Stroke intracerebral multiple infarcts: Rare neurological presentation of honey bee bite

Clinical complications in envenoming by Apis honeybee stings: insights into mechanisms, diagnosis, and pharmacological interventions

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.

Analysis of a Case of Facial Nerve Injury Caused by Bee Sting in a Child

Background

Bee sting injuries in children are accidental and occur in rural areas in summer and autumn. They have the characteristics of rapid onset, rapid change, many complications, complex treatment, and high disability rate. Patients experience various symptoms, such as vomiting, diarrhea, dyspnea, angioedema, multiple neuritis, myocardial infarction, acute renal failure, hypotension, and collapse. Systemic complications of the nervous system are rare. However, some cases of stroke, optic neuritis, and acute disseminated encephalomyelitis are related to bee stings. There are many cases of systemic multiple organ dysfunctions after bee sting injury, but there are few reports of facial nerve injury. The case presented here was caused by bee venom. This report is important because there are few instances of facial paralysis in the large number of notified bee sting cases. After active treatment, the facial paralysis of the child recovered gradually.

Case Presentation

The patient was a 6-year-old boy. The bee stings by bee swarm induced pain in many parts of the body for 8 h. After the injury, he had skin itching, rash, swelling, and pain in the head and face. The boy had soy sauce-colored urine later and was transferred to the Affiliated Hospital of Zunyi Medical University from a lower-level hospital for treatment. On the seventh day after transfer, the child suddenly suffered from deviated mouth, which was considered a delayed facial nerve injury. After active treatment, he recovered from facial paralysis and was discharged from the hospital.

Conclusion

This case report adds the clinical manifestation of facial paralysis after bee stings. They require close observation and being alert to possible clinical manifestations, as well as carrying out active intervention treatment.

Cerebral infarction following bee stings: Case report and literature review

Background

To date, only 25 cases of cerebral infarction following a bee or wasp sting have been reported. Due to its rarity, undefined pathogenesis, and unique clinical features, we report a case of a 62-year-old man with progressive cerebral infarction following bee stings, possibly related to vasospasm. Furthermore, we review relevant literature on stroke following bee or wasp stings.

Case presentation

A 62-year-old retired male presented with progressive ischemic stroke after bee stings to the ear and face. Initial magnetic resonance imaging of the brain showed small punctate infarcts in the left medulla oblongata. Head and neck computed tomography angiography showed significant stenosis in the basilar artery and occlusion in the left V4 vertebral artery. The patient received intravenous alteplase (0.9 mg/kg) without symptomatic improvement. Digital subtraction angiography later demonstrated additional near occlusion in the left posterior cerebral artery (PCA). Thrombectomy was considered initially but was aborted due to hemodynamic instability. Repeated CT brain after 24 h showed acute infarcts in the left parieto-occipital region and left thalamus. The near occluded PCA was found to be patent again on magnetic resonance angiography (MRA) 25 days later. This reversibility suggests that vasospasm may have been the underlying mechanism. Unfortunately, the patient had persistent significant neurological deficits after rehabilitation one year later.

Conclusion

Cerebral infarction following bee stings is rare. There are several proposed pathophysiological mechanisms. While the natural course of this phenomenon is not well characterized, early diagnosis and treatment are essential. Furthermore, it is important to establish standardized care procedures for this unique entity.

Allergic Anaphylactic Risk in Farming Activities: A Systematic Review

Allergic disorders in the agriculture sector are very common among farm workers, causing many injuries and occupational diseases every year. Agricultural employees are exposed to multiple conditions and various allergenic substances, which could be related to onset of anaphylactic reactions. This systematic review highlights the main clinical manifestation, the allergens that are mostly involved and the main activities that are usually involved. This research includes articles published on the major databases (PubMed, Cochrane Library, Scopus), using a combination of keywords. The online search yielded 489 references; after selection, by the authors, 36 articles (nine reviews and 27 original articles) were analyzed. From this analysis, the main clinical problems that were diagnosed in this category were respiratory (ranging from rhinitis to asthma) and dermatological (eczema, dermatitis, hives) in nature, with a wide symptomatology (from a simple local reaction to anaphylaxis). The main activities associated with these allergic conditions are harvesting or cultivation of fruit and cereals, beekeepers and people working in greenhouses. Finally, in addition to the allergens already known, new ones have emerged, including triticale, wine, spider and biological dust. For these reasons, in the agricultural sector, research needs to be amplified, considering new sectors, new technologies and new products, and ensuring a system of prevention to reduce this risk.

Africanised honey bee sting-induced ischaemic stroke

The Africanised honey bee, vernacularly known as the 'killer bee', is a hybrid of the western honey bee species. These bees tend to be more aggressive with a greater tendency for swarm formation. Their stings are frequently encountered with a broad spectrum of clinical manifestations, ranging from local to systemic effects, even with recorded fatalities. We report a case of an elderly man, who experienced a cerebrovascular event confirmed by neuroimaging within 24 hours after a multitude of Africanised honey bee stings.

A case report of an unusual complication from bee sting: acute brachial plexopathy

Brachial plexopathy is usually related to trauma like direct injury to the nerve and stretching injuries. Neurological complications following bee sting are uncommon. Here, we describe a rare case of acute brachial plexopathy as a neurological complication following bee sting. A23-year-old maleinitially presented with angioedema and anaphylactic shock one hour after a bee stung at his neck. Twenty four hours after the incidence, he presented with sudden onset of left upper limb weakness. Nerve conduction study and electromyography had shown evidence of left brachial plexopathy.

Multiple cerebral infarctions with severe multi-organ dysfunction following multiple wasp stings

Wasp and bee sting are commonly encountered worldwide. Local reactions are more common, generally are self-limiting and settle within a few hours. Multiple stings can lead to various clinical manifestations like vomiting, diarrhea, dyspnea, generalized edema, hypotension, syncope, acute renal failure, and even death. Rarely, they can cause vasculitis, serum sickness, neuritis, and encephalitis. We are reporting a case of 40-year-old male who presented with stroke, right hemiparesis with severe multi-organ dysfunction due to multiple wasp stings.

Brain Infarction: Rare Neurological Presentation of African Bee Stings

Bee stings are commonly encountered worldwide. Various manifestations after bee sting have been described including local reactions which are common, systemic responses such as anaphylaxis, diffuse intravascular coagulation and hemolysis. We report a case of a 74-year-old man who developed neurologic deficit 5 hours after bee stings, which was confirmed to be left frontal infarction on brain CT-scan. The case does not follow the reported  pattern  of hypovolemic or anaphylactic shock, hemolysis and/or  rhabdomyolysis, despite the potentially lethal amount of venom injected. Diverse mechanisms have been proposed to give an explanation to all the clinical manifestation of both toxic and allergic reactions secondary to bee stings. Currently, the most accepted one state that victims can develop severe syndrome characterized by the release of a large amount of cytokines.