging from 21 to 70 years, mean age 45 ± 23 years. Six had oliguria and two had hypotension. All 11 patients had evidence of rhabdomyolysis and three also had hemolysis. Ten patients required hemodialysis with a mean number of hemodialysis sessions of 8.7 ± 2.8. Renal biopsy carried out on four patients, showed acute interstitial nephritis (AIN) in one patient, acute tubular necrosis (ATN) in two patients, and one patient had both AIN and ATN. The two patients with AIN were given steroids, while all other patients were managed with supportive measures. One patient died within 48 h of presentation due to shock. At a mean follow-up of 24 months, one had progressed to chronic kidney disease and the remaining nine had normal renal function. Conclusions Wasp sting is an occupational hazard. AKI was most commonly due to rhabdomyolysis. Early renal biopsy is indicated in those patients who do not respond to supportive measures. Timely dialysis and steroid in the case of AIN improves renal survival.
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Affiliation(s)
- Jeyachandran Dhanapriya
- Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India
| | - Thanigachalam Dineshkumar
- Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India
| | - Ramanathan Sakthirajan
- Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India
| | - Palaniselvam Shankar
- Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India
| | - Natarajan Gopalakrishnan
- Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India
| | - Thoppalan Balasubramaniyan
- Department of Nephrology , Madras Medical College and Rajiv Gandhi Government General Hospital , Chennai , India
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15
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Villamil Cajoto I, Balo Araujo S, Paredes Vila S, Neira Rojo O. Rabdomiólisis por múltiples picaduras de avispa asiática (Vespa velutina). Rev Clin Esp 2015; 215:245-6. [DOI: 10.1016/j.rce.2014.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 11/28/2014] [Accepted: 12/04/2014] [Indexed: 01/04/2023]
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Ittyachen AM, Abdulla S, Anwarsha RF, Kumar BS. Multi-organ dysfunction secondary to severe wasp envenomation. Int J Emerg Med 2015; 8:6. [PMID: 25852776 PMCID: PMC4385238 DOI: 10.1186/s12245-015-0054-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/17/2015] [Indexed: 11/10/2022] Open
Abstract
Wasp sting is not an uncommon incident. Around 56% to 94% of the population is stung at least once in their lifetime by a member of the order Hymenoptera which includes wasps, bees, and ants. The response to a wasp sting may vary from mild local reaction to severe systemic and anaphylactic reactions. The clinical picture and mortality rate tend to be more severe in adults compared to children. We present a 32-year-old agricultural worker who was bitten by multiple wasps while on a coconut tree. In spite of the heavy load of venom due to the multiple bites, the patient did not develop anaphylaxis. However, a delayed reaction did occur within 48 h in the form of severe multi-organ dysfunction. There was significant improvement by around 2 weeks; but it took another 6 months for the serum creatinine to normalize. This case highlights the occupational risk of Hymenoptera envenomation, the life-threatening complications that may follow and which may even be delayed as was the case with this patient, and the value of emergency care and intensive management which can result in a favorable clinical outcome.
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Affiliation(s)
- Abraham M Ittyachen
- Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India
| | - Shanavas Abdulla
- Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India
| | - Rifzana Fathima Anwarsha
- Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India
| | - Bhavya S Kumar
- Malankara Orthodox Syrian Church Medical College and Hospital, Ernakulam District, Kolenchery, Kerala State 682311 India
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Xie C, Xu S, Ding F, Xie M, Lv J, Yao J, Pan D, Sun Q, Liu C, Chen T, Li S, Wang W. Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases. PLoS One 2013; 8:e83164. [PMID: 24391743 PMCID: PMC3877022 DOI: 10.1371/journal.pone.0083164] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/30/2013] [Indexed: 11/23/2022] Open
Abstract
Background Massive wasp stings have been greatly underestimated and have not been systematically studied. The aim of this study was to identify the clinical features and treatment strategies of severe wasp stings. Methods and Findings A multicenter retrospective study was undertaken in 35 hospitals and medical centers including 12 tertiary care hospitals and 23 secondary care hospitals in the Hubei Province, China. The detailed clinical data of 1091 hospitalized wasp sting patients were investigated. Over three-fourths (76.9%) of the cases had 10 or more stings and the in-hospital mortality of patients was 5.1%. Forty-eight patients died of organ injury following toxic reactions to the stings, whereas six died from anaphylactic shock. The in-hospital mortality in patients with >10 stings was higher than that of ≤10 stings (5.2% vs. 1.0%, p = 0.02). Acute kidney injury (AKI) was seen in 21.0% patients and most patients required blood purification therapy. Rhabdomyolysis was seen in 24.1% patients, hemolysis in 19.2% patients, liver injury in 30.1% patients, and coagulopathy in 22.5% patients. Regression analysis revealed that high creatinine level, shock, oliguria, and anemia were risk factors for death. Blood purification therapy was beneficial for patients with ≥20 stings and delayed hospital admission of patients (≥4 hours after sting). Conclusions In China, most patients with multiple wasp stings presented with toxic reactions and multiple organ dysfunction caused by the venom rather than an anaphylactic reaction. AKI is the prominent clinical manifestation of wasp stings with toxic reaction. High creatinine levels, shock, oliguria, and anemia were risk factors for death.
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Affiliation(s)
- Cuihong Xie
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fengfei Ding
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Minjie Xie
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiagao Lv
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihua Yao
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dengji Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenchen Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tie Chen
- Division of Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Shusheng Li
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (SL); (WW)
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail: (SL); (WW)
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Rhabdomyolysis secondary to bee sting. Case Rep Emerg Med 2013; 2013:258421. [PMID: 23606996 PMCID: PMC3623388 DOI: 10.1155/2013/258421] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/03/2013] [Indexed: 11/17/2022] Open
Abstract
Insect stings belonging to Hymenoptera defined as wasps, yellow jackets, bees, or hornets by human usually result in unserious clinical pictures that go with pain. Rhabdomyolysis following a bee sting is a rare condition. This paper emphasizes “rhabdomyolysis” as a rare complication of this frequently observed envenomation. Rare but severe clinical results may occur due to multiple bee stings, such as intravascular hemolysis, rhabdomyolysis, acute renal insufficiency, and hepatic dysfunction. In bee stings as in our case, clinicians should be alert for rhabdomyolysis in cases with generalized body and muscle pain. Early onset alkaline diuresis and management in patients with rhabdomyolysis are vital in protecting the renal functions and preventing morbidity and mortality.
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Cochran J, McSwain SD, Evans M, Webb S, Tecklenburg F. Anaphylaxis and delayed hymenoptera in a child with fire ant envenomation. Am J Emerg Med 2013; 31:632.e1-3. [PMID: 23347720 DOI: 10.1016/j.ajem.2012.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 09/18/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- Joel Cochran
- Division of Pediatric Critical Care Department of Pediatrics Medical University of South Carolina Charleston, SC, USA.
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20
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Nandi M, Sarkar S. Acute kidney injury following multiple wasp stings. Pediatr Nephrol 2012; 27:2315-7. [PMID: 22829174 DOI: 10.1007/s00467-012-2250-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 06/11/2012] [Accepted: 06/11/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Common manifestations of hypersensitivity reactions to toxins of stinging insects range from local swelling to angioedema and anaphylaxis. Sometimes it may result in unusual manifestations like intravascular hemolysis, disseminated intravascular coagulation, rhabdomyolysis, etc. Acute kidney injury (AKI) due to immune-mediated acute interstitial nephritis is an extremely uncommon manifestation of insect stings. CASE-DIAGNOSIS/TREATMENT A 9-year-old boy who developed renal failure from acute interstitial nephritis 7 days after getting stung by a swarm of wasps at multiple sites is described. He regained normal renal function after eight sessions of hemodialysis. CONCLUSIONS Acute interstitial nephritis resulting in AKI may be either due to immune-mediated tubulointerstitial injury or acute cellular injury caused by obstruction by pigments like hemoglobin and myoglobin. Timely and appropriate supportive management usually cures the patient without any residual damage. The objective of reporting this case is to draw the attention of fellow clinicians towards the possibility of this unusual but life-threatening delayed complication in multiple wasp stings, even if there are no significant immediate reactions.
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Affiliation(s)
- Madhumita Nandi
- IPGMER - Pediatrics, 244 AJC Bose Road, Kolkata, West Bengal, 700020, India.
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21
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Mizuno M, Ito Y, Morgan BP. Exploiting the nephrotoxic effects of venom from the sea anemone, Phyllodiscus semoni, to create a hemolytic uremic syndrome model in the rat. Mar Drugs 2012; 10:1582-1604. [PMID: 22851928 PMCID: PMC3407933 DOI: 10.3390/md10071582] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 06/29/2012] [Accepted: 07/12/2012] [Indexed: 01/22/2023] Open
Abstract
In the natural world, there are many creatures with venoms that have interesting and varied activities. Although the sea anemone, a member of the phylum Coelenterata, has venom that it uses to capture and immobilise small fishes and shrimp and for protection from predators, most sea anemones are harmless to man. However, a few species are highly toxic; some have venoms containing neurotoxins, recently suggested as potential immune-modulators for therapeutic application in immune diseases. Phyllodiscus semoni is a highly toxic sea anemone; the venom has multiple effects, including lethality, hemolysis and renal injuries. We previously reported that venom extracted from Phyllodiscus semoni induced acute glomerular endothelial injuries in rats resembling hemolytic uremic syndrome (HUS), accompanied with complement dysregulation in glomeruli and suggested that the model might be useful for analyses of pathology and development of therapeutic approaches in HUS. In this mini-review, we describe in detail the venom-induced acute renal injuries in rat and summarize how the venom of Phyllodiscus semoni could have potential as a tool for analyses of complement activation and therapeutic interventions in HUS.
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Affiliation(s)
- Masashi Mizuno
- Renal Replacement Therapy, Division of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan;
- Author to whom correspondence should be addressed; or ; Tel.: +81-52-744-2205; Fax: +81-52-744-2184
| | - Yasuhiko Ito
- Renal Replacement Therapy, Division of Nephrology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan;
| | - B. Paul Morgan
- Complement Biology Group, Institute of Infection and Immunology, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK;
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Dongol Y, Paudel YP, Shrestha RK, Aryal G. Acute renal failure following multiple hornet stings. Clin Kidney J 2012; 5:158-161. [PMID: 29497520 PMCID: PMC5783204 DOI: 10.1093/ckj/sfr171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/04/2011] [Indexed: 11/13/2022] Open
Abstract
Hornet stings are medically important stings which can cause allergic manifestations and, in severe cases, may lead to the unusual complication of acute renal failure (ARF) and other systemic complications. ARF results from toxic or ischaemic acute tubular necrosis in a setting of haemolysis or rhabdomyolysis or both and acute allergic interstitial nephritis. Venom from hornet stings can also contribute to myocardial injury or liver impairment. Here, we report three cases of hornet stings leading to ARF. Case #1 and Case #3 recovered their renal function and body physiology after a 38-day and 15-day stay in the hospital, respectively, whereas Case #2 died. They were meticulously supported by haemodialysis along with the combination of various drug regimens.
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Affiliation(s)
- Yashad Dongol
- Department of Biochemistry, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Yadab Prasad Paudel
- Department of Biochemistry, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Rakesh Kumar Shrestha
- Department of Biochemistry, Little Angels' College of Higher Studies, JF Institute of Health Education, Lalitpur, Nepal
| | - Gopi Aryal
- Department of Pathology, KIST Medical College and Teaching Hospital, Lalitpur, Nepal
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23
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Broides A, Maimon MS, Landau D, Press J, Lifshitz M. Multiple hymenoptera stings in children: clinical and laboratory manifestations. Eur J Pediatr 2010; 169:1227-31. [PMID: 20461529 DOI: 10.1007/s00431-010-1209-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 04/22/2010] [Indexed: 11/30/2022]
Abstract
Multiple hymenoptera stings are a cause of rhabdomyolysis, elevated liver enzymes, clotting abnormalities, kidney injury, and even death. However, the progression of the clinical and laboratory findings has been described mainly in sporadic case reports. We report the clinical and laboratory manifestations of multiple hymenoptera stings in six children who were hospitalized and referred for a nephrology evaluation and follow-up over a 12-year period. One patient succumbed 13 h after the stinging accident. In the five surviving patients, we found somewhat similar pattern of clinical and laboratory course: rhabdomyolysis with elevated liver enzymes are the earliest manifestations, followed by kidney injury and anemia. An asymptomatic phase of several days between the stinging accident and severe kidney injury can occur. There was a strong seasonal association, with all six events occurring in August or September. In children with multiple hymenoptera stings, a somewhat predictable clinical and laboratory course is expected and an initial laboratory evaluation is needed, and even in asymptomatic children, a repeated laboratory evaluation is highly recommended.
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Affiliation(s)
- Arnon Broides
- Pediatric Emergency Department, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel.
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A Rare Case of Severe Intoxication from Multiple Bee Stings with a Favorable Outcome. Folia Med (Plovdiv) 2010; 52:74-7. [DOI: 10.2478/v10153-010-0010-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A Rare Case of Severe Intoxication from Multiple Bee Stings with a Favorable OutcomeA 73-year old female of no allergic diathesis was attacked by bees and stung all over her body accidentally sustaining more than 518 stings for a very short time. Severe acute poisoning developed from the bee venom, manifested by coma, rhabdomyolysis, toxic hepatitis, acute renal failure, gastric hemorrhage and anemia. Following an active treatment the patient recovered. Literature search shows this to be a rare case of survival after multiple bee stings.
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Abstract
The medical records of patients admitted between 1985 and 2007 with wasp stings were retrospectively analyzed. Among the 45 children, seven developed acute renal failure. Classical clinical and laboratory data pointed to hemolysis and rhabdomyolysis as the underlying pathophysiology. All patients had hyponatremia and hyperkalemia as well as metabolic acidosis. Six patients had anemia. Five patients were oliguric for 9 to 15 days. Maximum serum creatinine was 4.0 to 11.9 mg/dl. Peritoneal dialysis was performed for 3 to 15 days. One patient died due to hyperkalemia, the remaining ones recovered completely. This paper wants to remind pediatricians to watch for acute renal failure in children with wasp stings.
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Yanagawa Y, Morita K, Sugiura T, Okada Y. Cutaneous hemorrhage or necrosis findings after Vespa mandarinia (wasp) stings may predict the occurrence of multiple organ injury: a case report and review of literature. Clin Toxicol (Phila) 2008; 45:803-7. [PMID: 17952752 DOI: 10.1080/15563650701664871] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
DATA SOURCES We report one case and analyzed 15 Japanese cases concerning multiple organ failure induced by wasp stings. DATA EXTRACTION Thirteen of 15 cases were associated with skin hemorrhage or necrosis after wasp stings. The mean number of stings (+/- standard error) in the patients who died (59 +/- 12) was significantly greater than that in those who survived (28 +/- 4, p=0.01). CONCLUSION The occurrence of skin hemorrhage or necrosis after wasp stings is extremely rare and multiple organ injury after wasp stings is also a rare complication. Thus, cutaneous hemorrhaging or necrosis findings after wasp stings may suggest the development of multiple organ injury. In addition, the number of stings may play an important role in predicting outcome.
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Affiliation(s)
- Youichi Yanagawa
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Saitama, Japan.
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Sharma A, Wanchu A, Mahesha V, Sakhuja V, Bambery P, Singh S. Acute tubulo-interstitial nephritis leading to acute renal failure following multiple hornet stings. BMC Nephrol 2006; 7:18. [PMID: 17118188 PMCID: PMC1664556 DOI: 10.1186/1471-2369-7-18] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 11/21/2006] [Indexed: 11/29/2022] Open
Abstract
Background Hornet stings are generally associated with local and occasionally anaphylactic reactions. Rarely systemic complications like acute renal failure can occur following multiple stings. Renal failure is usually due to development of acute tubular necrosis as a result of intravascular haemolysis, rhabdomyolysis or shock. Rarely it can be following development of acute tubulo-interstitial nephritis. Case presentation We describe a young male, who was stung on face, head, shoulders and upper limbs by multiple hornets (Vespa orientalis). He developed acute renal failure as a result of acute tubulo-interstitial nephritis and responded to steroids. Conclusion Rare causes of acute renal failure like tubulo-interstitial nephritis should be considered in a patient with persistent oliguria and azotemia following multiple hornet stings. Renal biopsy should be undertaken early, as institution of steroid therapy may help in recovery of renal function
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Affiliation(s)
- Aman Sharma
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Wanchu
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Mahesha
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - V Sakhuja
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pradeep Bambery
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Department of Internal medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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