1
|
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
|
2
|
Metz M, Elberskirch M, Reuter C, Liedtke L, Maurer M. Efficacy of Concentrated Heat for Treatment of Insect Bites: A Real-world Study. Acta Derm Venereol 2023; 103:adv11592. [PMID: 37358395 PMCID: PMC10309056 DOI: 10.2340/actadv.v103.11592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/17/2023] [Indexed: 06/27/2023] Open
Abstract
Insect bites that cause itch, pain and swelling are very common. The use of concentrated heat for relief of these symptoms may be a promising approach; however, the scientific evidence for efficacy of hyperthermia treatment is sparse. We report here the results of a large real-world study using a randomized control group to assess the efficacy of hyperthermia on insect bites in real-world conditions, specifically considering mosquito bites as the most common type. The study was conducted in a decentralized manner via a smartphone-controlled medical device, heat it®, for treatment of insect bites and stings through application of heat. The application that controls the device was accompanied by additional questionnaires, that collected data related to insect bites, such as itch and pain intensity. Analysis of data from over 12,000 collected treated insect bites, generated by approximately 1,750 participants (42% female, 39 ± 13 years) showed significant inhibition of itch and pain for all investigated insect species (mosquitoes, horseflies, bees and wasps). Mosquito bite-induced itch was reduced by 57% within the first minute and by 81% 5-10 min after treatment, and the overall reduction in itch and pain was more pronounced than in the control group. In conclusion, the results indicate that local application of heat relieves symptoms of insect bites.
Collapse
Affiliation(s)
- Martin Metz
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | | | | | | | - Marcus Maurer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany
| |
Collapse
|
3
|
Fehr D, Micaletto S, Moehr T, Schmid-Grendelmeier P. Risk factors for severe systemic sting reactions in wasp ( Vespula spp.) and honeybee ( Apis mellifera) venom allergic patients. Clin Transl Allergy 2019; 9:54. [PMID: 31632639 PMCID: PMC6788055 DOI: 10.1186/s13601-019-0292-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 09/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Hymenoptera stings are a major cause of anaphylaxis. Various risk factors are discussed in literature. This study aims to investigate potential risk factors for severe sting reactions in wasp (Vespula spp.) and honeybee (Apis mellifera) venom allergic patients and analyses the correlation between diagnostic test results and the severity of the allergic reaction. Methods 480 patients suffering from wasp or honeybee venom allergy were included in this retrospective case series. Only individuals allergic to Vespula spp. but not to other vespids such as Polistes were considered. The severity of their systemic field sting reaction was analysed with regard to the amount of specific IgE antibodies to whole venom extracts and to major allergens of honeybee and/or wasp venom. Furthermore, the following potential risk factors for severe sting reactions were examined: age, sex, latency time, skin symptoms, baseline serum tryptase levels and the concentration of venom inducing a positive intracutaneous test. Results The two following indicators for severe systemic sting reactions in honeybee and wasp venom allergic patients have been identified: a short latency time and the absence of skin symptoms. The patient’s age and baseline serum tryptase levels have been found to positively correlate with the grade of the sting reaction only in individuals allergic to wasp venom. No correlation could be found between the degree of sensitisation and the severity of the allergic reaction. Neither the amount of specific IgE antibodies to whole venom extracts nor to major allergens were significantly associated with the severity of the sting reaction. Conclusion The clinical history is essential for the allergological workup and therapeutic decision on Hymenoptera venom allergies. A short latency time and the absence of skin symptoms are indicators for severe systemic sting reactions, followed by the patient’s age and baseline serum tryptase levels.
Collapse
Affiliation(s)
- Danielle Fehr
- 1Allergy Unit, Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
| | - Sara Micaletto
- 1Allergy Unit, Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
| | - Thomas Moehr
- B,S,S. Economic Consultants, Aeschengraben 9, 4051 Basel, Switzerland
| | - Peter Schmid-Grendelmeier
- 1Allergy Unit, Department of Dermatology, University Hospital Zurich, Gloriastrasse 31, 8091 Zurich, Switzerland
| |
Collapse
|
4
|
Sato K, Hirata H, Tatewaki M, Shiromori S, Souma R, Satoh H, Sugiyama K, Arima M, Kurasawa K, Fukuda T, Fukushima Y. Emergency Treatment of Anaphylaxis in Japanese Beekeepers. J Agromedicine 2019; 25:153-157. [DOI: 10.1080/1059924x.2019.1674229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kozo Sato
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Hirokuni Hirata
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Masamitsu Tatewaki
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Sadaaki Shiromori
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Ryosuke Souma
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Hideyuki Satoh
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Kumiya Sugiyama
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| | - Masafumi Arima
- Department of Rheumatology, Dokkyo Medical University, Tochigi, Japan
| | - Kazuhiro Kurasawa
- Department of Rheumatology, Dokkyo Medical University, Tochigi, Japan
| | | | - Yasutsugu Fukushima
- Department of Respiratory Medicine and Clinical Immunology, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan
| |
Collapse
|
5
|
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
|
6
|
How fast does wasp venom immunotherapy affect a regulatory T cell subpopulation (CD4+ CD25+ Foxp3+) and the synthesis of interleukins 10, 21 and transforming growth factor β1? Postepy Dermatol Alergol 2019; 36:82-85. [PMID: 30858784 PMCID: PMC6409867 DOI: 10.5114/ada.2019.82828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 12/13/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction The literature describes the influence of venom immunotherapy (VIT) on the subpopulation of T regulatory cells (CD4+ CD25+ Foxp3+) and the synthesis of IL-10, TGF-β1 as well as many other cytokines at various times after immunotherapy. Aim To assess changes in the percentage of cells of CD4+ and CD25+ in peripheral blood and serum concentrations of IL-10, IL-21 and TGF-β1 in the early stages of VIT. Material and methods The study included 18 patients who were allergic to wasp venom and who in the past underwent systemic anaphylactic reaction after stinging, meeting the criteria to qualify for VIT. The immunoenzymatic method (ELISA) was used to assess concentrations of cytokines IL-10, IL-21 and TGF-β1 and the surface antigens CD4 and CD25 on the cells. The concentrations were determined by flow cytometry method at baseline (before VIT) and after 2.5 and 24 h from the VIT starting point. Results The mean values of the activity of T lymphocytes CD4+ CD25+ FoxP3+ and concentrations of the cytokines IL-10, IL-21 and TGF-β1 are shown in table. Conclusions A 24-hour activation assessment of serum concentrations of cytokines IL-10, IL-21 and TGF-β1 during the first day of the Hymenoptera venom immunotherapy by ultra-rush protocol does not show the significant dynamics of change of the examined parameters.
Collapse
|
7
|
Dillane D, Richards SL, Balanay JAG, Langley R. Risk Assessment and Recommendations for Forester Exposure to Hymenoptera. J Agromedicine 2019; 24:146-156. [DOI: 10.1080/1059924x.2019.1567425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Danielle Dillane
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Stephanie L. Richards
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Jo Anne G. Balanay
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Ricky Langley
- Department of Toxicology, North Carolina State University, Raleigh, NC, USA
| |
Collapse
|
8
|
Analysis of Hymenoptera venom allergy in own material. Clinical evaluation of reactions following stings, in patients qualified for venom immunotherapy. Postepy Dermatol Alergol 2018; 36:302-307. [PMID: 31333347 PMCID: PMC6640013 DOI: 10.5114/ada.2018.75607] [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: 03/25/2018] [Accepted: 03/30/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Hymenoptera venom allergy (HVA) in some patients occurs with general symptoms involving respiratory and cardiovascular system with anaphylactic shock with constitutes a significant threat to life. Aim Assessment of the prevalence of HVA in our own material. Material and methods There were 498 patients after a general reaction to wasp and/or bee venom. The survey included questions: the type of stinging insect, body parts stung by insects, profession, frequency of stings by wasps and bees depending on professional activity, places of stings, clinical symptoms using the scale according to Muller, and the treatment following the sting. Among 498 patients, there were 281 women and 217 men. Results Wasp stings were more frequent and affected 382 (77%) persons, while bee stings affected 116 (23%) persons. Limbs constituted the most common area of the body stung by both wasps and bees. The sting was more frequent in rural areas and during summer rest. A severe systemic reaction (class III and IV according to Muller) occurred more often in people stung by bees. The most common medications included intravenous glucocorticosteroids, calcium preparations and antihistamines. Intramuscular Adrenaline injection was used in 48% of patients, while only 15% received its prescription as an emergency medication. Bee stings were the most common cause of severe systemic symptoms. Conclusions The treatment after the sting in a significant percentage of episodes still deviates from the recommendations of the guidelines, especially in the field of adrenaline recommendations for patients in case of a resting by an insect
Collapse
|
9
|
Diagnostics in Hymenoptera venom allergy: current concepts and developments with special focus on molecular allergy diagnostics. ACTA ACUST UNITED AC 2017; 26:93-105. [PMID: 28503403 PMCID: PMC5406443 DOI: 10.1007/s40629-017-0014-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/06/2017] [Indexed: 11/05/2022]
Abstract
Background The high rate of asymptomatic sensitization to Hymenoptera venom, difficulty in correctly identifying Hymenoptera and loss of sensitization over time make an accurate diagnosis of Hymenoptera venom allergy challenging. Although routine diagnostic tests encompassing skin tests and the detection of venom-specific IgE antibodies with whole venom preparations are reliable, they offer insufficient precision in the case of double sensitized patients or in those with a history of sting anaphylaxis, in whom sensitization cannot be proven or only to the presumably wrong venom. Methods Systematic literature research and review of current concepts of diagnostic testing in Hymenoptera venom allergy. Results and discussion Improvements in diagnostic accuracy over recent years have mainly been due to the increasing use of molecular allergy diagnostics. Detection of specific IgE antibodies to marker and cross-reactive venom allergens improves the discrimination between genuine sensitization and cross-reactivity, and this provides a better rationale for prescribing venom immunotherapy. The basophil activation test has also increased diagnostic accuracy by reducing the number of Hymenoptera venom sensitizations overlooked with routine tests. This paper reviews current concepts of diagnostic testing in Hymenoptera venom allergy and suggests fields for further development.
Collapse
|
10
|
Bonadonna P, Bonifacio M, Lombardo C, Zanotti R. Hymenoptera Allergy and Mast Cell Activation Syndromes. Curr Allergy Asthma Rep 2016; 16:5. [PMID: 26714690 DOI: 10.1007/s11882-015-0582-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Mast cell activation syndrome (MCAS) can be diagnosed in patients with recurrent, severe symptoms from mast cell (MC)-derived mediators, which are transiently increased in serum and are attenuated by mediator-targeting drugs. When KIT-mutated, clonal MC are detected in these patients, a diagnosis of primary MCAS can be made. Severe systemic reactions to hymenoptera venom (HV) represent the most common form of anaphylaxis in patients with mastocytosis. Patients with primary MCAS and HV anaphylaxis are predominantly males and do not have skin lesions in the majority of cases, and anaphylaxis is characterized by hypotension and syncope in the absence of urticaria and angioedema. A normal value of tryptase (≤11.4 ng/ml) in these patients does not exclude a diagnosis of mastocytosis. Patients with primary MCAS and HV anaphylaxis have to undergo lifelong venom immunotherapy, in order to prevent further potentially fatal severe reactions.
Collapse
Affiliation(s)
- Patrizia Bonadonna
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, 37126, Verona, Italy.
- Multidisciplinary Outpatients clinics for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Massimiliano Bonifacio
- Section of Hematology, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale L.A. Scuro, 10-37134, Verona, Italy.
- Multidisciplinary Outpatients clinics for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Carla Lombardo
- Allergy Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, 37126, Verona, Italy.
- Multidisciplinary Outpatients clinics for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Roberta Zanotti
- Section of Hematology, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale L.A. Scuro, 10-37134, Verona, Italy.
- Multidisciplinary Outpatients clinics for Mastocytosis (GISM), Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| |
Collapse
|
11
|
Gálvez-Olortegui J, Álvarez-Vargas M, Durand-Vergara J, Díaz-Lozano M, Gálvez-Olortegui T, Armas-Ramírez I, Hilario-Vargas J. Henoch Schonlein purpura associated with bee sting: case report. Medwave 2015; 15:e6297. [PMID: 26610057 DOI: 10.5867/medwave.2015.09.6297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/20/2015] [Indexed: 11/27/2022] Open
Abstract
Henoch Schonlein purpura (HSP) is a common childhood vasculitis, characterized by a non-thrombocytopenic palpable purpura and systemic features. It can be triggered by conditions like infections and insect bites. We present the case of a six-year-old girl with palpable maculopapular lesions on the lower limbs, itching, mild pain, swelling of feet, limitation of limb mobility, and a history of bee sting. Thigh skin biopsy was performed, with a report of leucocytoclastic vasculitis, and was diagnosed as HSP. She was prescribed bed rest, and was given oral hydration. The patient outcome was favorable and was discharged after five days. This is the fifth report of a HSP case associated with a bee sting with an uncomplicated course, which is in contrast to previous case reports.
Collapse
Affiliation(s)
- José Gálvez-Olortegui
- Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú; Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú. Address: Manzana G, Lote 22, Urbanización Vista Hermosa, Trujillo, La Libertad, Perú.
| | - Mayita Álvarez-Vargas
- Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú; Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú
| | | | | | - Tomas Gálvez-Olortegui
- Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú; Scientia Clinical and Epidemiological Research Institute, Trujillo, Perú; Instituto Regional de Oftalmología, Trujillo, Perú
| | | | - Julio Hilario-Vargas
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú
| |
Collapse
|
12
|
Stajic Z, Djuric P, Grdinic A, Mijailovic Z. Unusual occurrence of ventricular tachycardia induced by single bee sting. Indian J Crit Care Med 2015; 19:429-30. [PMID: 26180439 PMCID: PMC4502499 DOI: 10.4103/0972-5229.160295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Zoran Stajic
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia, Southeast Europe
| | - Predrag Djuric
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia, Southeast Europe
| | - Aleksandra Grdinic
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia, Southeast Europe
| | - Zdravko Mijailovic
- Clinic of Cardiology, Military Medical Academy, Belgrade, Serbia, Southeast Europe
| |
Collapse
|
13
|
Silva LGMD, Bernardes Filho F, Quaresma MV, Leite EDSP, Marteloso ADO, Saldanha NF, Brum GG. Dermoscopy as an auxiliary method in the diagnosis of social wasp (Hymenoptera, Vespidae) stings. An Bras Dermatol 2014; 89:163-4. [PMID: 24626666 PMCID: PMC3938372 DOI: 10.1590/abd1806-4841.20142593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/08/2013] [Indexed: 11/26/2022] Open
Abstract
We describe the case of a 32-year-old male patient that sought medical treatment
complaining of severe pain in his second and third right-hand fingers. The symptoms
had started two hours before. The hypotheses of spider bite, scorpion or insect sting
and injury caused by a foreign body were considered in the differential diagnoses. On
dermoscopy, two foreign bodies were identified on his skin. After extraction, we
concluded that they were wasp stingers.
Collapse
Affiliation(s)
| | - Fred Bernardes Filho
- Santa Casa da Misericórdia do Rio de Janeiro, Prof. Rubem David Azulay Institute of Dermatology, Rio de JaneiroRJ, Brazil, Post-graduate student of Dermatology, Prof. Rubem David Azulay Institute of Dermatology - Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ) and Postgraduate Medical School at Pontifical Catholic University of Rio de Janeiro (EMPG/PUC-RJ) - Rio de Janeiro (RJ), Brazil
| | - Maria Victória Quaresma
- Santa Casa da Misericórdia do Rio de Janeiro, Prof. Rubem David Azulay Institute of Dermatology, Rio de JaneiroRJ, Brazil, Post-graduate student of Dermatology, Prof. Rubem David Azulay Institute of Dermatology - Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ) and Postgraduate Medical School at Pontifical Catholic University of Rio de Janeiro (EMPG/PUC-RJ) - Rio de Janeiro (RJ), Brazil
| | - Elaine de Souza Pinto Leite
- Hospital Municipal da Piedade, Rio de JaneiroRJ, Brazil, Internal Medicine Residency, Hospital Municipal da Piedade - Rio de Janeiro (RJ), Brazil
| | - Andresa de Oliveira Marteloso
- Hospital Municipal da Piedade, Rio de JaneiroRJ, Brazil, Internal Medicine Residency, Hospital Municipal da Piedade - Rio de Janeiro (RJ), Brazil
| | | | | |
Collapse
|
14
|
Xie C, Xu S, Ding F, Xie M, Lv J, Yao J, Pan D, Sun Q, Liu C, Chen T, Li S, Wang W. Clinical features of severe wasp sting patients with dominantly toxic reaction: analysis of 1091 cases. PLoS One 2013; 8:e83164. [PMID: 24391743 PMCID: PMC3877022 DOI: 10.1371/journal.pone.0083164] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/30/2013] [Indexed: 11/23/2022] Open
Abstract
Background Massive wasp stings have been greatly underestimated and have not been systematically studied. The aim of this study was to identify the clinical features and treatment strategies of severe wasp stings. Methods and Findings A multicenter retrospective study was undertaken in 35 hospitals and medical centers including 12 tertiary care hospitals and 23 secondary care hospitals in the Hubei Province, China. The detailed clinical data of 1091 hospitalized wasp sting patients were investigated. Over three-fourths (76.9%) of the cases had 10 or more stings and the in-hospital mortality of patients was 5.1%. Forty-eight patients died of organ injury following toxic reactions to the stings, whereas six died from anaphylactic shock. The in-hospital mortality in patients with >10 stings was higher than that of ≤10 stings (5.2% vs. 1.0%, p = 0.02). Acute kidney injury (AKI) was seen in 21.0% patients and most patients required blood purification therapy. Rhabdomyolysis was seen in 24.1% patients, hemolysis in 19.2% patients, liver injury in 30.1% patients, and coagulopathy in 22.5% patients. Regression analysis revealed that high creatinine level, shock, oliguria, and anemia were risk factors for death. Blood purification therapy was beneficial for patients with ≥20 stings and delayed hospital admission of patients (≥4 hours after sting). Conclusions In China, most patients with multiple wasp stings presented with toxic reactions and multiple organ dysfunction caused by the venom rather than an anaphylactic reaction. AKI is the prominent clinical manifestation of wasp stings with toxic reaction. High creatinine levels, shock, oliguria, and anemia were risk factors for death.
Collapse
Affiliation(s)
- Cuihong Xie
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shabei Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fengfei Ding
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Minjie Xie
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiagao Lv
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jihua Yao
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dengji Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qian Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenchen Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tie Chen
- Division of Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Shusheng Li
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: (SL); (WW)
| | - Wei Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail: (SL); (WW)
| |
Collapse
|
15
|
Müller D, Desel H. Common causes of poisoning: etiology, diagnosis and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:690-9; quiz 700. [PMID: 24194796 DOI: 10.3238/arztebl.2013.0690] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 07/31/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND In 2011, German hospitals treated approximately 205 000 patients suffering from acute poisoning. Change is seen over time both in the types of poisoning that occur and in the indications for specific treatment. METHODS This article is based on a selective review of the literature, with special attention to the health reports of the German federal government, the annual reports of the GIZ-Nord Poisons Center (the poison information center for the four northwestern states of Germany, i.e. Bremen, Hamburg, Lower Saxony and Schleswig-Holstein), and the recommendations of international medical associations. RESULTS From 1996 to 2011, the GIZ-Nord Poisons Center answered more than 450 000 inquiries, most of which involved exposures to medical drugs, chemicals, plants, foods, or cosmetics. Poisoning was clinically manifest in only a fraction of these cases. Ethanol intoxication is the commonest type of acute poisoning and suicide by medical drug overdose is the commonest type of suicide by poisoning. Death from acute poisoning is most commonly the result of either smoke inhalation or illegal drug use. Severe poisoning is only rarely due to the ingestion of chemicals (particularly detergents and cleaning products), cosmetics, or plant matter. Medical procedures that are intended to reduce the absorption of a poison or enhance its elimination are now only rarely indicated. Antidotes (e.g., atropine, 4-dimethylaminophenol, naloxone, toluidine blue) are available for only a few kinds of poisoning. Randomized clinical trials of treatment have been carried out for only a few substances. CONCLUSION Most exposures to poisons can be treated with general emergency care and, if necessary, with symptomatic intensive-care measures. Poison information centers help ensure that cases of poisoning are dealt with efficiently. The data they collect are a useful aid to toxicological assessment and can serve as a point of departure for research projects.
Collapse
Affiliation(s)
- Dieter Müller
- GIZ-Nord Poisons Center, University Medical Center Göttingen-Georg-August-Universität
| | | |
Collapse
|
16
|
Zhang L, Yang Y, Tang Y, Zhao Y, Cao Y, Su B, Fu P. Recovery from AKI following multiple wasp stings: a case series. Clin J Am Soc Nephrol 2013; 8:1850-6. [PMID: 24009218 DOI: 10.2215/cjn.12081112] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVE To observe the outcomes of AKI following multiple wasp stings. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Eighty-one patients (mean age ± SD, 45.5 ± 14.7 years; 55 men and 26 women; mean Acute Physiology and Chronic Health Evaluation II score, 16.85 ± 2.78) with AKI following multiple wasp stings between 1997 and 2011 were retrospectively analyzed. Data on their demographic characteristics, initial modalities of renal replacement therapy (RRT), urine output, serum creatinine, bilirubin, myoglobin, and other variables were collected. Renal outcomes included complete recovery of kidney function, CKD, and death. Subgroup analysis was performed according to initial modality of RRT in the first 48 hours, including continuous veno-venous hemofiltration (CVVH), intermittent hemodialysis (IHD), and CVVH plus plasma exchange (PE). RESULTS Of the 75 patients available for follow-up, 7 (9.3%) died, and 8 (10.7%, all in the IHD group) developed CKD. The average RRT time was 18.2 ± 8.4 days, and the average kidney function recovery time was 36.0 (29.0, 41.0) days. Subgroup analysis showed no difference in the mortality rates between the CVVH, CVVH + PE, and IHD groups (8.0%, 7.1%, and 11.1%, respectively; P>0.99). The recovery time for kidney function was significantly shorter in the CVVH and CVVH + PE groups than in the IHD group (31.9 ± 8.5 days, 28.6 ± 9.4 days, and 41.6 ± 8.1 days, respectively; P<0.001). CONCLUSIONS This is a large case series report on the outcomes of patients with AKI following multiple wasp stings. Most patients survived with complete recovery of their kidney function. Despite the lack of difference in mortality rates, the patients who began RRT with CVVH and CVVH + PE experienced a better and more rapid recovery of kidney function than those initiated with IHD.
Collapse
Affiliation(s)
- Ling Zhang
- Division of Nephrology and , †Division of Emergency, West China Hospital of Sichuan University, Sichuan, Chengdu, China
| | | | | | | | | | | | | |
Collapse
|
17
|
Tobüren A. Heat therapy--simple treatment for acute insects stings. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:494; author reply 494. [PMID: 22833768 PMCID: PMC3402079 DOI: 10.3238/arztebl.2012.0494a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
|