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PubMed1982

Diagnostic cardiac premonitory signs and symptoms of red scorpion sting.

The symptoms and signs of 51 patients with a history of scorpion sting were studied. Acute pulmonary oedema with peripheral circulatory failure due to myocarditis developed in 10. Pulmonary oedema appeared within thirty minutes to ten hours after the sting. 5 out of 7 male patients in whom pulmonary oedema subsequently developed presented with priapism. Profuse sweating, mydriasis, vomiting, and peripheral circulatory failure were also seen, and, in 1 patient, the clinical picture was suggestive on pancreatitis. The remaining 40 patients has severe local pain only and no subsequent cardiac manifestations. There appears to be a positive correlation between occurrence of priapism in a male and the later development of cardiac manifestations after a scorpion sting.

Acute Disease↗
PubMed1992

Ocular jellyfish stings.

BACKGROUND: Corneal stings from the sea nettle (Chrysaora quinquecirrha) indigenous to the Chesapeake Bay are usually painful but self-limited injuries, with resolution in 24 to 48 hours. METHODS: Five patients who developed unusually severe and prolonged iritis and intraocular pressure elevation after receiving corneal sea nettle stings were followed for 2 to 4 years. RESULTS: Decreased visual acuity, iritis, and increased intraocular pressure (32 to 48 mmHg) were noted in all cases. Iritis responded to topical corticosteroids and resolved within 8 weeks. Elevated intraocular pressure responded to topical beta blockers and oral carbonic anhydrase inhibitors. Mydriasis (4 of 5 cases), decreased accommodation (2 of 5 cases), peripheral anterior synechiae (2 of 5 cases), and iris transillumination defects (3 of 5 cases) also were noted. Mydriasis and decreased accommodation persisted for 5 months in 1 case and for more than 2 years in another. One patient has chronic unilateral glaucoma. Visual acuity returned to normal in all cases. CONCLUSIONS: The precise relationship between sea nettle venom and the observed clinical responses is not known. Corneal jellyfish stings usually produce a brief and self-limited reaction, but they do have the potential for long-term sequelae.

Adult↗
PubMed2000

Phospholipase A2-induced coagulation abnormalities after bee sting.

We will examine the correlation between various bee venom phospholipase A2 (PLA2) concentrations and several parameters of coagulation in human plasma in order to offer a rationale for requesting a particular laboratory coagulation test after bee sting(s). We will also evaluate in vitro the influence of clinically available drugs with a noncompetitive inhibitory effect on PLA2 on the anticoagulant effect of bee venom PLA2. Prothrombin index (PTi), partial thromboplastin time (PTT), antithrombin III (AT III), soluble fibrin monomers (SFM), the activity of coagulation factors I, II, V, and VIII, and thrombelastography (TEG) parameters (split point [Sp], reaction time [R], kinetic time [K], coagulation time [R + K], maximal amplitude [MA], and the growth angle [alpha]) were determined before and after addition of 1.4, 2.7, and 4.1 units (1, 2, and 3 microg protein respectively) of bee venom PLA2. Linear regression was used to determine the significance of the relationship between these coagulation parameters and bee venom PLA2 concentrations used. To study the influence of ketamine, lidocaine, magnesium, furosemide, and cromolyn on the anticoagulant effect of bee venom PLA2, PTi and factor II- and V-activities were measured before and after addition of 2.7 units of PLA2 and PLA2 plus one of the tested substances. Determinations of F II, PTi, F V, and F VIII showed a negative correlation to bee venom PLA2 concentration (r = -0.88, -0.86, -0.81, and -0.79 respectively). A positive correlation was found for PTT (r = 0.69). FII- activity and PTi correlated better with bee venom PLA2 concentration than other parameters. F I, AT III, and SFM showed no changes. Whereas Sp, R, and K were prolonged by bee venom PLA2 and a was reduced, there was no correlation to the PLA2 concentration. Addition of none of the 5 substances could correct the effects of bee venom PLA2 on the coagulation. In a patient with toxic reaction or a severe anaphylactic reaction after bee sting(s) we suggest determinations of FII and/or PTi. This will allow a quick and economical assessment of coagulation abnormalities after bee sting(s). Noncompetitive PLA2-inhibitors (ketamine, lidocaine, magnesium, furosemide, and cromolyn) are unable to correct in vitro the anticoagulant effect of bee venom PLA2. They cannot be recommended at this stage for this purpose. Further investigations with competitive PLA2-inhibitors are warranted.

Animals↗
PubMed1998

Eosinophilic foreign body granuloma after multiple self-administered bee stings.

A bee sting can cause a foreign body granuloma of the skin, due to activated macrophages at the stinging site. A 52-year-old woman presented with a large doughnut-shaped ulcerative tumour on the left side of her face. A bean-sized facial papule had grown to a 4.0 x 3.9 x 1.1 cm mass after multiple bee stings induced by herself over a period of 1 year. Histology showed epidermal ulceration with granulomatous inflammatory cell infiltration of many eosinophils. No micro-organisms or foreign bodies were identified. Intralesional triamcinolone acetonide was not effective, but an excellent outcome was obtained using carbon dioxide laser vaporization of the lesion.

Animals↗
PubMed2001

Acute tubulointerstitial nephritis after wasp stings.

A 61-year-old Caucasian man presented with acute renal failure after multiple wasp stings. The patient required dialysis support temporarily. Work-up failed to show rhabdomyolysis or hemolysis and a kidney biopsy revealed acute allergic interstitial nephritis. The patient's renal function recovered completely after a short course of steroid therapy. Acute renal failure after wasp stings is typically caused by acute tubular necrosis in the setting of hemolysis or rhabdomyolysis. Compared with previously reported cases of acute renal failure associated with bee stings, our patient is unique in that his renal failure was caused by a hypersensitivity reaction apparently to the wasp venom.

Animals↗
PubMed2004

Acute interstitial nephritis and pigmented tubulopathy in a patient after wasp stings.

Acute renal failure (ARF) is an unusual complication of wasp stings and mostly results from toxic-ischemic acute tubular necrosis. This patient, who was stung by a swarm of wasps, experienced an allergic reaction, rhabdomyolysis, intravascular hemolysis, and subsequent ARF. The originality of this case report is related to the finding of combined lesions of acute tubulointerstitial nephritis and acute tubular nephropathy. From our extensive literature review, it is the first case of a patient developing this type of injury after wasp stings, and the complications have been documented previously only in one form or another. Renal biopsy should be encouraged, especially for a patient with delayed recovery of renal function after wasp stings, to facilitate early steroid treatment for the patient with the histological change of acute interstitial nephritis. Early use of steroid therapy may hasten renal recovery by preventing the development of interstitial fibrosis.

Acute Kidney Injury↗
PubMed2001

[Bee sting of the cornea - a case report].

BACKGROUND: Bee stings of the cornea are very rare, though its response can range from minimal inflammation to severe damage like lens dislocation, cataract formation, iris atrophy, ophthalmoplegia and optic neuropathy. We report on a patient with typical, severe findings. PATIENT: A 42-year-old patient presented with an acute, corneal bee sting of the left eye, after he was stung only a few hours ago. The patient suffered from pain, blurred vision and epiphora. The left eye showed edema of the upper and lower eyelid, conjunctival hyperemia, chemosis, striate keratitis, a purulent infiltration of the cornea above the limbus at the 7 o'clock meridian and a massive hypopyon. Further examinations showed regular ophthalmological findings. Vision acuity was 1,0/0,4. Under therapy inflammation decreased quickly. One week after we could lokalize the stinger in the depth of the corneal infiltration and it was removed surgically. After one month the eye only showed a minimal infiltration of the cornea with fine neovascularisations. Visual acuity was 0,8. CONCLUSION: Clinical reactions to bee stings of the cornea are caused by toxical and immunological effects of different components of the bee venom. These toxical and/or inflammatory reactions can lead to severe intraocular damage. Treatment of choice is the systemic and local application of steroids and antibiotics as well as local therapy with antihistamins.

Adult↗
PubMed1989

Anaphylaxis from insect stings. Myths, controversy, and reality.

Some myths and controversies regarding allergy to insect stings have been resolved through research, and venom immunotherapy now has an important place in the prevention of life-threatening reactions to stings. Both children and adults who had cardiovascular and/or respiratory reactions to their most recent sting are candidates for this treatment, which should be discontinued at the end of 5 years (or sooner, if venom skin tests or radioallergosorbent tests are negative).

Adolescent↗
PubMed1991

Scorpion sting: a management problem.

Admissions for scorpion sting in 1 year and deaths resulting from scorpion sting over 3 years were analysed. Features that indicated the severity of the clinical condition were identified. Pulmonary oedema and shock were the usual causes of death. Poor management of fluid therapy was responsible for the frequently unsatisfactory resolution of envenoming, especially when purified human plasma was used. The role of the scorpion antivenom used is questioned and controversy regarding the most appropriate sedative to use in the management of scorpion sting is still not resolved. An in-depth study of these management issues is urgently required.

Animals↗
PubMed1991

Cardiovascular manifestations of severe scorpion sting in India (review of 34 children).

Scorpion sting in children is a hazardous and potentially fatal condition. Of 34 children admitted to hospital in Mahad, Maharashtra State, India following scorpion sting, 14 had hypertension (130/90-170/130 mmHg), five had myocardial failure, acute pulmonary oedema developed in nine, two had tachycardia (110-200/min) and four died. Analysis of data suggests that cardiovascular morbidity and mortality depend upon the time lapse between sting and administration of vasodilators. Current management of human scorpionism consists of early admission to hospital and immediate reduction of raised blood pressure with sublingual nifedipine while peripheral action of venom is antagonized by the post-synaptic alpha blocker prazosin; in addition, digoxin, frusemide, aminophylline and oxygen are administered. The patient is kept under close surveillance in an intensive care unit. Massive life-threatening pulmonary oedema is treated with a sodium nitroprusside drip. We suggest that aggressive medical management directed at the organ system specifically affected by scorpion venom can be effective.

Adolescent↗
PubMed1998

Quantitative trait loci for honey bee stinging behavior and body size.

A study was conducted to identify quantitative trait loci (QTLs) that affect colony-level stinging behavior and individual body size of honey bees. An F1 queen was produced from a cross between a queen of European origin and a drone descended from an African subspecies. Haploid drones from the hybrid queen were individually backcrossed to sister European queens to produce 172 colonies with backcross workers that were evaluated for tendency to sting. Random amplified polymorphic DNA markers were scored from the haploid drone fathers of these colonies. Wings of workers and drones were used as a measure of body size because Africanized bees in the Americas are smaller than European bees. Standard interval mapping and multiple QTL models were used to analyze data. One possible QTL was identified with a significant effect on tendency to sting (LOD 3.57). Four other suggestive QTLs were also observed (about LOD 1.5). Possible QTLs also were identified that affect body size and were unlinked to defensive-behavior QTLs. Two of these were significant (LOD 3.54 and 5.15).

Animals↗
PubMed2002

Ocular lesions arising after stings by hymenopteran insects.

PURPOSE: To describe the ocular lesions that occur after stings from hymenopteran insects. METHODS: We examined the ocular alterations in five patients who suffered ocular trauma from hymenopteran insect stings. RESULTS: In 4 cases where the insect was identified as a wasp, all the patients presented with persistent corneal decompensation and two presented with total cataract, requiring surgical treatment. In the case of trauma by a bee sting, the patient presented with corneal edema and an inflammatory reaction of the anterior chamber with total regression of these alterations after clinical treatment. CONCLUSION: Although a rare occurrence, ocular trauma caused by hymenopteran insects can result in severe ocular alterations in humans.

Adult↗
PubMed1981

Treatment of local skin response to imported fire ant sting.

The sting of the imported fire ant (IFA), Solenopsis invicta Buren and Solenopsis richteri Forel, produces characteristic sterile pustules. Substantial morbidity and occasional mortality from secondary infection of the IFA pustule(s) or anaphylaxis in hypersensitive persons has occurred. IFAs are found in the southeastern and south central United States. The effects of various medical regimens currently used to treat IFA pustules were evaluated clinically and histologically in rabbits. Neither prophylaxis before the sting nor treatment after the sting altered the clinical or pathologic course of the IFA pustule in rabbit skin.

Abscess↗
PubMed1984

Rush venom immunotherapy: a 3-day programme for hymenoptera sting allergy.

In a series of 102 patients consulting for allergic reactions following hymenoptera sting, fifty-two of them, who had experienced one or more severe systemic adverse reactions were selected for rush immunotherapy. The method employed made it possible to attain the maintenance dose of 100 micrograms of venom in 3 days. Patient tolerance was excellent, no serious side-effect was observed; immunotherapy never had to be stopped. Clinical effectiveness seems to be very satisfactory, since no abnormal reaction was reported in seven patients who later were spontaneously stung, and in fourteen patients who received an induced insect sting. The level of IgG antivenom antibodies rose regularly from the first month onwards to remain at a stable level. Because of its safety and effectiveness, it appears that this method should be recommended for immunotherapy in patients who are allergic to hymenoptera stings.

Adolescent↗
PubMed1987

Diagnostic value of the skin-prick test and RAST assay in insect sting allergy.

The results of skin-prick tests to four concentrations of venom (0.1, 1, 10 and 1000 micrograms/ml) carried out on two occasions were analysed in relation to the history of adverse reactions to stings and to the level of venom-specific IgE antibody in serum, in forty-two subjects allergic to insect stings (sixteen to bee and twenty-six to wasp). Fifty control subjects (some of whom had never been stung by bee or wasp) with no history of adverse reaction to stings were also studied. No subject gave a positive skin-test reaction to 0.1 microgram/ml, and small numbers reacted to either 1 or 10 micrograms/ml. The lowest concentration of venom to which most subjects had a positive skin test was 100 micrograms/ml. Our data suggest that in wasp-allergic patients a positive skin test to 100 micrograms/ml is normally significant (reflecting the presence of specific IgE), whereas in bee-allergic patients a skin test reaction to 100 micrograms/ml is usually non-specific for the following reasons. (i) In the allergic patients when skin tests were repeated, a reaction to 100 micrograms/ml bee venom often became negative (in six of eight), whereas for wasp venom the reaction became more positive (at 10 or 1 micrograms/ml) in seven of eight patients. Whilst this might reflect lack of reproducibility, the consistent direction of change for either bee or wasp venom suggests responses to this concentration of these venoms may have different interpretations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Emergency treatment of allergic reactions to Hymenoptera stings.

Allergic reactions to Hymenoptera stings are frequently observed all over Europe. Rarely they may induce long-standing morbidity or even be fatal. Several investigations have shown that the emergency treatment given to these patients is often inadequate. Cutaneous symptoms respond well to antihistamines and also to adrenaline. Adrenaline is the mainstay for outside hospital treatment of more severe reactions involving the respiratory tract (bronchial asthma, laryngeal oedema) and the cardiovascular system (anaphylactic shock). Inhaled adrenaline is especially useful in respiratory symptoms, while parenteral application of adrenaline is prefered for shock treatment. All patients with severe respiratory or cardiovascular reactions must be hospitalized, treated under intensive care conditions and observed for at least 24 hr. Emergency medications including adrenaline for inhalation or for self-injection must be given to all patients with a history of systemic allergic reactions to hymenoptera stings. These patients must also get instructions for safety measures to avoid further stings. They should be referred to an allergist in order to evaluate the indication for venom immunotherapy.

Anaphylaxis↗
PubMed1993

Anaphylactoid shock following Hymenoptera sting as a presenting symptom of systemic mastocytosis.

Systemic mastocytosis is a rare and chronic disorder characterized by a pathologically increased number of mast cells in various tissues and overproduction of mast cell mediators. From a group of 15 patients (10 females, 5 males) with systemic mastocytosis five female patients presented with a history of an anaphylactoid shock reaction to wasp sting. Three of them had no demonstrable specific IgE against wasp or bee venom in serum, and a skin test that was only weakly positive for wasp venom. One patient had specific IgE against wasp venom and a clearly positive skin test to wasp venom. The other patient had specific IgE against both wasp and bee venom and a skin test that was only weakly positive to wasp venom. Two patients had to stop a hyposensitization procedure because of systemic side effects. The five patients did not differ from the other patients with systemic mastocytosis with regard to either clinical symptoms and signs or urinary excretion of histamine metabolites. From the latter group two female and three male patients said they had been stung by a wasp in the past. Thus, anaphylactoid shock after Hymenoptera sting can be a presenting symptom of systemic mastocytosis and may be caused by an IgE- as well as a non-IgE-mediated mechanism. In cases of anaphylactoid reaction to Hymenoptera sting, especially when there is no IgE demonstrable in serum or in cases of intolerance of hyposensitization, the diagnosis of systemic mastocytosis should be considered, also in the absence of the clinical hallmarks of urticaria pigmentosa.

Adult↗
PubMed1996

Honeybee venom allergy: immunoblot studies in allergic patients after immunotherapy and before sting challenge.

By immunoblot techniques, detailed antibody studies were performed with sera of 20 honeybee-venom-allergic patients during or at the end of specific immunotherapy (median duration: 3 years) and before honeybee sting challenge. Before immunotherapy, all patients had experienced systemic allergic reactions to a honeybee sting, with a mean severity of 3.5 +/- 0.5 according to the Müller classification. After the sting challenge, 10 patients (reactors) reacted again with a systemic allergic reaction, whereas 10 patients (nonreactors) did not. No differences were observed between reactors and nonreactors in total serum IgE and specific IgE to honeybee venom at the time of challenge. For immunoblot, honeybee venom (RELESS) was separated on 7.5-20% SDS-PAGE. For detection of specific IgE, IgG, IgG1, IgG4, and IgM, an alkaline phosphatase-linked second antibody was used. Both groups showed 11 antibody-binding bands: at 52, 46, 40, 31, 18.7, 16.9, 13, 11, 10, 9, and 8 kDa; however, the antibody-binding pattern was individual. The reactors differed from nonreactors in showing intense IgE and less IgG4 binding to at least one single component of the venom extract. For nonreactors, the inverse relationship was observed. The hypothesis, "intensity of IgE > or = IgG4 leads to allergic symptoms", was highly significant (P = 0.00026; chi-square). These immunoblot findings could offer predictive value in distinguishing reactors from nonreactors.

Adolescent↗