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Sedighi G, Dehghani R, Varzandeh M. Toxic reaction of a 3-year-old boy due to Hornet multiple stings in Kerman-Iran province: A case report. Toxicon 2022; 221:106976. [DOI: 10.1016/j.toxicon.2022.106976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
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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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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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Ombati R, Luo L, Yang S, Lai R. Centipede envenomation: Clinical importance and the underlying molecular mechanisms. Toxicon 2018; 154:60-68. [DOI: 10.1016/j.toxicon.2018.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/21/2018] [Accepted: 09/25/2018] [Indexed: 12/11/2022]
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Beccari M, Castiglione A, Cavaliere G, D'Aloya G, Fabbri C, Losi B, Ranzini C, Romagnoni G, Sorgato G. Unusual Case of Anuria Due to African Bee Stings. Int J Artif Organs 2018. [DOI: 10.1177/039139889201500505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We describe a case of multiple African bee stings in which the exceptionally high dose suggests a direct effect of hymenoptera venom on the renal tubules. The case does not follow the previously reported pattern of hypovolemic or anaphylactic shock, hemolysis and/or rhabdomyolysis, despite the potentially lethal amount of venom injected
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Affiliation(s)
- M. Beccari
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - A. Castiglione
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - G. Cavaliere
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - G. D'Aloya
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - C. Fabbri
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - B. Losi
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - C. Ranzini
- Department of Immunohematology and Blood Transfusion, Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - G. Romagnoni
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
| | - G. Sorgato
- Department of Nephrology and Dialysis Ospedale Fatebenefratelli e Oftalmico, Milano - Italy
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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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Liu Z, Li XD, Guo BH, Li Y, Zhao M, Shen HY, Zhai Y, Wang XL, Liu T. Acute interstitial nephritis, toxic hepatitis and toxic myocarditis following multiple Asian giant hornet stings in Shaanxi Province, China. Environ Health Prev Med 2016; 21:231-6. [PMID: 26910407 DOI: 10.1007/s12199-016-0516-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 02/03/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES During July to October 2013, the Asian giant hornet has killed 42 and injured 1,675 people in the southern part of Shaanxi Province, China. This study investigated this unusual and frequent public health event. METHODS During the 3 months, 103 patients with severe Asian hornet stings were hospitalized in our hospital. Clinical data were collected using a standardized data collection form which included sex, age, length of hospital stay and medical recorder. RESULTS After physical examination and laboratory investigation, 25.2, 46.6 and 44.7 % of the patients were found with varying degrees of acute interstitial nephritis, acute toxic hepatitis and acute toxic myocarditis, respectively. After timely and appropriate treatment including removal of the stings and the use of intravenous methylprednisolone and antihistamines, the kidney function, liver function and heart function of 99 patients recovered within 1 month, while four patients died. CONCLUSIONS This study provided a good opportunity for recognizing the effect of Asian giant hornet stings and evaluating this serious public health event.
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Affiliation(s)
- Zheng Liu
- Department of Pathology, 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, 723000, Shaanxi, China
| | - Xiang-Dong Li
- Department of Nephrology, 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, 723000, Shaanxi, China
| | - Bo-Hui Guo
- Department of Nephrology, 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, 723000, Shaanxi, China
| | - Yi Li
- Department of Nephrology, 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, 723000, Shaanxi, China
| | - Ming Zhao
- Department of Nephrology, 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, 723000, Shaanxi, China
| | - Hai-Yan Shen
- Department of Nephrology, 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, 723000, Shaanxi, China
| | - Ying Zhai
- Department of Nephrology, 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, 723000, Shaanxi, China
| | - Xue-Li Wang
- Intensive Care Unit, 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, 723000, Shaanxi, China
| | - Tao Liu
- Department of Medical Education, 3201 Affiliated Hospital of Medical College of Xi'an Jiaotong University, Hanzhong, 723000, Shaanxi, China.
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8
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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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Goldberg A, Shefler I, Panasoff J, Paitan Y, Confino-Cohen R. Immunotherapy with Commercial Venoms Is Efficacious for Anaphylactic Reactions toVespa orientalisStings. Int Arch Allergy Immunol 2013; 161:174-80. [DOI: 10.1159/000345139] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 10/15/2012] [Indexed: 11/19/2022] Open
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Kumar V, Nada R, Kumar S, Ramachandran R, Rathi M, Kohli HS, Sakhuja V, Jha V. Acute kidney injury due to acute cortical necrosis following a single wasp sting. Ren Fail 2012; 35:170-2. [PMID: 23173621 DOI: 10.3109/0886022x.2012.741467] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Acute kidney injury (AKI) can develop after multiple wasp or bee stings. The etiology is the acute tubular necrosis secondary to shock, pigment toxicity, interstitial nephritis, or direct nephrotoxicity of venom. We report a 40-year-old female who presented with oliguric AKI after a single wasp sting on her hand. Her history, examination, and investigations did not support any of the established causes of AKI in such settings. She did not improve with supportive management and dialysis, and kidney biopsy showed acute cortical necrosis (ACN). This is the first report of ACN after a single wasp sting.
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Affiliation(s)
- Vivek Kumar
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rachaiah NM, Jayappagowda LA, Siddabyrappa HB, Bharath VK. Unusual case of acute renal failure following multiple wasp stings. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:104-6. [PMID: 22408758 PMCID: PMC3296316 DOI: 10.4103/1947-2714.93380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The wasp stings usually cause local reactions and rarely anaphylaxis. However the multiple wasp stings may cause multisystem involvement. We report a case of acute renal failure (ARF) following multiple wasp stings. A middle aged healthy gentleman presented with pain and swelling of the upper part of the body following multiple wasp stings. After 2 days, he developed progressive decrease in urine output with high colored urine. Physical examination revealed the edematous and tender affected part. On investigating, it was found to have sequential elevations in renal function tests. The markers of muscle injury were grossly elevated and liver enzymes were deranged. These findings suggest multisystem involvement predominantly ARF secondary to rhabdomyolysis. With the initiation of the intense hemodialysis, all the above parameters became normal. Timely intervention of multiple wasp stings causing ARF with multiorgan involvement by hemodialysis not only prevents mortality but also other complications.
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Affiliation(s)
- Niranjan M Rachaiah
- Department of Medicine, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
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12
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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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Mortari MR, do Couto LL, dos Anjos LC, Mourão CBF, Camargos TS, Vargas JAG, Oliveira FN, Gati CDC, Schwartz CA, Schwartz EF. Pharmacological characterization of Synoeca cyanea venom: An aggressive social wasp widely distributed in the Neotropical region. Toxicon 2012; 59:163-70. [DOI: 10.1016/j.toxicon.2011.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 11/01/2011] [Accepted: 11/02/2011] [Indexed: 10/15/2022]
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Ghosh JB, Roy M, Bala AK. Delayed onset interstitial nephritis following multiple wasp stings. Indian J Nephrol 2011; 19:71-3. [PMID: 20368928 PMCID: PMC2847812 DOI: 10.4103/0971-4065.53326] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A wasp sting rarely causes delayed / late onset hypersensitivity reaction. Although unknown, the mechanism of such a delayed hypersensitivity reaction is thought to be an immunologically mediated, type III hypersensitivity reaction with the deposition of immune complexes and activation of the complement system. We present here the case of a seven year-old girl with acute interstitial nephritis following multiple wasp stings. To the best of our knowledge, this is the first such report of delayed presentation in a child from India.
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Affiliation(s)
- J B Ghosh
- Department of Pediatric Medicine, Institute of Post-graduate Medical Education and Research, Kolkata, India
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Golden DBK, Moffitt J, Nicklas RA, Freeman T, Graft DF, Reisman RE, Tracy JM, Bernstein D, Blessing-Moore J, Cox L, Khan DA, Lang DM, Oppenheimer J, Portnoy JM, Randolph C, Schuller DE, Spector SL, Tilles SA, Wallace D. Stinging insect hypersensitivity: a practice parameter update 2011. J Allergy Clin Immunol 2011; 127:852-4.e1-23. [PMID: 21458655 DOI: 10.1016/j.jaci.2011.01.025] [Citation(s) in RCA: 156] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 01/05/2011] [Accepted: 01/11/2011] [Indexed: 11/26/2022]
Abstract
These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma and Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Stinging insect hypersensitivity: a practice parameter update II." Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task Force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or the ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. These parameters are not designed for use by pharmaceutical companies in drug promotion. The Joint Task Force understands that the cost of diagnostic tests and therapeutic agents is an important concern that may appropriately influence the work-up and treatment chosen for a given patient. The Joint Task Force recognizes that the emphasis of our primary recommendations regarding a medication may vary, for example, depending on third party payer issues and product patent expiration dates. However, since a given test or agent's cost is so widely variable, and there is a paucity of pharmacoeconomic data, the Joint Task Force generally does not consider cost when formulating Practice Parameter recommendations. In extraordinary circumstances, when the cost benefit of an intervention is prohibitive as supported by pharmacoeconomic data, commentary may be provided.
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Affiliation(s)
- David B K Golden
- Joint Council of Allergy, Asthma and Immunology, 50 N Brockway St, #3-3, Palatine, IL 60067, USA
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Xuan BHN, Mai HL, Thi TXN, Thi MTH, Nguyen HN, Rabenou RA. Swarming hornet attacks: shock and acute kidney injury--a large case series from Vietnam. Nephrol Dial Transplant 2009; 25:1146-50. [PMID: 19934093 DOI: 10.1093/ndt/gfp583] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Social hornets attack victims in swarms in Asia, Africa and the Middle East. The venom consists of multiple proteins with myotoxin, haemotoxin, vasodilatory and anticoagulant effects. METHODS We reviewed the records of 65 patients at Cho Ray Hospital (Ho Chi Minh City, Vietnam) attacked by swarms of the lesser banded hornet, Vespa affinis. Patients were divided into four groups. Groups A and B presented within 3 days of attack and C and D after 3 days with </=50 or >50 stings, respectively. RESULTS Varying degrees of acute kidney injury (AKI) were seen in 38 (58.5%) patients in all groups. Twenty nine required renal replacement therapy. AKI was likely to be myoglobin and toxin induced with a clinical course consistent with acute tubular injury. The prognosis for renal recovery is excellent in those who survive. Seven patients (one from Group A and six from Group B) developed non-anaphylactic shock which led to four deaths. The predominant finding in Groups C and D who sought delayed tertiary care is renal failure. CONCLUSIONS This cases which illustrate the varied effects of hornet venom and the need to be vigilant for shock within the first 2 days and persistent AKI beyond 3 days of attack.
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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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Yang X, Wang Y, Lu Z, Zhai L, Jiang J, Liu J, Yu H. A novel serine protease inhibitor from the venom of Vespa bicolor Fabricius. Comp Biochem Physiol B Biochem Mol Biol 2009; 153:116-20. [PMID: 19258046 DOI: 10.1016/j.cbpb.2009.02.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 02/06/2009] [Accepted: 02/16/2009] [Indexed: 11/24/2022]
Abstract
Hornets possess highly toxic venoms, which are rich in toxin, enzymes and biologically active peptides. Many bioactive substances have been identified from wasp venoms but only a few serine protease inhibitors have been identified from two kinds of wasp venoms. In this work, a serine protease inhibitor named bicolin was purified and characterized from the venom of the wasp, Vespa bicolor Fabricius. The precursor encoding bicolin was cloned from the cDNA library of the venomous glands. It is a cysteine-rich small protein containing 54 amino acid residues including 6 half-cysteines. The peptide is homologous to serine protease inhibitors isolated from venoms of Anoplius samariensis and Pimpla hypochondriaca. Bicolin showed inhibitory ability against trypsin and thrombin.
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Affiliation(s)
- Xinbo Yang
- College of Life Sciences, Hebei Normal University, Shijiazhuang 050016, Hebei, China
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Abstract
Asia, the largest continent in the world, is heterogeneous in the ethnic, socioeconomic, and developmental status of its populations. A vast majority of it is poor with no adequate access to modern health care, making an accurate estimation of the nature and extent of acute kidney injury (AKI) difficult. Community-acquired AKI in otherwise healthy individuals is common, and the population developing AKI is younger compared with its counterparts in Europe or North America. The etiologic spectrum varies in different geographic regions of Asia depending on environmental, cultural, and socioeconomic factors. Some of the etiologic factors include AKI in relation to infectious diseases, intravascular hemolysis caused by glucose 6-phosphate dehydrogenase deficiency, poisonings caused by industrial chemicals or copper sulphate, animal venoms, natural medicines, heat stroke, and after complications of pregnancy. Preventive opportunities are missed because of failure to recognize the risk factors and early signs of AKI. Patients often present late for treatment, leading to multi-organ involvement and increased mortality. The exact etiologic diagnosis cannot be established in many instances because of a lack of appropriate laboratory support. Modern methods of renal replacement therapy are not universally available; and intermittent peritoneal dialysis is still widely practiced in many areas.
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Affiliation(s)
- Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirpal S Chugh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India..
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Han J, You D, Xu X, Han W, Lu Y, Lai R, Meng Q. An anticoagulant serine protease from the wasp venom of Vespa magnifica. Toxicon 2008; 51:914-22. [DOI: 10.1016/j.toxicon.2008.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Revised: 12/20/2007] [Accepted: 01/09/2008] [Indexed: 11/26/2022]
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Yang H, Xu X, Ma D, Zhang K, Lai R. A phospholipase A1 platelet activator from the wasp venom of Vespa magnifica (Smith). Toxicon 2007; 51:289-96. [PMID: 18023835 DOI: 10.1016/j.toxicon.2007.10.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 09/04/2007] [Accepted: 10/04/2007] [Indexed: 10/22/2022]
Abstract
Wasp is an important venomous animal that can induce human fatalities. Aortic thrombosis and cerebral infarction are major clinical symptoms after massive wasp stings but the reason leading to the envenomation manifestation is still not known. In this paper, a toxin protein is purified and characterized by Sephadex G-75 gel filtration, CM-Sephadex C-25 cationic exchange and fast protein liquid chromatography (FPLC) from the venom of the wasp, Vespa magnifica (Smith). This protein, named magnifin, contains phospholipase-like activity and induces platelet aggregation. The cDNA encoding magnifin is cloned from the venom sac cDNA library of the wasp. The predicted protein was deduced from the cDNA with a sequence composed of 337 amino acid residues. Magnifin is very similar to other phospholipase A(1) (PLA(1)), especially to other wasp allergen PLA(1). Magnifin can activate platelet aggregation and induce thrombosis in vivo. The current results proved that PLA(1) in wasp venom could be contributable to aortic thrombosis after massive wasp stings.
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Affiliation(s)
- Hailong Yang
- Biotoxin Units of Key Laboratories of Animal Models and Human Disease Mechanisms, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming 650223, Yunnan, China
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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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Vikrant S, Pandey D, Machhan P, Gupta D, Kaushal SS, Grover N. Wasp envenomation-induced acute renal failure: a report of three cases. Nephrology (Carlton) 2006; 10:548-52. [PMID: 16354236 DOI: 10.1111/j.1440-1797.2005.00482.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute renal failure is an unusual complication of wasp stings. We report three cases who developed acute renal failure after multiple wasp stings (Vespa magnifica). Two patients had evidence of intravascular haemolysis and rhabdomyolysis whereas one patient investigation showed no evidence of intravascular haemolysis or rhabdomyolysis. All three cases had impaired liver functions. Oligo-anuria was seen in all three of the patients and all of them required dialytic support. One patient died of massive gastrointestinal bleeding while the remaining two recovered completely. Although acute renal failure after wasp stings is typically caused by acute tubular necrosis in the setting of haemolysis or rhabdomyolysis, in some patients, renal failure may result from a direct nephrotoxic effect or acute interstitial nephritis from a hypersensitivity reaction to the wasp venom.
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Affiliation(s)
- Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
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Bhatta N, Singh R, Sharma S, Sinnha A, Raja S. Acute renal failure following multiple wasp stings. Pediatr Nephrol 2005; 20:1809-10. [PMID: 16222551 DOI: 10.1007/s00467-005-2044-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2004] [Revised: 06/30/2005] [Accepted: 07/01/2005] [Indexed: 10/25/2022]
Abstract
We report the cases of two patients who developed acute renal failure following multiple wasp stings. Both patients required dialysis and recovered within 4 weeks. The kidney biopsy from one patient showed acute tubular necrosis with interstitial nephritis. One patient had complete recovery of renal function on follow-up, while the other was lost to follow-up.
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Affiliation(s)
- Nisha Bhatta
- Department of Pediatrics, B.P. Koirala Institute of Health Science, Dharan, Nepal.
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Chen DM, Lee PT, Chou KJ, Fang HC, Chung HM, Chen DM, Chang LK. Descending aortic thrombosis and cerebral infarction after massive wasp stings. Am J Med 2004; 116:567-9. [PMID: 15063823 DOI: 10.1016/j.amjmed.2003.08.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Chao YW, Yang AH, Ng YY, Yang WC. Acute interstitial nephritis and pigmented tubulopathy in a patient after wasp stings. Am J Kidney Dis 2004; 43:e15-9. [PMID: 14750120 DOI: 10.1053/j.ajkd.2003.10.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute renal failure (ARF) is an unusual complication of wasp stings and mostly results from toxic-ischemic acute tubular necrosis. This patient, who was stung by a swarm of wasps, experienced an allergic reaction, rhabdomyolysis, intravascular hemolysis, and subsequent ARF. The originality of this case report is related to the finding of combined lesions of acute tubulointerstitial nephritis and acute tubular nephropathy. From our extensive literature review, it is the first case of a patient developing this type of injury after wasp stings, and the complications have been documented previously only in one form or another. Renal biopsy should be encouraged, especially for a patient with delayed recovery of renal function after wasp stings, to facilitate early steroid treatment for the patient with the histological change of acute interstitial nephritis. Early use of steroid therapy may hasten renal recovery by preventing the development of interstitial fibrosis.
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Affiliation(s)
- Yu-Wen Chao
- Department of Medicine, Division of Nephrology, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
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28
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Jha V, Chugh KS. Nephropathy Associated With Animal, Plant, and Chemical Toxins in the Tropics. Semin Nephrol 2003. [DOI: 10.1016/s0270-9295(03)70007-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
A 61-year-old Caucasian man presented with acute renal failure after multiple wasp stings. The patient required dialysis support temporarily. Work-up failed to show rhabdomyolysis or hemolysis and a kidney biopsy revealed acute allergic interstitial nephritis. The patient's renal function recovered completely after a short course of steroid therapy. Acute renal failure after wasp stings is typically caused by acute tubular necrosis in the setting of hemolysis or rhabdomyolysis. Compared with previously reported cases of acute renal failure associated with bee stings, our patient is unique in that his renal failure was caused by a hypersensitivity reaction apparently to the wasp venom.
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Affiliation(s)
- R Zhang
- Section of Nephrology, the Department of Medicine, VA Medical Center, New Orleans, LA, USA
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Watemberg N, Weizman Z, Shahak E, Aviram M, Maor E. Fatal multiple organ failure following massive hornet stings. JOURNAL OF TOXICOLOGY. CLINICAL TOXICOLOGY 1995; 33:471-4. [PMID: 7650773 DOI: 10.3109/15563659509013757] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We describe a fatal outcome in a three-year-old child following massive stings by the oriental hornet (Vespa orientalis). The primary clinical features were coma, respiratory failure, coagulopathy, renal failure and liver dysfunction. On postmortem the main organs involved were brain, lungs, kidney and liver.
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Affiliation(s)
- N Watemberg
- Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
A case of multiple hornet stings is described with a rapidly fatal course due to the combination of massive haemolysis, coagulopathy, rhabdomyolysis, hyperkalaemia, acute renal failure, encephalopathy, hepatotoxicity and hyperglycaemia. These features of systemic envenomation can all be attributed to the toxic properties of Oriental hornet venom described in in vitro and in vivo experimental studies. Greater awareness of these features, aggressive treatment of hyperkalaemia and early institution of treatments such as peritoneal dialysis and plasma exchange may prevent fatalities in such cases.
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Affiliation(s)
- S H Korman
- Department of Paediatrics, Hadassah University Hospital, Mount Scopus, Jerusalem, Israel
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Abstract
To investigate the effect of cocaine on standard liver function tests (LFT), we studied 46 cocaine users with no history of parenteral drug use or homosexuality. LFT were similar in 21 users of cocaine only (Group A) and 25 users of cocaine and alcohol (Group B). Only three patients, two of whom were hepatitis B carriers, had an alanine aminotransferase level more than five units above normal limits. Group B patients were significantly more likely to complain of headaches, irritability, and loss of memory. We conclude that (1) non-parenteral cocaine use is rarely associated with significant LFT abnormalities and (2) alcohol may potentiate some adverse effects of cocaine.
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Abstract
Although a great deal has been learned about the medical aspects of intraoperative blood salvage, several fundamental medical issues remain controversial. As pressure increases to maximize the use of IBS, more research will be needed on the application of salvage techniques in cancer surgery and in the presence of bacterial contamination. The reintroduction of the use of devices that do not wash salvaged blood have reopened investigations into the effects of reinfusion of partially hemolyzed and partially clotted salvaged blood on coagulation, renal function, and cardiopulmonary performance. More studies are also needed so that empirically based standards of practice for the collection and storage of salvaged blood can be established. No longer confined to a few pioneering surgical departments, IBS is now widely practiced and likely to continue to grow rapidly. Knowledge and research of the medical issues surrounding its use will become increasingly valuable in transfusion medicine.
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Affiliation(s)
- W H Dzik
- Department of Pathology, New England Deaconess Hospital, Boston, MA 02215
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