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PubMedDate not supplied

[Diagnosis in 1348 patients which consulted for a probable spider bite or insect sting].

Accumulate experience, from 1955 to 1995, in an outpatient university parasitology clinic in Santiago, with 1,384 patients referred from diverse public and private medical institutions because of a probable spider bite or insect stings, is presented. It is noteworthy that only 618 (44.7%) of consultations corresponded to clinical conditions originated by arthropods, whereas from the remaining 766, 612 (44.2%) were due to a bacterial, viral or parasitic etiology and 154 (11.1%) were caused by physical or chemical agents. Frequency of diagnosis was: loxoscelism 16.6%, spider bites (excluded Loxosceles laeta) 1.3%, scorpion sting 0.9%, tick stings 2.2%, insect bites 23.7%, impetigo 6.6%, folliculitis 11.3%, boil 22.7%, erysipelas 0.1%, pustula maligna 0.3%, herpes simplex 2.5, palpebral herpes zoster 0.3%, acute Chagas' disease 0.4%, angioneurotic edema 0.1%, ecchymosis 3.0, contact dermitis 7.8% and chemical dermitis 0.2%. These frequencies do not indicate the real occurrence of the diagnosed nosologies, but what happened in a specialized outpatient clinic dealing cheaply with parasitic diseases and arthropod envenomations. Description of relevant clinical features and epidemiological considerations of pathology observed, conjointly with differential diagnosis are presented.

Angioedema↗
PubMed2006

Outcome of scorpion sting envenomation after a protocol guided therapy.

OBJECTIVE: Scorpion sting (SS) envenomation is a life threatening emergency in children, though not so severe in adults. Attempt to develop protocol using prazosin and dobutamine and few other drugs to treat SS. METHODS: Children aged 0-13 years with a history of scorpion sting were studied. Clinical features, complications, drug therapy and outcome of the cases for the period 1992-97(N = 186) was collected by the authors and also from the medical records department (RETROSPECTIVE GROUP). Cases treated during 1997-2000 (N = 198) as per the protocol were recorded as PROSPECTIVE GROUP. All the cases were observed for at least for 24 hours. Cases coming within 4 hours of a sting were given a dose of Prazosin (30 mic.gm/Kg/dose) and were observed. Those who came after 4 hours & were asymptomatic received only symptomatic treatment. Cases with signs of envenomation received Prazosin every 6 hourly till recovery. Cases having acute pulmonary edema (APE) were treated with dobutamine and sodium nitroprusside drip. Complicated cases were monitored in PICU as per the protocol. RESULT: Complications associated with excessive parasympathetic and sympathetic stimulation were observed. Myocarditis was observed due to the toxin and excessive catecholamine, which complicated in left ventricular failure (LVF) and APE. Nearly half of the children with acute myocarditis developed APE. Death was mainly due to myocarditis and APE, with or without encephalopathy. Mortality was high in children who received steroid and antihistaminics outside and who came late (> 4 hours). CONCLUSION: Complication rate remained almost same in both the groups. There was a significant reduction in overall mortality (P = < 0.0155) and in deaths associated with APE (P = < 0.0001) after the protocol guided therapy. There was also a reduction in mortality in encephalopathy group though not statistically significant. This treatment protocol and aggressive management of APE reduced the mortality due to SS significantly.

Adolescent↗
PubMed2003

[Persistent skin reaction and Raynaud phenomenon after a sting by Echiichthys draco (great weever fish)].

A 54-year-old recreational angler was stung in his right forefinger by Echiichthys draco. Within a few seconds he developed severe swelling with extreme pain sensation at the sting site, accompanied by dizziness and chill. Even under morphine therapy the pain symptoms were only slightly reduced. During the subsequent weeks, an erythema with marginate medium-sized scaling developed at the sting site and the patient experienced a approximately 50% reduced bending capacity of the forefinger and permanent numbness in this region. After 4 months, Raynaud phenomenon developed limited to the right forefinger. Great weever fishes (Echiichthys spp.) are the most venomous fishes in European waters. In humans, life-threatening sting reactions occur only in exceptional cases. As a commercial antiserum is not available, the therapy is mainly empiric (General measures of first aid and emergency medicine, the wound should be thoroughly washed). Patients should be informed that reduced motion ability, swelling or Raynaud's phenomenon can persist for several months.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Stings by red scorpions (Buthotus tamulus) in Maharashtra State, India: a clinical study.

Of 33 cases of scorpion sting admitted to hospital in Mahad, Maharashtra State, India, 10 had a mean blood pressure between 100 and 137 mm/Hg and 11 had a heart rate between 130 and 215 per min. Seven patients developed acute pulmonary oedema; there were 2 deaths. Three patients had local pain at the site of sting. The role of vasodilators such as prazosin hydrochloride, sodium nitroprusside and nifedipine were investigated in addition to digoxin, diuretics and aminophylline to alleviate refractory myocardial failure due to scorpion sting.

Adolescent↗
PubMed1989

Epidemiological characteristics of scorpion sting in León, Guanajuato, México.

Poisoning with scorpion venom in the city of León, Guanajuato state, México, is a significant public health problem. The hospital of the Mexican Red Cross gave medical attention to 38,068 cases of envenomation by scorpion sting during 1981-1986; 77% of all accidents occurred among persons under 30 years of age. The 100% survival rate can be attributed to prompt serotherapy. Most stings were due to scorpions from the species Centruroides infamatus infamatus. Scorpion stings increase dramatically in the spring and are lowest during winter. The distribution of scorpions throughout the city is uniform and accidents occur at any time of day or night with no preference in regard to the sex of the affected persons. The epidemiological aspects of scorpion poisoning are emphasized.

Animals↗
PubMed1983

The stinging response of the honeybee: effects of morphine, naloxone and some opioid peptides.

Changes in responsiveness for the stinging reaction of honeybees fixed in a holder after receiving 3 electrical shocks delivered with 1 min interval, was registered and used as measurement for the effect of 2 microliter of different solutions injected. Every shock consisted of a train of pulses of 1 msec each, delivered for 2 sec at a frequency of 100 Hz. Injection of morphine-HCl (50 to 200 n-moles/bee) produced a dose dependent reduction of the honeybee stinging response to the electrical shocks. The morphine dose that produced a 50% inhibition of the response (D50) was 148 n-moles/bee (927 micrograms/g), i.e., a value far greater than that reported for vertebrates in behavioral test of analgesia. Naloxone 1.1 micrograms/g produces a significant reduction of morphine D50 effect and at 4-5 micrograms/g, a full disinhibition. Thus, whereas the D50 of morphine for honeybees is far greater than that for vertebrates, the doses of naloxone that antagonize morphine are similar for bees and vertebrates. Possible explanations of this difference are mentioned. Injections of met-enkephalin, leu-enkephalin, kyotorphin and (D-Ala2) methionine-enkephalinamide, given in doses of 200 n-moles/bee, an amount greater than that of the morphine D50, exhibited no effect on the stinging response.

Animals↗
PubMed1984

Natural history of large local reactions from stinging insects.

In ongoing studies of the natural history of stinging-insect allergy, 133 patients with large local reactions have been evaluated over 8 yr; 79 patients returned for reevaluation. Based on RAST analysis with honeybee and vespid venoms, patients were divided into RAST-positive and RAST-negative groups. Sixty-six patients were RAST-negative with positive venom skin tests in 58%. Seventy-five testings in this group led to no systemic reactions and 74 large local reactions. At follow-up RASTs remained negative, and the incidence of positive skin tests was unchanged. Sixty-seven patients had detectable serum venom-specific IgE covering a wide range in antibody titers, indistinguishable from patients with systemic reactions. Twenty-four of 67 patients received venom immunotherapy (VIT). RAST titers decreased similarly in the VIT and untreated groups. There were 55 testings resulting in 40 recurrent large local reactions occurring in equal incidence in treated and untreated patients. One systemic reaction occurred in an untreated patient. In reviewing 118 patients with sting anaphylaxis, a previous large local reaction occurred in five. These results suggest that after repeat stings, patients with large local reactions tend to have subsequent large local reactions, regardless of the presence of venom-specific IgE or immunotherapy. There is small risk of anaphylaxis. Determination of serum venom-specific IgE by RAST or skin tests does not aid in treatment or in predicting prognosis. Thus skin tests are not necessary in patients who have had large local reactions, and venom immunotherapy is not indicated.

Desensitization, Immunologic↗
PubMed1991

Bee venom anti-idiotypic antibody is associated with protection in beekeepers and bee sting-sensitive patients receiving immunotherapy against allergic reactions.

Bee venom (BV) anti-idiotypic (anti-Id) antibodies (Abs) were studied in nonreactive beekeepers, patients receiving BV immunotherapy (IT), and in patients with bee-sting hypersensitivity. Detection of serum anti-BV was determined either by the Phadebas RAST test for IgE and IgG concentrations or by isoelectric focusing followed by capillary blotting onto nitrocellulose membranes. Clonotypic analyses of Ab were made with specific probes for BV or BV anti-Id; 13/14 nonreactive multiple-sting beekeepers (93%; p = 0.00006) and 3/3 patients receiving BV IT (100%; p = 0.0026) had detectable amounts of BV anti-Id in serum, whereas five BV-sensitive patients (0%) and four ragweed-sensitive control patients (0%) did not. Beekeeper's serum containing BV anti-Id was found to recognize and bind to IgE anti-BV idiotype from two different patient sources and inhibit their reactions in a Phadebas RAST test in a dose-dependent manner. Nonreactive beekeepers generally had BV-specific IgE levels less than 0.35 PRU/ml in serum with detectable BV anti-Id. BV-allergic patients before IT had elevated BV-specific serum IgE levels, even in the presence of BV-specific IgG greater than 136 U/ml with no BV anti-Id present. These findings provide strong support for a protective role of BV anti-Id against bee sting--allergic reactions.

Adolescent↗
PubMed1994

Medical consequences of multiple fire ant stings occurring indoors.

Stings by the imported fire ant almost always lead to dermal wheal and flare reactions followed by sterile pustules at sting sites. Less commonly, large local dermal reactions, pyoderma, anaphylaxis, or neuropathy may occur. Such reactions have previously been associated with contact with the insects out of doors. We present two previously unreported cases of indoor attacks on individuals by imported fire ants. One patient experienced a cerebrovascular accident in association with the attack, whereas the second patient had no obvious sequelae. With those two reports, a total of four such indoor massive sting episodes have appeared in the recent medical literature. Physicians and other individuals living in areas indigenous to the fire ant should be aware that infestation of buildings with fire ants may be associated with attacks on human beings indoors. Individuals with cognitive dysfunction seem to be especially at risk for attacks by fire ants.

Aged↗
PubMed1995

[Scorpion stings in children. Saudi Arabian experience].

Scorpion stings are a major public health problem in Saudi Arabia. The main victims are children who accidentally tread on a scorpion, about 900 children being admitted to hospitals each summer for such stings. Many cases are fatal. The pathophysiology of scorpion stings is complex and its management is difficult. Almost all body systems are affected but circulatory shock and pulmonary oedema are the usual cause of death. The treatment is based on scorpion antivenom and symptomatic treatment of the envenoming manifestations in an intensive care unit. The currently used antivenom is a polyvalent horse serum preparation given intravenously.

Animals↗
PubMed2005

Insect sting allergy and venom immunotherapy: a model and a mystery.

Whole-body extracts of Hymenoptera were used for diagnosis and treatment until controlled clinical trials proved them no better than placebo, whereas venom is 85% to 98% effective. Studies of natural history reveal why whole-body extracts were thought to work. The chance of future systemic reactions is low in large local reactors and in most children and varies between 20% and 70% in adults. Venom skin tests are most accurate, but RAST is an important complementary test. The degree of sensitivity on skin tests or RASTs does not reliably predict the severity of a sting reaction. Venom immunotherapy is recommended for patients at high risk for sting reactions. Rapid regimens are as safe as slower regimens. The recommended dose is 100 microg, but some patients require higher doses for full protection. Venom immunotherapy is continued every 4 to 8 weeks for at least 5 years in most cases. Skin test results become negative in only 25% after 5 years of therapy but in 60% to 70% after 7 to 10 years. When treatment is stopped after 5 years or more, there is a 10% chance of systemic reaction to each future sting, but most reactions are mild. Some patients have a higher risk of relapse and should continue treatment for an extended period.

Adult↗
PubMed2026

Mycobacterium tuberculosis Rv0158 negatively regulates the cGAS-STING pathway mediated type I IFN production and enhances intracellular survival.

BACKGROUND: Type I interferons (IFN) play an important role in the host defense against Mycobacterium tuberculosis (M. tb) infection and disease pathogenesis. Although M. tb has evolved several mechanisms to evade host immune surveillance, the mechanism used to regulate type I IFN expression remains unclear. METHODS: In this study, genome-wide high-throughput loss-of-function screening was performed to screen M. tb determinants that regulate the Type I IFN pathway, and the role for M. tb Rv0158 in inhibiting type I IFN responses was identified in vitro and in vivo. RESULTS: The M. tb coding protein Rv0158 was identified among many transposon (Tn) insertion mutants, which increased the expression of IFN-&#x3b2; and some pro-inflammatory cytokines. The results suggested that Rv0158 is associated with reduced STING protein levels and suppression of cGAS-STING-mediated innate immune responses, suggesting that Rv0158 may indirectly facilitate STING degradation or modulate its stability through host-interacting partners. Rv0158 also down-regulated the transcription of interferon-stimulated genes (ISGs) and increased the bacterial load in mice. CONCLUSION: Overall, our finding identified a new bacterial factor Rv0158, these results reveal an important role for M. tb Rv0158 in inhibiting Type I IFN responses, which improves our understanding of the immune evasion mechanisms of M. tb.

Immune escape↗
PubMed1976

Acute myocardial infarction following wasp sting. Report of two cases and critical survey of the literature.

Over the span of two or three days in August, 1972, in two separate communities in eastern Massachusetts two men, one aged 39, the other 66, each without previous overt heart disease, were stung by wasps. Each went into shock rapidly after an interval of over a half-hour developed chest pain and, later, sequential electrocardiographic changes diagnostic of acute myocardial infarction. Each survived; each had normal electrocardiograms before the sting. Though preexistent coronary artery disease can be excluded in neither, the view is favored that acute myocardial infarction in each was caused by deficient coronary perfusion secondary to anaphylactic shock induced by the wasp stings. An intriguing case was just recently reported58 of a 62-year-old man with previous angina who developed pulmonary edema but no chest pain following wasp sting and went on to show rapidly reversed electrocardiographic changes attributable to subendocardial ischemia or infarction. In a sense, this sequence fills the gap as an intermediate phase between the normal and the two individuals described here who developed pain after anaphylactic shock, then proceeded, perhaps through this phase, to develop transmural infarction.

Adult↗
PubMed2005

Corneal honeybee sting.

BACKGROUND: We report the complications and management of a retained bee sting injury to the cornea. The case highlights the acute and chronic management of an uncommon injury and its pathogenesis. METHODS: A 67-year-old man was attacked by a swarm of bees and was referred for severe chemosis on the right eye. A retained corneal bee stinger (ovipositor) was seen but removal was only partially successful. He subsequently developed a large corneal epithelial defect, anterior uveitis, intractable glaucoma, traumatic cataract, toxic optic neuropathy, and corneal scarring. We reviewed the literature on corneal bee sting injuries and their complications. RESULTS: Inflammation was controlled with topical steroids and the patient underwent a combined phacoemulsification and trabeculectomy with mitomycin-C for uncontrolled glaucoma. However, optic neuropathy did not resolve. INTERPRETATION: Corneal bee sting injuries are uncommon but can result in severe sight-threatening complications such as toxic optic neuropathy. Early recognition of the possible complications and appropriate treatment may help to prevent permanent loss of vision. Removal of a retained corneal bee stinger remains controversial.

Aged↗
PubMed2006

[Dorsal medulla oblongata stroke after a wasp sting].

INTRODUCTION: Although wasp stings can cause local reactions such as pain, flare, edema, swelling and severe reactions, including anaphylaxis; neurological vascular complications are rare. CASE REPORT: We report a case of a 36-year-old male who developed focal neurological symptoms after a wasp sting. The brain MRI showed an infarct in the left dorsal medulla. The blood test has showed an elevated level of venom-specific IgE antibodies and the skin test with wasp venom was highly positive. Improvement occurred rapidly after treatment with methylprednisone. The postulated mechanisms include vasoconstriction and platelet aggregation secondary to an injection of distinct allergens contained in wasp venom. CONCLUSION: It would thus be important to ask patients about any recent wasp sting, in order to provide appropriate treatment.

Adult↗
PubMed1992

Insect-sting challenge in 138 patients: relation between clinical severity of anaphylaxis and mast cell activation.

One hundred thirty-eight patients with a previous anaphylactic reaction to a yellow jacket or a honeybee sting, as well as eight volunteers, were subjected to an in-hospital sting challenge. Plasma levels of histamine, tryptase, and prostaglandin D2 (PGD2) during sting challenge were studied in relation to clinical symptoms. Prechallenge levels (mean +/- SD) of histamine, tryptase, and PGD2 were 2 +/- 1 nmol/L, 0.3 +/- 0.3 U/L, and 320 +/- 223 ng/L, respectively. In the volunteers and in none except for one of the nonreacting patients, these levels did not change significantly after challenge. In contrast, mean increases in the group of 18 patients with a mild reaction were significant for histamine and tryptase at one or more time points after the challenge. (Five patients demonstrated no increase in histamine; nine demonstrated no increase in tryptase.) Except for histamine levels in one patient, these increases were considerably more in all 17 patients with a severe reaction, starting from the first anaphylactic symptoms. Fifteen minutes later, peak values were reached of 1275 +/- 2994 nmol of histamine per liter (range, 3 to 12800 nmol/L; median, 11 nmol/L) and 406 +/- 1062 U of tryptase per liter (range, 1.8 to 4400 U/L; median, 17 U/L). This rise in levels inversely correlated with the mean arterial pressure. Plasma levels of PGD2 in severely reacting patients did not differ significantly from those in patients with a mild or no reaction. In conclusion, only 28% of patients with a history of Hymenoptera anaphylaxis developed an anaphylactic reaction after an in-hospital challenge.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaphylaxis↗
PubMed1996

The value of an in-hospital insect sting challenge as a criterion for application or omission of venom immunotherapy.

BACKGROUND: Venom immunotherapy is a generally accepted treatment for serious allergy to bee and yellow jacket venom. However, it is not precisely known to whom venom immunotherapy should be offered. OBJECTIVE: The purpose of this study was to determine whether an in-hospital insect sting challenge (IHC) can be used as a criterion for application or omission of venom immunotherapy. METHODS: An IHC was carried out in a group of 479 patients (136 sensitized to bee venom and 343 sensitized to yellow jacket venom). The patients with a negative IHC response were interviewed about their experience with subsequent stings under natural circumstances. RESULTS: A total of 76 of 136 bee-sensitized patients (56%) and 284 of 343 yellow jacket-sensitized patients (83%) had a negative IHC response. All of the patients who had a systemic reaction after the IHC were advised to receive venom immunotherapy. The success rate of this therapy was 96.4% for patients allergic to bee venom (54 of 56) and 91.4% for patients allergic to yellow jacket venom (53 of 58). Of a total of 76 bee-sensitized patients with negative IHC responses, 41 were subsequently stung in the field; six patients had a mild (Mueller grade I) systemic reaction (14.6%). Of a total of 284 yellow jacket-sensitized with negative IHC responses, 127 were subsequently stung in the field; nine patients had a mild (Mueller grades I and II) systemic reaction (7.1%), and four patients had a severe (Mueller grades III and IV) systemic reaction (3.1%). Without an IHC as a selection criterion for venom immunotherapy, the percentage of patients unnecessarily treated was calculated to be 48% for bee venom-sensitized patients and 74% for yellow jacket-sensitized patients. However, with a negative test IHC response as a selection criterion for the omission of venom immunotherapy, 14.6% of the bee venom-sensitized patients and 10.2% of the yellow jacket-sensitized patients were proven to be at risk for systemic reactions on subsequent field stings. CONCLUSION: Venom immunotherapy with bee or yellow jacket venom is justifiable only after a positive response to an IHC is observed.

Adult↗
PubMed2001

Constitutively raised serum concentrations of mast-cell tryptase and severe anaphylactic reactions to Hymenoptera stings.

Anaphylactic IgE-mediated reactions to Hymenoptera stings vary in their severity for reasons that are not clear. We investigated patients with a history of systemic anaphylatic reactions to honeybee or wasp stings. Nine (75%) of 12 patients with raised tryptase concentrations but only 28 (28%) of 102 patients with lower tryptase concentrations, had a history of severe sting reactions (p=0.004). Raised baseline serum concentrations of mast-cell tryptase and mastocytosis are potential risk factors for severe allergic reactions to Hymenoptera venom.

Adult↗