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Non-fatal acute renal failure due to wasp stings in children.

We report two children who developed acute renal failure after multiple wasp stings. Each case involved intravascular hemolysis which caused acute renal failure, volume overload, hypertension, anemia, hyponatremia, hyperkalemia, and metabolic acidosis. Peritoneal dialysis was required for short periods. The children recovered completely with blood urea nitrogen and creatinine returning to normal within 3 months. One child had a renal biopsy which showed mild tubulointerstitial nephritis. Although there is no specific treatment or antivenom, dialysis and supportive care have proved to be successful.

Acute Kidney Injury↗

Elevated serum enzymes in patients with wasp/bee sting and their clinical significance.

Seventeen patients who had been admitted to hospital for wasp/bee sting were studied. Mild pyrexia was encountered in 7 patients, rash/urticaria in 3, angioneurotic oedema in 2, oliguria in 2, microscopic haematuria and albuminuria in 3, transient hypotension in 1. However, there were frequent elevations of serum glutamic-oxaloacetic transaminase (9 out of 17 patients), serum creatine phosphokinase (14 out of 17 patients) and serum lactate dehydrogenase (8 out of 14 patients), indicating presence of damage to muscle fibres. This was confirmed by the histological findings of a muscle-biopsy from the most severe case. Elevation of serum glutamic-pyruvic transaminase was found in 6, and elevation of serum isocitrate dehydrogenase in 5 out of 14 patients, suggesting presence of liver damage. The above enzyme elevations appeared short-lived except in the clinically most severe patient (case 9) who developed acute tubular necrosis. All patients except the latter suffered no clinical sequelae and there was no correlation between their clinical condition and the presence or degree of elevations of serum enzymes.

Adolescent↗

Multiple hornet stings with features of Reye's syndrome.

Hornet's venom is known to possess a variety of toxic effects. A 19-mo-old girl who developed a Reye-like syndrome following multiple stings by the Oriental hornet (Vespa orientalis) is described. She presented with encephalopathy associated with hepatomegaly, elevated transaminase levels, low prothrombin time, and hyperammonemia. Liver biopsy demonstrated microvesicular fatty infiltration and diffuse mitochondrial changes. Additional features were acute renal tubular necrosis and massive hemolysis.

Antibodies↗

Jelly fish sting with serious hand complications.

The consequences of a jelly fish sting on the arm are described. The effects of the venom and inadequate early treatment resulted in vascular spasm in the forearm and necrosis of the digits. The toxicological properties of jelly fish venom are briefly described.

Adult↗

Analysis of vesicle fluid following the sting of the lionfish Pterois volitans.

Fluid aspirated from blisters following a lionfish (Pterois volitans) sting was analyzed utilizing combined capillary column gas chromatography and negative ion chemical ionization mass spectrometry. Analysis for prostaglandin F2 alpha demonstrated 16.91 ng/ml, for prostaglandin E2 0.143 ng/ml, for 6-keto-prostaglandin F1 alpha less than 0.1 ng/ml (nondetectable) and for thromboxane B2 1.65 ng/ml. Platelet aggregation studies showed that blister fluid caused aggregation of isolated platelets only, which was inhibited by heat treatment or by the presence of normal donor plasma.

Adult↗

Issues in management of scorpion sting in children.

All children admitted to Madina Maternity and Children's Hospital, Saudi Arabia, in 1989 because of scorpion stings (primarily Leiurus quinquestriatus) were studied. Of 96 children studied, 20 suffered either shock, pulmonary oedema or both. These 20 shared characteristic clinical features such as vomiting, priapism and failure to maintain normal temperature and/or blood pressure. The management protocol emphasized fluid restriction and the i.v. administration of venom antitoxin. Doubling the recommended dose did not improve the outcome. Two children died and the rest recovered.

Adolescent↗

Unusual reactions following insect stings. Clinical features and immunologic analysis.

Fifteen patients were studied who had unusual reactions following insect stings. These included serum sickness, neurologic disease, renal disease, and delayed hypersensitivity-type reactions. The clinical features are briefly outlined. Measurements were made of serum venom-specific IgE and IgG antibodies. These antibodies were present in some patients and in these instances suggested an immunologic pathogenesis for the reactions. Alternative etiologies for the unusual reactions are also discussed.

Acute Kidney Injury↗

Neurologic sequelae following the imported fire ant sting.

Four cases are described in which neurologic disturbances are the presenting symptoms after the imported fire ant (IFA) sting. The neurologic sequelae include focal motor and grand mal seizures and a mononeuropathy. The possible pathogenesis of these disorders is discussed.

Adult↗

The evaluation of the common diagnostic methods of hypersensitivity for bee and yellow jacket venom by means of an in-hospital insect sting.

Between 1979 and 1983 230 patients visited our clinic in connection with allergic reactions after insect stings. One hundred six patients were subjected to a diagnostic provocation test with a live insect; 86 of these patients had a history of systemic reactions and a positive skin test and RAST with insect venom. Thirty-one of these patients, including one patient with a negative RAST and another with a negative skin test, demonstrated a generalized reaction and were subjected to immunotherapy with pure insect venom. Comparison of the diagnostic data from 31 patients with reactions with those of the 57 nonreacting patients from the 86 patients aforementioned reveals that at this time only a provocation test with a live insect can provide the evidence of an allergy to insect venom leading to such a severe generalized reaction that admission to probably lifelong immunotherapy is justified. The measurement of the venom-specific IgG, the ratio of IgG/IgE, and (for bee patients) the serum antibody titer against the bee venom components phospholipase A and hyaluronidase did not improve the diagnosis of a current hypersensitivity against insect venom.

Adolescent↗

Combined active and passive immunotherapy in honeybee-sting allergy.

Five honeybee sting-allergic patients in whom bee venom immunotherapy (VIT) had previously been stopped because of repeated allergic side effects (SE) were resubmitted to bee VIT after pretreatment with beekeeper gammaglobulin. The tolerated bee venom dose was increased five to 800 times after this passive immunotherapy, and the maintenance dose of 100 micrograms of honeybee venom (BV) was reached in all patients after 6 to 15 days of a rush hyposensitization. The IgG response to BV was not suppressed by the beekeeper-gammaglobulin infusion. After 2 to 9 weeks of continued bee VIT, SE recurred in all patients. Therapy had to be stopped in one patient. The other four patients are currently on a maintenance dose of 60 to 80 micrograms. The possibility of a qualitative inferiority of the patients own IgG response was studied by crossed radioimmunoelectrophoresis and IgG subclass analysis. Lack of an IgG response to particular BV components to which IgE was present was demonstrated in three patients. The IgG subclass antibody pattern to BV at the time of recurrence of SE was similar to that found in beekeepers with a prominent IgG4 response. In contrast to beekeepers, however, there was no IgG2 response in patients.

Adult↗

Smooth muscle contracting compounds in the venom of Megascolia flavifrons (Hym: Scoliidae) with notes on the stinging behaviour.

1. The wasp Megascolia flavifrons stings larvae of the stag beetle Oryctes nasicornis on the ventral side of all segments, except the last three, which do not contain nerve ganglia. 2. Experiments indicate a central rather than a peripheral action of the venom. 3. From pharmacological analysis it is concluded that the venom does not contain cholinergic or serotonergic activity, but contains histamine- and bradykinin-like substances. 4. The presence of histamine was confirmed by a radioenzymatic method.

Animals↗

Anaphylaxis: drug allergy, insect stings, and latex.

The highest rates of anaphylaxis in humans occur in early childhood associated with food allergy. Latex allergy, pharmaceutical drugs, and stinging insect reactions are important later in childhood, with drug allergy peaking in adult populations. Knowledge about diagnosis and therapy of anaphylaxis is critical, because a large percentage of subjects are not previously known to be at risk at the time of initial reactions. This article summarizes the basic clinical knowledge of anaphylaxis in childhood.

Adult↗

Insect sting allergy.

Insect sting allergy has served as an excellent model for the allergic process over the past century. In particular, during the last 30 years, a new form of diagnostic testing and treatment with vo m has been one of the great suc-cess stories in the entire field of allergy. VIT reduces the risk of recurrent life-threatening reactions from about 60% to less than 2%. Progress and further questions continue with a search for a definitive diagnostic test that more accurately predicts which patients are at risk for future reactions, and defines which patients can stop VIT and which ones need to continue treatment.

Animals↗

Scorpion sting on the penis.

A 58-year-old man was stung on the penis by a scorpion of the species Tityus serrulatus. The patient felt a severe sharp local pain that did not improve until he presented to the hospital 12 hours later. Block of the dorsal nerves of the penis with 1% lidocaine led to immediate relief of the pain. The aim of treatment of a Tityus scorpion sting on the penis, without systemic manifestations, should be concentrated on relief of the pain. Local or regional block with a local anesthetic is the treatment of choice. The use of the specific antivenom is recommended only for cases of systemic manifestations, particularly in children.

Animals↗

Increased plasma levels of IL-1beta, IL-6, IL-8, IL-10 and TNF-alpha in patients moderately or severely envenomed by Tityus serrulatus scorpion sting.

Scorpion envenomation is a common medical problem in many countries and an important cause of morbidity and mortality, especially among children. The plasma levels of pro-inflammatory (IL-1beta, IL-6, IL-8 and TNF-alpha) and anti-inflammatory (IL-10) cytokines were measured in individuals stung by Tityus serrulatus (Ts) scorpions. According to clinical manifestations patients were classified, as defined by the Brazilian Ministry of Health, as having mild (n=15, mean age=42.2 years), moderate (n=8, mean age=26 years) or severe (n=4, mean age=14 years) envenomation. Blood samples were taken immediately (T1) and 6h (T2) after admission to the hospital. Eighteen age-matched healthy volunteers were used as control. TNF-alpha, IL-1beta, IL-6 and IL-8 levels were significantly increased in moderate and severe cases and the levels of these cytokines were positively correlated with the severity of envenomation, as evaluated by clinical profile and plasma venom concentration. IL-10 levels were increased in severe and moderate cases and reduced in mild cases. The results reported in the present study suggest that the physiopathological manifestation of Ts envenomation may be mediated, at least in part, by cytokines, and that the early treatment after scorpion sting with drugs that inhibit cytokine production, such as glucocorticoids, may have a potential beneficial effect, ameliorating the severity of the clinical manifestations observed, particularly in severe and moderate cases.

Adolescent↗

Relationship between plasmatic levels of various cytokines, tumour necrosis factor, enzymes, glucose and venom concentration following Tityus scorpion sting.

A sandwich enzyme-linked immunosorbent assay was developed for measuring Tityus venom levels in plasma. The method proved capable of distinguishing patients with only local symptoms from controls, and was used to quantify venom in 205 accidental human envenomations. Our results show that the severity of envenoming is related to the patient plasma venom concentration. This depends on time elapsed between the sting and when the plasma was drawn. We observed that 46 and 49% of patients with moderate to severe symptoms (MS, n=41) showed hyperamylasemia and hyperglycemia, respectively. In addition, 39% of cases with MS symptoms had partial thromboplastin time values prolonged or shorted and 6.5% of patients with local symptoms (LS, n=164) had only prolonged prothrombin time values. Interleukin 6 (IL6) increased significantly in patients with MS symptoms. IL6 values increased with hyperamylasemia, envenoming severity and time hyperamylasemia.

Amylases↗

Prevalence of allergy to hymenoptera stings in different samples of the general population.

To get figures of prevalence of systemic reactions (SRs) to hymenoptera sting in adults between the ages of 18 to 65 years, we performed three different surveys using the same questionnaire from 1984 to 1988. The first one was a door-to-door survey in Southeast France, which included 8271 adults and used a questionnaire. The second one, which included 2067 adults, was performed in a health care center and comprised the same questionnaire and venom skin tests in subjects reporting a history of SRs. The third survey was a national poll performed through a home-based national computer network. The percentage of SRs ranged from 0.66% in the second survey including skin tests to 3.3% in the poll survey. The higher prevalence figure in this latter survey may be related to a false-positive history. There was no urban-rural difference in prevalence of SR.

Adolescent↗