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PubMed2004

[Establishment and analysis of a log to record scorpion stings in Morocco].

Within the framework of a strategy against scorpion stings, an information system was established to track the indicators of morbidity and mortality caused by scorpion stings. The study of these indicators was carried out based upon a national record of scorpion stings. During the year 2001, 15,571 cases of scorpion stings were reported, that translates into an incidence rate of 1.2%. The patients were poisoned in 11.6% of the cases. Most of the patients (79.3%) were only put under clinical surveillance and did not receive any symptomatic treatment. The death rate was 6.3% and death only occurred in children of less than 15 years old (2.1% of the cases). This study demonstrated an improvement in morbidity and mortality indicators in comparison to the data collected before this campaign, all of which verifies the positive impact of the strategy which was put into place. However, it is necessary to continue monitoring until Morocco can overcome this problem.

Adolescent↗
PubMed1978

Acute renal failure following scorpion sting.

Fifteen cases of acute renal failure follwoing scorpion sting were studied. The onset of disease was characterized by the occurrence of hemoglobinuria within 24 h of the sting. Most of the patients developed oliguria, edema, hemolytic anemia, and hemolytic jaundice. Renal failure developed within a few days after the sting, and in five patients was severe enough to need dialysis. The onset of diuresis in oliguric patients occurred between 6 and 21 days following the sting. Renal biopsies were possible in four cases and showed mesangial proliferation, variable degrees of tubular changes, and mild interstitial infiltration. The pathogenesis of acute renal failure in these patients is discussed

Acute Kidney Injury↗
PubMed1984

Bee-sting mortality in Australia.

Death as a result of a bee sting is uncommon in Australia. During the 22 years from 1960 to 1981, 25 individuals have been recorded by the Australian Bureau of Statistics as having died shortly after a bee sting. This gives a mortality incidence of 0.086/1 000 000 population per year, but may be an underestimate, as we report two additional fatalities that did not appear in the records of the Bureau of Statistics. South Australia has the highest mortality rate from bee stings of all the Australian States, with a recorded fatality rate of 0.26/1 000 000 population per year. As in other surveys, fatalities occur predominantly in men over 40 years of age, which suggests that there may be other contributory risk factors, for example, coronary atherosclerosis. No deaths were reported in individuals aged from six to 19 years, the age group in which bee-sting anaphylaxis is particularly common. It thus appears that the prevention of death per se is not a strong rationale for routine bee-venom immunotherapy in schoolchildren and young adults.

Adolescent↗
PubMedDate not supplied

Effects of stings of Australian native bees.

Five cases of stings by native bees are reported. The reactions were various and include a fatality as a result of the sting of a presumed Lasioglossum sp. (Halictidae). The effects of stings from Lasioglossum spp., Homalictus dotatus (Cockerell) (Halictidae), and Euryglossa cf adelaidae Cockerell (Colletidae) are described. The rarity of severe allergic reactions to native bees and the rarity of stings by the same species makes a programme of immunotherapy inappropriate.

Adolescent↗
PubMed1998

[Cardiac failure following sting of yellow scorpion in an adult].

3 men, aged 18, 29, and 47 had severe cardiovascular disturbances following the sting of the yellow scorpion (Leiurus quinquestriatus hebraeus), which is considered the most dangerous scorpion in Israel. Cardiovascular complications are common in children after scorpion sting, but are rare in adults. Pulmonary edema developed in 1 of those being reported and hypertension and arrhythmias in the other 2. Severe deterioration in left ventricle function was confirmed by echocardiographic measurement of diminished ejection fraction. All patients recovered completely. This is the first report of severe cardiac involvement in adults following scorpion sting. We therefore recommend that even adults who develop cardiac symptoms after scorpion sting, particularly those with chronic cardiac disease, be monitored and treated in an intensive care unit.

Adolescent↗
PubMed2002

Oropharyngeal hymenoptera stings: a special concern for airway obstruction.

Hymenoptera stings are common and cause 40 to 50 deaths each year. Hymenoptera venom contains a variety of toxic and allergenic substances that can produce many types of both local and systemic reactions. Of these, anaphylaxis is the most feared and the most common cause of sting-related deaths. Oropharyngeal stings, although rare, have the added potential to produce life-threatening airway obstruction via localized swelling. This threat is of particular concern to military personnel who operate in environments where stings are more likely to occur and where emergency medical resources are limited or lacking. This risk can be minimized if such victims are treated early and aggressively, even though they may initially present with minimal symptoms.

Adult↗
PubMed2003

Stinging insect allergy.

Systemic allergic reactions to insect stings are estimated to occur in about 1 percent of children and 3 percent of adults. In children, these reactions usually are limited to cutaneous signs, with urticaria and angioedema; adults more commonly have airway obstruction or hypotension. Epinephrine is the treatment of choice for acute anaphylaxis, and self-injection devices should be prescribed to patients at risk for this allergic reaction. Stinging insect allergy can be confirmed by measurement of venom-specific IgE antibodies using venom skin tests or a radioallergosorbent test. Patients with previous large local reactions have a 5 to 10 percent risk of experiencing systemic reactions to future stings. Patients with previous systemic reactions have a variable risk of future reactions: the risk is as low as 10 to 15 percent in those with the mildest reactions and in some children, but as high as 70 percent in adults with the most severe recent reactions. Because of demonstrated efficacy (98 percent), venom immunotherapy is recommended for use in patients who are at risk for severe systemic reactions to future insect stings. Venom immunotherapy is administered every four to eight weeks for at least five years. Immunotherapy may be needed indefinitely in patients at higher risk for recurrence of anaphylaxis after treatment is stopped.

Anaphylaxis↗
PubMed2003

Hymenoptera sting anaphylactic reactions in the Mediterranean population of Albania.

BACKGROUND: Relatively few studies have examined the relation of different hymenoptera sting reactions. OBJECTIVE: To investigate the relation of anaphylactic reactions against stings of different hymenoptera subspecies in the Mediterranean population of Albania. MATERIALS AND METHODS: A retrospective study was conducted using the clinic files of 111 patients who were diagnosed for hymenoptera sting reactions from 1987 to 1996. Antigens used consisted of purified hymenoptera venom (bee, wasp, and paperwasp). The patients were diagnosed by intracutaneous tests in concentrations of 0.001 microgram/ml, 0.01 microgram/ml, 0.1 microgram/ml, and 1 microgram/ml. RESULTS: The median age of the patients was 27 years. 57% of stings occurred between 20 to 40 years of age. The majority of anaphylactic reactions were recorded during the months of June to October, 81% of the patients were admitted to the hospital due to Mueller grade II to III reactions. In 26% of all cases, crossreactions (bee-wasp 16%, bee-wasp-paperwasp 7%, wasp-paperwasp 2%, bee-paperwasp 1%) were found. Of all anaphylactic reactions, 64% were attributed to bees, 24% to wasps, 8% to both bees and wasps, and 2% to paperwasps. CONCLUSIONS: In contrast to industrialized countries such as the United States or Western Europe where urban populations predominate, reactions to bee venom were more prevalent in the present study population.

Adolescent↗
PubMedDate not supplied

The management of allergic reaction to venomous insect stings.

Insects that sting play a vital role in our ecosystem by consuming crop pests and by pollinating plants (Earth-Life Web Productions, 2004). Some of these insects, particularly bees and wasps (hymenoptera), can also deliver a painful and venomous sting. Their bodies contain a sac of venom attached to a stinger which is forced through the skin. The painful sting occurs when the sac contracts and venom is deposited in the tissues (Prodigy, 2004). The venom contains allergens that typically produce an intense, burning pain followed by erythema (redness) and a small area of oedema (up to 1 cm) which usually subsides within a few hours (Ewan, 1998a). Some people suffer more serious localised or systemic reactions including anaphylaxis. Every year in the UK between two and nine people die as a consequence of a severe allergic reaction to a bee or wasp sting (The Anaphylaxis Campaign, 2004).

Anaphylaxis↗
PubMedDate not supplied

Clinical and echocardiographic findings in patients with myocardial toxicity due to scorpion sting.

BACKGROUND: Myocardial toxicity following a sting by the Indian red scorpion (Mesobuthus tamulus) is a life-threatening medical emergency. A perusal of the published literature suggests that this problem has seldom been studied systematically. METHODS: We retrospectively studied the clinical presentation and echocardiographic findings in 24 patients (mean [SD] age 23.2 [11.7] years; 19 males) with myocardial toxicity caused by the sting of an Indian red scorpion (Mesobuthus tamulus). They were treated with inotropic support and diuretics depending on the requirement. At admission, oral L-carnitine was administered in a dose of 1980 mg/day in three divided doses till the left ventricular (LV) function normalized. None of the patients received digitalis, prazosin, hydrocortisone or antivenin. RESULTS: Extreme anxiety and severe pain at the site of sting were present in all the patients. Hypotension (n = 19), pulmonary oedema (n= 15) and acute renal failure (n=8) were the other presenting features. Chest X-ray revealed cardiomegaly in 8 and pulmonary oedema in 13 patients. Serum creatinine phosphokinase levels were elevated more than two times the upper limit of normal (200 IU/L) in 22 patients (92%). The mean duration of hospitalization was 5 days (range 3- 11 days). L-carnitine treatment resulted in significant reduction in the LV diameter (mm) in diastole (47.6 [6.2] v. 42 [6.1], p < 0.01) and systole (42 [7.1] v. 28.2 [4], p<0.001); end-diastolic volume (ml) (108.7 [31.9] v. 81 [26.7], p <0.01) and end-systolic volume (ml) (81.3 [30.9] v. 31.1 [10.7], p < 0.001); and significant improvement in the stroke volume (ml) 27.8 [13.2] v. 61.7 [6.2], p<0.001) and ejection fraction (%) (25.5 [12.8] v. 61.2 [6.5], p<0.001). All the patients responded well to treatment and none died. CONCLUSION: Our initial observations suggest a potential benefit with additional oral L-carnitine treatment in patients with myocardial toxicity caused by scorpion sting presenting with hypotension and severe LV dysfunction. These findings merit further study.

Adolescent↗
PubMed2005

[Scorpion poisonous stings in the population of Khouribga (Morocco)].

Poisonous stings caused by scorpion constitute a public health problem in Morocco because of their frequency severity and socio-economic consequences that they generate. The province of Khouribga surveyed for this study is situated in a zone of high incidence and high lethality caused by scorpion stings in Morocco. In order to analyze the epidemiological profile and the poisoning risk factors, we are presenting the results of a past study conducted from April to December 2001. It consisted in making an exhaustive follow up from admission to release of all patients stung by scorpion. These patients consulted a sanitary structure (dispensary health centre or hospital) in the province of Khouribga, Morocco. Within a total of 1212 cases of stings, 63% of them occurred at night (between 06 pm and 06 am) particularly during July and August. Youngsters under fifteen represented 36% of these cases. 3.4% of the people who got stung presented typical poisoning and envenomation. The delay expected from sting to transfer to a medical structure was 1.85 +/- 0.11 hours for the patients who recovered against 2.67 +/- 0.11 for those who did not recover. To be noticed as well that 1.3% of the subjects who got stung die. Variance analysis indicates that the type of sanitary structures receiving patients, admission classes, and age of patients influence significantly the recovery rate of people who are stung.

Adolescent↗
PubMedDate not supplied

[Hymenoptera sting arthropathy as an occupational injury: a case report].

Hymenoptera (Apid and Vespid) sting reactions represent a specific occupational risk factor for beekeepers, farmers, floriculturists, forestry workers, gardeners, greenhouse workers, fruit dealers, fire-fighters, street sweepers, outdoor workers. As a consequence of the Hymenoptera stings it can appear: acute toxic or allergic reactions and sub-acute symptoms that involve various body systems including the joints in which a Hymenoptera Sting Arthropathy (HSA) may occur. We describe the case of a 54-year-old male farmer beekeeper who developed in 1998 a systemic reaction due to multiple bee stings while he was collecting honey. He was hospitalised at the Policlinico Gemelli in Rome because skin (prick and intradermal test) and in vitro tests had shown evidence of an allergic reaction and had required a venom immunotherapy. During the years the patient had been victim of various episodes of acute arthritis on his interphalangeal joints) and, in one occasion, on his right elbow. The symptoms were localized intense pain and a severe impairment of joint function with inability to perform the work. After 7-14 days of corticosteroid treatment the arthritis subsided. In literature there are similar cases described that, at times, assume a greater severeness and lead to significant functional outcomes. The HSA's aetiology includes pharmacologically active substances (melittin, phosfolipase A2, leukotrienes present in venom), infection, or foreign body synovitis. The relative gravity of the symptoms and the possibility of outcomes all indicate that further attempts must be made in order to prevent HSA.

Acute Disease↗
PubMedDate not supplied

Isolated prolongation of activated partial thromboplastin time following wasp sting.

Reactions after bee or wasp sting are similar to anaphylaxis. Symptoms such as weakness, fatigue, vomiting, diarrhea, urticaria, and hypotension may occur. Serious toxic reactions usually occur after numerous stings. Massive bee envenomations can result in immediate onset of shock, hemolysis, rhabdomyolysis, disseminated intravascular coagulation (DIC), coma, and renal failure. In milder cases, patients may only have isolated prolonged activated partial thromboplastin time (aPTT) and normal prothrombin time (PT), clinically without a tendency to bleed. As a rule, they recover spontaneously without any complication. We report three cases of wasp stings; they all manifested prolongation of aPTT and finally recovered completely. Isolated prolongation of aPTT in cases of wasp stings may be related to an extract from the venom inhibiting the coagulation pathway.

Animals↗
PubMed1991

[Allergy to insect stings].

Components in the insect venom and probably also in their saliva may have direct toxic effects or may cause sensitization and may result in allergic reactions to subsequent stings. In Denmark, only the stings of honey bees and wasps (yellow jackets) are of clinical significance and it is important to be aware that these insects contain separate allergenic components. Clinical manifestations following stings are observed from all of the organ systems on the whole. The commonest are itching of the skin, urticaria, possibly angioedema and slight generalized symptoms with vertigo, headache and fatigue. Life-threatening reactions may also occur and one or two fatal cases are registered annually in Denmark. It may be difficult to decide whether an allergic or a toxic reaction is involved on the basis of the symptoms. Possible IgE-sensitization must therefore be assessed by means of a prick test and measurement of specific IgE. The main treatment in cases of acute systemic reactions is adrenaline which may possibly be supplemented with antihistamine and corticosteroid. In cases of massive local reactions and urticaria, antihistamines will, as a rule, prove sufficient. Hyposensitization with insect venom preparations eliminates the future risk for systemic insect sting reactions practically entirely and this must be recommended for patients with demonstrated IgE-sensitizing and generalized reactions. At present, treatment should be continued for three to five years and protection lasts for a series of years after cessation of treatment.

Humans↗
PubMed1986

[The key role of IgG4 subclass antibodies in the development of protection against allergic reactions to insect stings].

Allergen immunotherapy results in protection against allergen challenge and in the production of allergen specific antibodies. We investigated the reaction to bee sting exposure and its relationship to the subclass of IgG-antibodies produced. 23 patients who had a history of systemic allergic reactions to bee stings were given 2-5 years courses of venom immunotherapy. 19 individuals tolerated a sting challenge 1, 2, and 3 years after the start of treatment, and after immunotherapy was discontinued. Four patients with persisting systemic reactions and 6 bee keepers served as controls. All detectable IgG-antibodies were restricted to subclass 1 and 4. In successfully treated patients the mean rise of IgG-subclass was 273%, and of IgG4 703%, compared to pretreatment levels. IgG4-antibodies were maintained at high levels in protected individuals when immunotherapy was discontinued. On the contrary, in non-protected individuals low IgG4-levels were observed. Specific IgG4-antibodies most closely reflect clinical protection from stings provided by immunotherapy or a repeated antigenic stimulation.

Adolescent↗
PubMed1979

Stinging insect allergy.

One to two million Americans have a history of systemic allergic reactions to stinging insects and must live with the knowledge that future stings could be catastrophic. Recent advances have been made in diagnosis and treatment of this problem. Pure venoms have been recognized to be superior to the whole body extract as diagnostic and treatment antigens. Use of pure venoms for immunotherapy gives far better protection than whole body extract for the allergic patient and represents a major advance in the field of allergy. The imported fire ant is very different from the other common stinging insects in its venom components, the type of local reactions caused by its sting, and the fact that whole body extract from this insect seems to be as good an antigen for diagnosis and treatment as pure venom. Although important discoveries about insect allergy have been made recently, some very important questions are yet to be answered. Among these are: (1) Can suppliers of venom provide us with enough venom to treat all patients with insect allergy? (2) How long should immunotherapy be continued? and (3) Would treatment with specific antigens from venom be superior to using whole venom? We all await the answer to these and other questions with hopeful anticipation.

Anaphylaxis↗
PubMed1980

[Allergy to insect stings. diagnosis and therapy (author's transl)].

An allergic reaction to stings by insects can occur within minutes and may be fatal. The history serves to assess the severity of the reaction and may aid in the identification of the insect involved. The diagnosis is established by a skin test and the hyposensitization tested by determining the levels of insect venom specific IgE. Minor allergic reactions can be treated with drugs, the more severe forms require hyposensitization therapy with pure insect venom, especially when the risk of re-exposure to insect sting is high. By means of the rush-hyposensitization, a protection against insect stings can be achieved within 1 week. With increasing dosage, patients who have previously had severe reactions to insect stings, develop allergic side-effects. During the course of the treatment with insect venom, the levels of allergic IgE- and the levels of the protective IgG-antibiodies rise. After 6 months, the allergic antibody levels fall, the protective IgG-antibodies, however, remain above their pretreatment level.

Antivenins↗
PubMed1993

Controlled insect-sting challenge in 55 patients: correlation between activation of plasminogen and the development of anaphylactic shock.

The pathogenesis of anaphylactic shock is not completely understood. Mast cell degranulation products may stimulate endothelial cells, leading to activation of fibrinolytic and coagulation systems. We investigated the activation of these systems in insect-sting anaphylaxis. Fifty-five patients with a previous insect-sting anaphylactic reaction and 8 volunteers were challenged with an in-hospital sting. Plasma levels of von Willebrand factor (vWF), coagulation, and fibrinolytic parameters were assessed. After the sting challenge, 20 patients developed anaphylactic symptoms, 7 of whom developed hypotension. In only these 7 patients, but not in the volunteers or in the other patients with no or mild anaphylactic symptoms, vWF levels increased from 107% +/- 33% (mean +/- SD) before, to 235% +/- 134% 60 minutes after the onset of clinical symptoms. This increase of vWF was accompanied by an increase of circulating tissue-type plasminogen-activator (tPA) levels from 5 +/- 3 micrograms/L to 50 +/- 59 micrograms/L and of plasminogen-alpha 2-antiplasmin complex (PAP-c) levels from 6 +/- 3 nmol/L to 297 +/- 225 nmol/L. Both tPA and PAP-c levels peaked 5 minutes after the onset of clinical symptoms. Such increases of tPA and PAP-c were not observed in the volunteers or in the patients who did not develop shock. The increase of tPA and PAP-c levels in the hypotensive patients correlated positively with the degree of mast cell degranulation and inversely with the mean arterial pressure. We conclude that activation of plasminogen may be involved in the pathogenesis of anaphylactic shock induced by insect venom.

Adult↗