1
|
Cavalcante JS, Riciopo PM, Pereira AFM, Jeronimo BC, Angstmam DG, Pôssas FC, de Andrade Filho A, Cerni FA, Pucca MB, Ferreira Junior RS. Clinical complications in envenoming by Apis honeybee stings: insights into mechanisms, diagnosis, and pharmacological interventions. Front Immunol 2024; 15:1437413. [PMID: 39359723 PMCID: PMC11445026 DOI: 10.3389/fimmu.2024.1437413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 08/20/2024] [Indexed: 10/04/2024] Open
Abstract
Envenoming resulting from Apis honeybee stings pose a neglected public health concern, with clinical complications ranging from mild local reactions to severe systemic manifestations. This review explores the mechanisms underlying envenoming by honeybee sting, discusses diagnostic approaches, and reviews current pharmacological interventions. This section explores the diverse clinical presentations of honeybee envenoming, including allergic and non-allergic reactions, emphasizing the need for accurate diagnosis to guide appropriate medical management. Mechanistic insights into the honeybee venom's impact on physiological systems, including the immune and cardiovascular systems, are provided to enhance understanding of the complexities of honeybee sting envenoming. Additionally, the article evaluates emerging diagnostic technologies and therapeutic strategies, providing a critical analysis of their potential contributions to improved patient outcomes. This article aims to provide current knowledge for healthcare professionals to effectively manage honeybee sting envenoming, thereby improving patient care and treatment outcomes.
Collapse
Affiliation(s)
- Joeliton S Cavalcante
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Pedro Marques Riciopo
- Department of Bioprocess and Biotechnology, School of Agriculture, Agronomic Sciences School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Ana Flávia Marques Pereira
- Center for the Study of Venoms and Venomous Animals of UNESP (CEVAP), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Bruna Cristina Jeronimo
- Center for the Study of Venoms and Venomous Animals of UNESP (CEVAP), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Davi Gomes Angstmam
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Felipe Carvalhaes Pôssas
- Minas Gerais Toxicological Information and Assistance Center, João XXIII Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Adebal de Andrade Filho
- Minas Gerais Toxicological Information and Assistance Center, João XXIII Hospital, Belo Horizonte, Minas Gerais, Brazil
| | - Felipe A Cerni
- Graduate Program in Tropical Medicine of the State University of Amazonas, Manaus, Amazonas, Brazil
| | - Manuela B Pucca
- Center for the Study of Venoms and Venomous Animals of UNESP (CEVAP), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Rui Seabra Ferreira Junior
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Center for the Study of Venoms and Venomous Animals of UNESP (CEVAP), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- Center for Translational Science and Development of Biopharmaceuticals FAPESP/CEVAP-UNESP, Botucatu, São Paulo, Brazil
| |
Collapse
|
2
|
V V, Mehta H, Dhingra P, Ballani A. Multiple Bee Stings and Acute Kidney Injury: A Case Report. Cureus 2024; 16:e66488. [PMID: 39246940 PMCID: PMC11381098 DOI: 10.7759/cureus.66488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Acute kidney injury (AKI) is a common complication following multiple honey bee stings and usually presents after 24-48 hours following the incidence. The severity of AKI is related to the number of stings. A single sting can cause an allergic reaction, and as the stings increase, a higher amount of venom is inoculated, leading to systemic poisoning. Bee venom can have direct or indirect effects on the kidneys. AKI is a combination of toxic and ischemic acute tubular necrosis. Patients may require dialysis, and the usual renal recovery time is 4-120 days. The patient with multiple honey bee stings needs emergency medical treatment, sometimes in the ICU setting, with the aim of treating or preventing anaphylaxis reactions. A case of AKI due to multiple honey bee stings is presented, which is rare but a known occurrence. The patient survived with a recovery of renal function.
Collapse
Affiliation(s)
- Veena V
- Department of Medicine, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Hemant Mehta
- Department of Nephrology, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Preeti Dhingra
- Department of Otorhinolaryngology, Lilavati Hospital and Research Centre, Mumbai, IND
| | - Anil Ballani
- Department of Medicine, Lilavati Hospital and Research Centre, Mumbai, IND
| |
Collapse
|
3
|
Méndez GP, Jobet J, Bravo I, Enos D, Hernández MJ. Relapsing nephrotic syndrome with acute renal failure following a unique episode of multiple bee stings: A case report. Clin Case Rep 2024; 12:e9118. [PMID: 38947546 PMCID: PMC11211087 DOI: 10.1002/ccr3.9118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 07/02/2024] Open
Abstract
The commonest renal involvement after bee stings is acute kidney injury due to rhabdomyolysis. Nephrotic syndrome combined with AKI is unusual complication of Hymenoptera stings. We diagnosed a minimal change disease and six-year follow up relapses.
Collapse
Affiliation(s)
| | - Josefina Jobet
- San Sebastian University Medical School InternsRegion del BiobioChile
| | - Ignacia Bravo
- San Sebastian University Medical School InternsRegion del BiobioChile
| | - Daniel Enos
- Nephrology Unit, Hospital Víctor Ríos Ruiz Los AngelesRegión del BiobioChile
- San Sebastian University Medical School Teachers, Los Angeles CampusRegion del BiobioChile
| | - Mariel Jose Hernández
- Nephrology Unit, Hospital Víctor Ríos Ruiz Los AngelesRegión del BiobioChile
- San Sebastian University Medical School Teachers, Los Angeles CampusRegion del BiobioChile
| |
Collapse
|
4
|
Osman UMA, Turfan S, Mohamud MFY. Multi-Organ Dysfunction Due to Envenoming Syndrome Following a Massive Bee Attack: A Fatal Case Study and Comprehensive Literature Review. Int Med Case Rep J 2024; 17:353-357. [PMID: 38646457 PMCID: PMC11032669 DOI: 10.2147/imcrj.s456777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/03/2024] [Indexed: 04/23/2024] Open
Abstract
Honeybee bites are a common public health hazard, the incidence of which is gradually increasing. A bee sting incident involving more than fifty stings is categorized as massive envenomation. The clinical manifestations of honey bee stings can range from localized symptoms to severe allergic and systemic reactions.This case study presents a 60-year-old male who experienced multi-organ failure following a severe bee sting incident. According to our research, this is the first documented instance in Somalia of multi-organ failure resulting from a sting by a giant honey bee. The case highlights the potential severity of bee stings, which, while often considered minor, can lead to serious medical complications. Interestingly, despite the patient suffering numerous stings and receiving a substantial amount of venom, an immediate anaphylactic reaction did not occur. Instead, a delayed severe response leading to multi-organ failure emerged within 48 hours of the incident.
Collapse
Affiliation(s)
- Ubah Mumin Ali Osman
- Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia
| | - Selim Turfan
- Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia
| | - Mohamed Farah Yusuf Mohamud
- Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia
- Somalia Society for Emergency Medicine (SOSEM), Mogadishu, Somalia
- Tayo Institute for Health, Research, and Development, Mogadishu, Somalia
- Faculty of Medicine, Mogadishu University, Mogadishu, Somalia
| |
Collapse
|
5
|
Tender T, Rahangdale RR, Nampoothiri M, Raychaudhuri R, Mutalik S, Sharma K, Chandrashekar H R. Revamped mini-αA-crystallin showed improved skin permeation and therapeutic activity against melittin-induced toxicity. Toxicon 2024; 239:107611. [PMID: 38211805 DOI: 10.1016/j.toxicon.2024.107611] [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: 10/06/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 01/13/2024]
Abstract
Melittin is honey bee venom's primary and most toxic pharmacologically active component. Melittin causes haemolysis, lymphocyte lysis, long-term pain, localised inflammation followed by rhabdomyolysis, and severe renal failure. Renal failure or cardiovascular complications could lead to the victim's death. Severe honey bee bites are treated with general medication involving antihistaminic, anti-inflammatory, and analgesic drugs, as a specific treatment option is unavailable. An earlier study showed the anti-hemolysis and anti-lymphocyte lysis activity of mini- αA-crystallin (MAC), a peptide derived from human eye lens alpha-crystallin. MAC's use has often been restricted despite its high therapeutic potential due to its poor skin permeability. This study compared the skin permeation, anti-inflammatory and analgesic activities of natural peptide MAC and its modified version (MAC-GRD) formed by attaching cell-penetrating peptide (CPP) and GRD amino residues into MAC. Gel formulations were prepared for MAC and MAC-GRD peptides using carbopol (1% w/w), Tween 80 (1%), and ethanol (10%). An ex-vivo skin permeation study was performed using a vertical-type Franz diffusion apparatus. Preclinical in-vivo experiments were conducted to compare the native and modified peptide formulations against melittin-induced toxicity in Wistar rats. MAC gel, MAC-GRD gel and 1% hydrocortisone cream significantly reduced the melittin-induced writhing (20.16 ± 0.792) response in rats with 15.16 ± 0.47, 11.16 ± 0.477 and 12.66 ± 0.66 wriths, respectively. There was a significant reduction in melittin-induced inflammation when MAC-GRD gel was applied immediately after melittin administration. At 0.5, 1, 3, and 5 h, the MAC-GRD-treated rat paws were 0.9 ± 0.043 mm, 0.750 ± 0.037 mm, 0.167 ± 0.0070 mm, and 0.133 ± 0.031 mm thick. Administration of melittin resulted in reduced GSH (antioxidant) levels (47.33 ± 0.760 μg/mg). However, treatment with MAC-GRD gel (71.167 ± 0.601 μg/mg), MAC gel (65.167 ± 1.138 μg/mg), and 1% hydrocortisone (68.33 ± 0.667 μg/mg) significantly increased the antioxidant enzyme levels. MAC-GRD gel significantly reduced the elevated MDA levels (6.933 ± 0.049 nmol/mg) compared to the melittin group (12.533 ± 0.126 nmol/mg), followed by the 1% hydrocortisone (7.367 ± 0.049 nmol/mg) and MAC gel (7.917 ± 0.048 nmol/mg). MAC-GRD demonstrated more skin permeability and superior anti-inflammatory, analgesic, and antioxidant activities when compared to MAC gel. When compared to standard 1% hydrocortisone cream, MAC-GRD had better anti-inflammatory, analgesic, antioxidant, and comparable action in anti-oxidant restoration against melittin. These findings suggest that the developed MAC-GRD gel formulation could help to treat severe cases of honey bee stings.
Collapse
Affiliation(s)
- Tenzin Tender
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Rakesh Ravishankar Rahangdale
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Madhavan Nampoothiri
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Ruchira Raychaudhuri
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Srinivas Mutalik
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Krishna Sharma
- Department of Ophthalmology, University of Missouri, Columbia, MO, 65212, United States
| | - Raghu Chandrashekar H
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, India.
| |
Collapse
|
6
|
Shaji A, Parvez M, Chirumamilla NK, Sharma N, Pannu AK. Severe pulmonary-renal syndrome in honeybee sting envenomation - A case report. Turk J Emerg Med 2023; 23:246-249. [PMID: 38024185 PMCID: PMC10664193 DOI: 10.4103/tjem.tjem_138_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 12/01/2023] Open
Abstract
Honeybee stings with features of envenomation (either local or allergic and rarely systemic toxicity) are often seen in agriculture workers. An initial presentation with severe diffuse alveolar hemorrhage or pulmonary-renal syndrome is rare and only confined to a few case reports. Herein, we describe a case of a 45-year-old male who presented with multiple bee stings and subsequently developed acute kidney injury and pulmonary hemorrhage. He was managed with hemodialysis, invasive mechanical ventilation, red-cell transfusion, and pulse methylprednisolone. However, he developed cardiac arrhythmias with ventricular tachycardia and died.
Collapse
Affiliation(s)
- Alan Shaji
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Malik Parvez
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh Kumar Chirumamilla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalin Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashok Kumar Pannu
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Safak S, Dirim AB, Solakoglu S, Garayeva N, Demir E, Artan AS, Oto OA, Ozluk Y, Ozturk S, Yazici H, Kilicaslan I, Turkmen A. Nephrotic syndrome and acute tubular injury after bee stings in a beekeeper: expanding the electron microscopic findings of bee venom-induced renal injury. Int Urol Nephrol 2023; 55:2131-2132. [PMID: 36847974 DOI: 10.1007/s11255-023-03537-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/20/2023] [Indexed: 03/01/2023]
Affiliation(s)
- Seda Safak
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey.
| | - Ahmet Burak Dirim
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Seyhun Solakoglu
- Department of Histology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurane Garayeva
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Erol Demir
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Ayse Serra Artan
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Ozgur Akin Oto
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Yasemin Ozluk
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Savas Ozturk
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Halil Yazici
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| | - Isin Kilicaslan
- Department of Pathology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydin Turkmen
- Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Capa, Fatih, 34093, Istanbul, Turkey
| |
Collapse
|
9
|
Arshad AR, Rashid A. Acute Kidney Injury Complicating Wasp Stings: A Report of Two Cases and Literature Review. Cureus 2023; 15:e37343. [PMID: 37182065 PMCID: PMC10169251 DOI: 10.7759/cureus.37343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Acute kidney injury could occasionally complicate wasp stings. We describe two such cases. The first one developed acute kidney injury as a result of rhabdomyolysis and hemolysis, whereas the other patient developed acute kidney injury as part of multiorgan dysfunction syndrome resulting from shock and rhabdomyolysis. Both remained dependent on intermittent hemodialysis for a short period of time before recovering spontaneously. These cases highlight different pathophysiological processes leading to acute kidney injury, and the importance of timely diagnosis to achieve favourable clinical outcomes.
Collapse
Affiliation(s)
| | - Amir Rashid
- Internal Medicine, Pak Emirates Military Hospital, Rawalpindi, PAK
| |
Collapse
|
10
|
Acehan S, Satar S, Gulen M, Yucel C, Segmen MS. Angina and Arrhythmia Symptoms Following Multiple Bee Stings: Kounis Syndrome. Wilderness Environ Med 2022; 33:417-421. [PMID: 36109267 DOI: 10.1016/j.wem.2022.06.003] [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: 12/15/2021] [Revised: 06/19/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
Kounis syndrome (KS) is an acute coronary syndrome including coronary spasm, acute myocardial infarction, and stent thrombosis preceded by an anaphylactic, anaphylactoid, allergic, or hypersensitivity injury. In this case presentation, we discussed Type I and Type II KS. Case 1 was a 72-y-old man who presented to the emergency department with allergic symptoms and chest pain that developed after multiple bee stings. Electrocardiography showed ST depression in the lateral leads. Case 2 was a 42-y-old woman who presented to the emergency department with complaints of chest pain, dizziness, and presyncope that developed after multiple bee stings. Mobitz Type II Block with right bundle branch block was observed in 42 beats·min-1 in the electrocardiography. Both patients were first treated for allergic reaction. Although early percutaneous coronary intervention was performed for graft thrombosis in Case 1, a permanent pacemaker was inserted in Case 2. The patients were discharged without any complications. Increasing physician awareness towards the existence of KS can prevent fatal outcomes with early diagnosis and treatment.
Collapse
Affiliation(s)
| | | | | | - Ceyhun Yucel
- Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey
| | | |
Collapse
|
11
|
Nwaji AR, Arieri O, Anyang AS, Nguedia K, Abiade EB, Forcados GE, Oladipo OO, Makama S, Elisha IL, Ozele N, Gotep JG. Natural toxins and One Health: a review. SCIENCE IN ONE HEALTH 2022; 1:100013. [PMID: 39076609 PMCID: PMC11262277 DOI: 10.1016/j.soh.2023.100013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/28/2023] [Indexed: 07/31/2024]
Abstract
Background The One Health concept considers the interconnectivity, interactions and interdependence of humans, animals and the environment. Humans, animals and other organisms are constantly exposed to a wide range of natural toxins present in the environment. Thus, there is growing concern about the potential detrimental effects that natural toxins could pose to achieve One Health. Interestingly, alkaloids, steroids and bioactive peptides obtained from natural toxins could be used for the development of therapeutic agents. Methodology Our literature search focused on the following keywords; toxins, One Health, microbial toxins, mycotoxins, phytotoxins, phycotoxins, insect toxins and toxin effects. Google Scholar, Science Direct, PubMed and Web of Science were the search engines used to obtain primary databases. We chose relevant full-text articles and review papers published in English language only. The research was done between July 2022 and January 2023. Results Natural toxins are poisonous substances comprising bioactive compounds produced by microorganisms, invertebrates, plants and animals. These compounds possess diverse structures and differ in biological function and toxicity, posing risks to human and animal health through the contamination of the environment, causing disease or death in certain cases. Findings from the articles reviewed revealed that effects of natural toxins on animals and humans gained more attention than the impact of natural toxins on the environment and lower organisms, irrespective of the significant roles that lower organisms play to maintain ecosystem balance. Also, systematic approaches for toxin control in the environment and utilization for beneficial purposes are inadequate in many regions. Remarkably, bioactive compounds present in natural toxins have potential for the development of therapeutic agents. These findings suggest that global, comprehensive and coordinated efforts are required for improved management of natural toxins through an interdisciplinary, One Health approach. Conclusion Adopting a One Health approach is critical to addressing the effects of natural toxins on the health of humans, animals and the environment.
Collapse
Affiliation(s)
- Azubuike Raphael Nwaji
- Department of Physiology, Faculty of Basic Medical Sciences, Alex Ekwueme Federal University, Ndufu-Alike, Ebonyi State, Nigeria
| | - Onikisateinba Arieri
- Department of Industrial Chemistry and Petrochemical Technology, Faculty of Science Laboratory, University of Portharcourt, Nigeria
| | | | - Kaze Nguedia
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon
| | | | | | | | - Sunday Makama
- Biochemistry Division, National Veterinary Research Institute, Vom, Plateau State, Nigeria
| | - Ishaku Leo Elisha
- Drug Development Division, National Veterinary Research Institute, Vom, Plateau State, Nigeria
| | - Nonyelim Ozele
- Biochemistry Division, National Veterinary Research Institute, Vom, Plateau State, Nigeria
| | - Jurbe Gofwan Gotep
- Drug Development Division, National Veterinary Research Institute, Vom, Plateau State, Nigeria
| |
Collapse
|
12
|
Cai ZY, Xu BP, Zhang WH, Peng HW, Xu Q, Yu HB, Chu QG, Zhou SS. Acute respiratory distress syndrome following multiple wasp stings treated with extracorporeal membrane oxygenation: A case report. World J Clin Cases 2022; 10:11122-11127. [PMID: 36338203 PMCID: PMC9631122 DOI: 10.12998/wjcc.v10.i30.11122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/07/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND It is necessary for clinicians to be aware of a rare but possible acute respiratory distress syndrome (ARDS) complication caused by multiple wasp stings. Severe ARDS has a high mortality rate but no specific pharmacotherapies have been identified to date. This case study presents the first case of severe ARDS caused by multiple wasp stings, treated successfully with extracorporeal membrane oxygenation (ECMO). It also emphasizes the effectiveness of early ECMO treatment for severe ARDS with persistent hypoxemia.
CASE SUMMARY A 24-year-old woman was admitted to the emergency department after being stung by more than 10 wasps within a 30-min period, with clinical symptoms of multiple rashes, dizziness, chest tightness, nausea, and vomiting. On the 2nd day of admission, the patient developed progressive dyspnea. The patient was diagnosed with ARDS based on clinical manifestations and lung computed tomography (CT) scan. Because of the progressive dyspnea, the intensive care unit physician performed endotracheal intubation and continued to provide ventilator support, but the patient’s respiratory distress worsened, as indicated by the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen. Veno-venous ECMO was initiated for 6 d. On day 7 of admission, ECMO was stopped. On the 11th day of admission, CT scan of the lungs revealed significant reduction of ground-glass opacities and consolidations. After about 2 wk, the patient recovered completely from ARDS and was discharged to home. At the 2-mo follow-up, the patient was in good health with no recurrence of dyspnea nor chest tightness.
CONCLUSION ARDS complication caused by multiple wasp stings may be fatal when mechanical ventilation becomes dangerous due to persistent hypoxemia and despite optimization of ARDS management. We propose that the early implementation of ECMO is a relatively effective treatment, although the evidence is relatively limited.
Collapse
Affiliation(s)
- Zheng-Yin Cai
- Department of Critical Care Medicine, Traditional Chinese Hospital of Lu'an Affiliated to Anhui University of Traditional Chinese Medicine, Lu'an 237000, Anhui Province, China
| | - Bao-Ping Xu
- Department of Critical Care Medicine, Traditional Chinese Hospital of Lu'an Affiliated to Anhui University of Traditional Chinese Medicine, Lu'an 237000, Anhui Province, China
| | - Wei-Hao Zhang
- Department of Critical Care Medicine, Traditional Chinese Hospital of Lu'an Affiliated to Anhui University of Traditional Chinese Medicine, Lu'an 237000, Anhui Province, China
| | - Huai-Wen Peng
- Department of Critical Care Medicine, Traditional Chinese Hospital of Lu'an Affiliated to Anhui University of Traditional Chinese Medicine, Lu'an 237000, Anhui Province, China
| | - Qing Xu
- Department of Critical Care Medicine, Traditional Chinese Hospital of Lu'an Affiliated to Anhui University of Traditional Chinese Medicine, Lu'an 237000, Anhui Province, China
| | - Huai-Bin Yu
- Department of Critical Care Medicine, Traditional Chinese Hospital of Lu'an Affiliated to Anhui University of Traditional Chinese Medicine, Lu'an 237000, Anhui Province, China
| | - Quan-Gen Chu
- Department of Chinese Medicine, Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
| | - Shu-Sheng Zhou
- Department of Intensive Care Unit, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
| |
Collapse
|
13
|
Wang Y, Kang H, Jin M, Wang G, Ma W, Liu Z, Xue Y, Li C. Phenotypic and Transcriptomics Analyses Reveal Underlying Mechanisms in a Mouse Model of Corneal Bee Sting. Toxins (Basel) 2022; 14:toxins14070468. [PMID: 35878206 PMCID: PMC9323056 DOI: 10.3390/toxins14070468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022] Open
Abstract
Corneal bee sting (CBS) is one of the most common ocular traumas and can lead to blindness. The ophthalmic manifestations are caused by direct mechanical effects of bee stings, toxic effects, and host immune responses to bee venom (BV); however, the underlying pathogenesis remains unclear. Clinically, topical steroids and antibiotics are routinely used to treat CBS patients but the specific drug targets are unknown; therefore, it is imperative to study the pathological characteristics, injury mechanisms, and therapeutic targets involved in CBS. In the present study, a CBS injury model was successfully established by injecting BV into the corneal stroma of healthy C57BL/6 mice. F-actin staining revealed corneal endothelial cell damage, decreased density, skeletal disorder, and thickened corneal stromal. The terminal-deoxynucleotidyl transferase mediated nick end labeling (TUNEL) assay showed apoptosis of both epithelial and endothelial cells. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that cytokine–cytokine interactions were the most relevant pathway for pathogenesis. Protein–protein interaction (PPI) network analysis showed that IL-1, TNF, and IL-6 were the most relevant nodes. RNA-seq after the application of Tobradex® (0.3% tobramycin and 0.1% dexamethasone) eye ointment showed that Tobradex® not only downregulated relevant inflammatory factors but also reduced corneal pain as well as promoted nerve regeneration by repairing axons. Here, a stable and reliable model of CBS injury was successfully established for the first time, and the pathogenesis of CBS and the therapeutic targets of Tobradex® are discussed. These hub genes are expected to be biomarkers and therapeutic targets for the diagnosis and treatment of CBS.
Collapse
Affiliation(s)
- Yanzi Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Honghua Kang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Mengyi Jin
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
| | - Guoliang Wang
- School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China;
| | - Weifang Ma
- Department of Ophthalmology, No.4 West China Teaching Hospital, Sichuan University, Chengdu 610041, China;
| | - Zhen Liu
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
| | - Yuhua Xue
- School of Pharmaceutical Sciences, Xiamen University, Xiamen 361102, China;
- Correspondence: (Y.X.); (C.L.); Tel./Fax: +86-592-2189698 (Y.X.)
| | - Cheng Li
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen 361102, China; (Y.W.); (H.K.); (M.J.); (Z.L.)
- Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen 361102, China
- Correspondence: (Y.X.); (C.L.); Tel./Fax: +86-592-2189698 (Y.X.)
| |
Collapse
|
14
|
Liu Y, Shu H, Long Y, Nie X, Tang H, Tu L, Zhang H, Qiu G, He D, Huang Q, Zhang Q, Qing S, Xu D, Xia H. Development and internal validation of a Wasp Sting Severity Score to assess severity and indicate blood purification in persons with Asian wasp stings. Clin Kidney J 2022; 15:320-327. [PMID: 35145646 PMCID: PMC8825213 DOI: 10.1093/ckj/sfab201] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background In recent years, the incidence of wasp sting has increased annually in China. Organ damage and high mortality due to mass wasp envenomation remain major challenges. Timely and appropriate medical intervention can improve survival. However, there are currently no normalized tools for early assessment of severity. Methods The clinical data of wasp sting patients hospitalized from 2011 to 2019 were used as a training set. Logistic regression was used to explore major risk factors for the development of a severe case of wasp sting (SC). The Wasp Sting Severity Score (WSS) was determined considering these risk factors to identify SCs and was tested in a validation dataset that was prospectively collected in 2020. Results The data of 1131 wasp sting patients from 2011 to 2019 were included in the training set. Logistic regression analysis showed that tea-colored urine, number of stings, and lactate dehydrogenase and total bilirubin levels were risk factors for developing an SC. The WSS was developed considering these four risk factors, and the total possible WSS was 20 points. The WSS was tested using the validation dataset, comprising the data of 153 patients, in 2020, and we found that a WSS ≥3 points was an important indication for blood purification, with a sensitivity of 71.9%, specificity of 92.6% and an area under the curve of 0.918 (95% confidence interval 0.873–0.962). Among patients with more than 30 stings, mortality in those who underwent plasma exchange (PE) within 24 h after admission was significantly lower than that in those who did not receive PE treatment (14.3% versus 46.9%, P = 0.003). However, continuous venovenous hemofiltration (CVVH) (P = 0.317) and hemoperfusion (HP) (P = 0.869) did not significantly reduce mortality. Conclusions Patients with WSS scores ≥3 should be considered for blood purification as early as possible in addition to routine treatment. In addition, PE is better than CVVH and HP at reducing mortality in patients suffering from severe wasp stings.
Collapse
Affiliation(s)
- Yong Liu
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Hongmei Shu
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Youlin Long
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xiaoqin Nie
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Hongfu Tang
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Lang Tu
- Department of Critical Care Medicine, Shehong People's Hospital, Sichuan Province, China
| | - Hao Zhang
- Department of Critical Care Medicine, Shehong People's Hospital, Sichuan Province, China
| | - Gang Qiu
- Department of Critical Care Medicine, Pengxi County People's Hospital, Sichuan Province, China
| | - Daihua He
- Department of Critical Care Medicine, Pengxi County People's Hospital, Sichuan Province, China
| | - Qiang Huang
- Department of Critical Care Medicine, Daying County People's Hospital, Sichuan Province, China
| | - Qi Zhang
- Department of Critical Care Medicine, Daying County People's Hospital, Sichuan Province, China
| | - Shuang Qing
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Donglin Xu
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| | - Hongtao Xia
- Department of Critical Care Medicine, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, An Affiliated Hospital of North Sichuan Medical College, Suining, Sichuan Province, China
| |
Collapse
|
15
|
Pannu A, Shaji A, Parvez M, Chirumamilla N, Sharma N. Severe pulmonary-renal syndrome in honeybee sting envenomation – A case report. Turk J Emerg Med 2022. [DOI: 10.4103/2452-2473.357332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
16
|
Wang M, Prince S, Tang Y, Zhong X, Chen S, Li G, Wang L, Wang W. Macroscopic hematuria in wasp sting patients: a retrospective study. Ren Fail 2021; 43:500-509. [PMID: 33706645 PMCID: PMC7971319 DOI: 10.1080/0886022x.2021.1896547] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/21/2021] [Accepted: 02/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Macroscopic hematuria after wasp sting has been reported in Asia to occur before acute kidney injury (AKI), and is often used by clinicians as a sign indicating the need for intensive care and blood purification therapy. However, there is no study on the clinical characteristics and prognosis of this symptom. METHODS The clinical data of 363 patients with wasp sting admitted to Suining Central Hospital from January 2016 to December 2018 were retrospectively analyzed. At admission, the poisoning severity score (PSS) was used as the criterion for severity classification. According to the presence of macroscopic hematuria, the patients were divided into macroscopic hematuria and non-macroscopic hematuria group. RESULTS Of the 363 wasp sting patients, 219 were male and 144 were female, with a mean age of 55.9 ± 16.3 years. Fifty-one (14%) had macroscopic hematuria, 39 (10.7%) had AKI, 105 (28.9%) had rhabdomyolysis, 61 (16.8%) had hemolysis, 45 (12.4%) went on to received hemodialysis, and 14 (3.9%) died. The incidence of AKI in macroscopic hematuria group was 70.6%, and oliguric renal failure accounted for 72.2%. Patients with macroscopic hematuria had significantly higher PSS (2.2 ± 0.5 vs. 1.1 ± 0.3, p < .001). CONCLUSION Macroscopic hematuria can be regarded as a surrogate marker of deteriorating clinical outcome following wasp stings. In wasp sting patients with symptoms of macroscopic hematuria or serum LDH higher than 463.5 u/L upon admission, the risk of AKI increases significantly, therefore hemodialysis should be considered. The PSS is helpful in early assessment of the severity of wasp sting patients.
Collapse
Affiliation(s)
- Maohe Wang
- Zunyi Medical University, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Nephrology & Institute of Nephrology, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, China
- Suining central hospital, Suining, China
| | - Singh Prince
- Division of Nephrology & Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong Tang
- Suining central hospital, Suining, China
| | - Xiang Zhong
- Department of Nephrology & Institute of Nephrology, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, China
| | - Shasha Chen
- Department of Nephrology & Institute of Nephrology, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, China
| | - Guisen Li
- Department of Nephrology & Institute of Nephrology, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, China
| | - Li Wang
- Department of Nephrology & Institute of Nephrology, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, China
| | - Wei Wang
- Zunyi Medical University, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Department of Nephrology & Institute of Nephrology, Sichuan Academy of Medical Science & Sichuan Provincial People’s Hospital, China
| |
Collapse
|
17
|
Pillur Tamilarasu K, Shankar T, Kabi A. Unusual case of recurrent hypoglycaemia in multiple bee sting envenomation. BMJ Case Rep 2021; 14:14/7/e242440. [PMID: 34312127 PMCID: PMC8314743 DOI: 10.1136/bcr-2021-242440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A bee sting can result in allergic and toxin-mediated local manifestations like pain, swelling, redness and itching to serious systemic effects like acute kidney injury (AKI), pancreatitis, Kounis syndrome and stroke. Melittin and phospholipase A2, which make up 62% of honeybee venom, have vasoactive, haemolytic properties causing severe AKI. Its role in lowering blood glucose in diabetics is an interesting research topic. We report an elderly herdsman, a known diabetic on irregular oral hypoglycaemic drugs, who presented with altered mental status due to hypoglycaemia. On further prodding, a recent multiple bee sting attack 5 days ago was found which was followed by altered coloured urine for 2 days for which no medical attention was sought. Additional analyses revealed reticulocytosis, azotemia and high serum creatine phosphokinase. The patient was treated with dextrose infusion, antihistamines, fluids and haemodialysis. Renal failure resolved completely and the patient was discharged in a stable condition.
Collapse
Affiliation(s)
| | - Takshak Shankar
- Emergency Medicine, All India Institute of Medical Sciences-Rishikesh, Dehradun, Uttarakhand, India
| | - Ankita Kabi
- Emergency Medicine, All India Institute of Medical Sciences-Rishikesh, Dehradun, Uttarakhand, India
| |
Collapse
|
18
|
Barbosa AN, Ferreira RS, de Carvalho FCT, Schuelter-Trevisol F, Mendes MB, Mendonça BC, Batista JN, Trevisol DJ, Boyer L, Chippaux JP, Medolago NB, Cassaro CV, Carneiro MTR, de Oliveira APP, Pimenta DC, da Cunha LER, Dos Santos LD, Barraviera B. Single-Arm, Multicenter Phase I/II Clinical Trial for the Treatment of Envenomings by Massive Africanized Honey Bee Stings Using the Unique Apilic Antivenom. Front Immunol 2021; 12:653151. [PMID: 33841437 PMCID: PMC8025786 DOI: 10.3389/fimmu.2021.653151] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/05/2021] [Indexed: 12/17/2022] Open
Abstract
We evaluated the safety, optimal dose, and preliminary effectiveness of a new-approach Africanized honeybee (Apis mellifera) Antivenom (AAV) in a phase I/II, multicenter, non-randomized, single-arm clinical trial involving 20 participants with multiple stings. Participants received 2 to 10 vials of AAV depending on the number of stings they suffered, or a predefined adjuvant, symptomatic, and complementary treatment. The primary safety endpoint was the occurrence of early adverse reactions within the first 24 h of treatment. Preliminary efficacy based on clinical evolution, including laboratory findings, was assessed at baseline and at various time points over the four following weeks. ELISA assays and mass spectrometry were used to estimate venom pharmacokinetics before, during, and after treatment. Twenty adult participants, i.e., 13 (65%) men and 7 (35%) women, with a median age of 44 years and a mean body surface area of 1.92 m2 (median = 1.93 m2) were recruited. The number of stings ranged from 7 to > 2,000, with a median of 52.5. Symptoms of envenoming were classified as mild, moderate, or severe in 80% (16), 15% (3), and 5% (1) of patients, respectively; patients with mild, moderate, or severe envenoming received 2, 6, and 10 vials of AAV as per the protocol. None of the patients had late reactions (serum sickness) within 30 d of treatment. There was no discontinuation of the protocol due to adverse events, and there were no serious adverse events. One patient had a moderate adverse event, transient itchy skin, and erythroderma. All participants completed the intravenous antivenom infusion within 2 h, and there was no loss to follow-up after discharge. ELISA assays showed venom (melittin and PLA2) concentrations varying between 0.25 and 1.479 ng/mL prior to treatment. Venom levels decreased in all patients during the hospitalization period. Surprisingly, in nine cases (45%), despite clinical recovery and the absence of symptoms, venom levels increased again during outpatient care 10 d after discharge. Mass spectrometry showed melittin in eight participants, 30 d after treatment. Considering the promising safety results for this investigational product in the treatment of massive Africanized honeybee attack, and its efficacy, reflected in the clinical improvements and corresponding immediate decrease in blood venom levels, the AAV has shown to be safe for human use. Clinical Trial Registration: UTN: U1111-1160-7011, identifier [RBR-3fthf8].
Collapse
Affiliation(s)
- Alexandre Naime Barbosa
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil
| | - Rui Seabra Ferreira
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Clinical Research, Center for the Study of Venoms and Venomous Animals (CEVAP) and Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Francilene Capel Tavares de Carvalho
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Fabiana Schuelter-Trevisol
- Clinical Research Center, Nossa Senhora da Conceição Hospital, Tubarão, Brazil.,Graduate Program in Health Sciences, University of Southern Santa Catarina at Tubarão, Tubarão, Brazil
| | - Mônica Bannwart Mendes
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil
| | - Bruna Cavecci Mendonça
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - José Nixon Batista
- Clinical Research Center, Nossa Senhora da Conceição Hospital, Tubarão, Brazil
| | - Daisson José Trevisol
- Clinical Research Center, Nossa Senhora da Conceição Hospital, Tubarão, Brazil.,Graduate Program in Health Sciences, University of Southern Santa Catarina at Tubarão, Tubarão, Brazil
| | - Leslie Boyer
- VIPER Institute, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Jean-Philippe Chippaux
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France.,CRT, Institut Pasteur, Paris, France
| | - Natália Bronzatto Medolago
- Clinical Research Unit (UPECLIN), Botucatu Medical School, São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Claudia Vilalva Cassaro
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Márcia Tonin Rigotto Carneiro
- Clinical Research Unit (UPECLIN), Botucatu Medical School, São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Ana Paola Piloto de Oliveira
- Clinical Research Unit (UPECLIN), Botucatu Medical School, São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Daniel Carvalho Pimenta
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Biochemistry and Biophysics Laboratory, Butantan Institute, São Paulo, Brazil
| | | | - Lucilene Delazari Dos Santos
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Clinical Research, Center for the Study of Venoms and Venomous Animals (CEVAP) and Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Benedito Barraviera
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Clinical Research, Center for the Study of Venoms and Venomous Animals (CEVAP) and Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| |
Collapse
|
19
|
Prasad SK, Mehta SK, Satyanarayan B, Panda SK. Multi-organ dysfunction following honeybee bite-A rare entity. J Family Med Prim Care 2020; 9:5052-5054. [PMID: 33209844 PMCID: PMC7652159 DOI: 10.4103/jfmpc.jfmpc_629_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 11/06/2022] Open
Abstract
Honeybee bites have been known to cause localized allergic reactions and anaphylaxis but systemic toxic reactions leading to multiorgan dysfunction is very rare. Serious complications like acute renal failure, acute myocardial infarction (Kounis syndrome) and even death have been reported as the complication of honeybee bite. Herein, we report a case of multiorgan dysfunction following honeybee bite, which was complicated with acute kidney injury, thrombocytopenia, bradycardia, keratitis, and deranged liver function along with localized allergic reaction and pain.
Collapse
Affiliation(s)
- Satish Kumar Prasad
- M.D. Medicine, Senior Consultant, Consultant, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Sameer Kumar Mehta
- M.D. Medicine, Specialist, Consultant, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | | | - Suman Kumar Panda
- M.D. Medicine, Consultant, Tata Main Hospital, Jamshedpur, Jharkhand, India
| |
Collapse
|
20
|
Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176162. [PMID: 32854269 PMCID: PMC7504193 DOI: 10.3390/ijerph17176162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022]
Abstract
Background: Hymenopteran stings are the most common animal insult injury encountered in the emergency department. With increasing global spread of imported fire ants in recent decades, the rate of Formicidae assault has become a serious problem in many countries. Formicidae-associated injuries gradually increased in Taiwan in recent decades and became the second most common arthropod assault injury in our ED. The present study aimed at comparing the clinical characteristics of Formicidae sting patients with those of the most serious and common group, Vespidae sting patients, in an emergency department (ED) in Taiwan. Methods: This retrospective study included patients who were admitted between 2015 to 2018 to the ED in a local teaching hospital in Taiwan after a Vespidae or Formicidae sting. Cases with anaphylactic reaction were further compared. Results: We reviewed the records of 881 subjects (503 males, 378 females; mean age, 49.09 ± 17.62 years) who visited our emergency department due to Vespidae or Formicidae stings. A total of 538 (61.1%) were categorized into the Vespidae group, and 343 (38.9%) were sorted into the Formicidae group. The Formicidae group had a longer ED length of stay (79.15 ± 92.30 vs. 108.00 ± 96.50 min, p < 0.01), but the Vespidae group had more cases that required hospitalization (1.9% vs. 0.3%, p = 0.04). Antihistamines (76.8% vs. 80.2%, p < 0.01) were more frequently used in the Formicidae group, while analgesics were more frequently used in the Vespidae group (38.1% vs. 12.5%, p < 0.01). The Vespidae group had more local reactions, and the Formicidae group had more extreme, systemic, or anaphylactic allergic reactions. Creatine kinase was significantly higher in the Vespidae group with an anaphylactic reaction. Sting frequency in both groups exhibited the same positive associations with average temperature of the month and weekend days. Conclusion: Formicidae sting patients presented to the ED with higher rate allergic reactions and spent more time in the ED than Vespidae sting patients. However, Vespidae sting patients had more complications and higher rates of admission, especially with anaphylactic reaction. Laboratory data, especially creatine kinase data, were more valuable to check in Vespidae sting patients with an anaphylactic reaction in the ED. Both groups exhibited positive correlations with temperature and a higher rate on weekend days.
Collapse
|
21
|
Constantino K, Pawlukiewicz AJ, Spear L. A Case Report on Rhabdomyolysis After Multiple Bee Stings. Cureus 2020; 12:e9501. [PMID: 32879823 PMCID: PMC7458714 DOI: 10.7759/cureus.9501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Envenoming syndrome is an uncommon condition associated with significant morbidity and mortality following multiple Hymenoptera stings. We review the case of a 90-year-old male who presented after receiving greater than 100 bee stings and was found to have rhabdomyolysis with concomitant acute kidney injury. Physicians should consider envenoming syndrome in all patients presenting with greater than 50 bee stings, despite hemodynamically stability upon initial presentation.
Collapse
|
22
|
Deng YY, Shen JM, Mao YN, Gou R, Li WW, Ye TT. Sustained low-efficiency diafiltration is superior to hemodialysis in promoting renal function recovery in elderly wasp sting victims with stage III acute kidney injury: a retrospective study. Ren Fail 2020; 41:814-820. [PMID: 31488010 PMCID: PMC6735344 DOI: 10.1080/0886022x.2019.1655449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To study the efficacy and safety of sustained low-efficiency diafiltration (SLEDf) versus hemodialysis (HD) for patients with wasp stings who developed stage III acute kidney injury (AKI). Methods: We retrospectively analyzed the clinical data of consecutive patients who developed AKI following wasp stings. All eligible patients received renal replacement therapy in combination with hemoperfusion. Thereafter, blood purification therapy and HD were performed with a volumetrically controlled machine and 1.7 m2 surface, Fresenius Polysulfone HD filter and SLEDf was undertaken with a volumetrically controlled machine and 1.3 m2 surface, Fresenius Polysulfone HD filter. Results: Forty patients developed stage III AKI following wasp stings, including 14 patients that received SLEDf and 26 patients underwent HD. Thirteen patients were aged less than 60 years and underwent HD (group I), 27 patients were aged at least 60 years, including 13 patients undergoing HD (group II) and 14 patients receiving SLEDf (group III). Groups I and II completed 150 and 162 sessions of HD, respectively, and group III completed 156 sessions of sustained low-efficiency blood purification therapy, including 50 sessions of SLEDf. The time to return to normal serum creatinine levels was 38.8 ± 2.7 days for group I, 47.2 ± 5.3 days for group II, and 39.2 ± 3.3 days for group III. A statistically significant difference was observed in time to normal serum creatinine levels among the three groups. Conclusion: Elderly wasp victims have more severe illness than younger wasp victims and SLEDf is safe and superior to HD in recovery of renal function of elderly wasp victims.
Collapse
Affiliation(s)
- Yan-Yan Deng
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine , Shiyan , China
| | - Jian-Ming Shen
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine , Shiyan , China
| | - Ya-Ni Mao
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine , Shiyan , China
| | - Rong Gou
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine , Shiyan , China
| | - Wen-Wen Li
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine , Shiyan , China
| | - Ting-Ting Ye
- Department of Nephrology, Renmin Hospital, Hubei University of Medicine , Shiyan , China
| |
Collapse
|
23
|
Jagua-Gualdrón A, Peña-Latorre JA, Fernadez-Bernal RE. Apitherapy for Osteoarthritis: Perspectives from Basic Research. Complement Med Res 2020; 27:184-192. [PMID: 31896107 DOI: 10.1159/000505015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022]
Abstract
Osteoarthritis is one of the most common rheumatic disease in the world and one of the leading causes of disability in the elderly. There is still no curative management for the disease, so the search for new therapeutic alternatives continues. -Apitherapy is a therapeutic tool based on the use of beehive products used since ancient times and, at present, their mechanism of action begins to be known. Many of the mechanisms of action of the beehive products are useful for chronic articular pathophysiological processes such as those described in osteoarthritis. This article presents a review of the current state of understanding of the mechanisms through which bee venom, propolis, honey, pollen, and royal jelly may act on osteoarthritis.
Collapse
Affiliation(s)
- Andrés Jagua-Gualdrón
- Universidad Nacional de Colombia, Bogotá, Colombia, .,Apitherapy Investigation and Development Group, Sociedad Colombiana de Apiterapia - Colombian Apitherapy Society, Bogotá, Colombia,
| | - José Adolfo Peña-Latorre
- Universidad Nacional de Colombia, Bogotá, Colombia.,Apitherapy Investigation and Development Group, Sociedad Colombiana de Apiterapia - Colombian Apitherapy Society, Bogotá, Colombia.,Complementary and Alternative Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Roger Edwin Fernadez-Bernal
- Apitherapy Investigation and Development Group, Sociedad Colombiana de Apiterapia - Colombian Apitherapy Society, Bogotá, Colombia.,Universidad Provada del Valle, Cochabamba Bolivia Medical Director Medizen Bolivia, Cochabamba, Bolivia
| |
Collapse
|
24
|
Chauhan K, Shandilya N. An interesting story of intravascular hemolysis but normal haptoglobin and bilirubin levels. JOURNAL OF CLINICAL SCIENCES 2020. [DOI: 10.4103/jcls.jcls_76_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
25
|
Pucca MB, Cerni FA, Oliveira IS, Jenkins TP, Argemí L, Sørensen CV, Ahmadi S, Barbosa JE, Laustsen AH. Bee Updated: Current Knowledge on Bee Venom and Bee Envenoming Therapy. Front Immunol 2019; 10:2090. [PMID: 31552038 PMCID: PMC6743376 DOI: 10.3389/fimmu.2019.02090] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/19/2019] [Indexed: 12/13/2022] Open
Abstract
Honey bees can be found all around the world and fulfill key pollination roles within their natural ecosystems, as well as in agriculture. Most species are typically docile, and most interactions between humans and bees are unproblematic, despite their ability to inject a complex venom into their victims as a defensive mechanism. Nevertheless, incidences of bee stings have been on the rise since the accidental release of Africanized bees to Brazil in 1956 and their subsequent spread across the Americas. These bee hybrids are more aggressive and are prone to attack, presenting a significant healthcare burden to the countries they have colonized. To date, treatment of such stings typically focuses on controlling potential allergic reactions, as no specific antivenoms against bee venom currently exist. Researchers have investigated the possibility of developing bee antivenoms, but this has been complicated by the very low immunogenicity of the key bee toxins, which fail to induce a strong antibody response in the immunized animals. However, with current cutting-edge technologies, such as phage display, alongside the rise of monoclonal antibody therapeutics, the development of a recombinant bee antivenom is achievable, and promising results towards this goal have been reported in recent years. Here, current knowledge on the venom biology of Africanized bees and current treatment options against bee envenoming are reviewed. Additionally, recent developments within next-generation bee antivenoms are presented and discussed.
Collapse
Affiliation(s)
- Manuela B. Pucca
- Medical School, Federal University of Roraima, Boa Vista, Brazil
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Felipe A. Cerni
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Isadora S. Oliveira
- Department of Physics and Chemistry, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Timothy P. Jenkins
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Lídia Argemí
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Christoffer V. Sørensen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| | - Shirin Ahmadi
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
- Department of Biotechnology and Biosafety, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - José E. Barbosa
- Department of Biochemistry and Immunology, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Andreas H. Laustsen
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Lyngby, Denmark
| |
Collapse
|
26
|
Ryakitimbo A, Kennedy M, Shao E, Itana ME, Mbwasi R, Kinabo G, Yeates K, Kilonzo K. Acute kidney injury in a Tanzanian boy following multiple bee stings in resource-limited setting: a case report. Oxf Med Case Reports 2018; 2018:omy070. [PMID: 30302262 PMCID: PMC6169196 DOI: 10.1093/omcr/omy070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/02/2018] [Accepted: 07/16/2018] [Indexed: 11/16/2022] Open
Abstract
Bee sting has been identified as among causative agents of nephrotoxic acute tubular necrosis which may lead to acute kidney injury. Bee envenomation has medicinal properties but when a higher dose is inoculated may cause severe anaphylaxis with very poor prognosis. We report a 12-year-old boy with acute kidney injury following multiple bee stings who recovered well after hemodialysis.
Collapse
Affiliation(s)
- Amon Ryakitimbo
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Misso Kennedy
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Elichilia Shao
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Maria E Itana
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ronald Mbwasi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Grace Kinabo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | | |
Collapse
|