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We described here a patient envenomated by a bee sting that caused myocardial damage compatible with non-ST elevation acute myocardial infarction. She developed a typical course of myocardial infarction; the ECG changes were reversed to almost all normal limits. She had normal coronary angiography and reversible wall motion abnormalities. Myocardial damage following prolonged spasm in the coronary arteries may be the underlying factor.
STUDY OBJECTIVES: To assess the clinical severity of envenomation by the Centruroides scorpion in young children; the potential benefit of antivenin administration with regard to time to resolution of symptoms, prevention of hospitalization, and prevention of invasive intervention; and the risk of acute and delayed hypersensitivity reaction. DESIGN: Retrospective chart review with follow-up contact. SETTING: Referral toxicology management center. TYPE OF PARTICIPANTS: Children less than 10 years of age experiencing severe Centruroides scorpion envenomation. INTERVENTIONS: Administration of goat serum-derived anti-Centruroides antivenin. MEASUREMENTS AND MAIN RESULTS: Stings in young children may be life threatening, resulting in extreme neuromuscular activity, tachycardia, and respiratory distress. Administration of anti-Centruroides antivenin resulted in rapid resolution of all symptoms without acute reaction in all 12 patients so treated; 58% of patients treated with antivenin had a delayed onset of rash or symptoms of serum sickness. CONCLUSION: The benefit of rapid resolution of life-threatening symptoms and potential for outpatient management of severe envenomation in young children may justify the risk of acute and delayed reaction associated with antivenin use in this group. The use of antivenin for the less severe envenomation common in older children and adults may subject them to unjustified risk.
There is a large population of unprotected individuals who are susceptible to Hymenoptera-induced anaphylaxis. Medical antishock trousers (the MAST suit) can play an important role in field treatment of anaphylactic shock. Upon application, both blood pressure and cerebral perfusion are preserved despite clinically profound vasodilation. The MAST suit mechanically increases peripheral resistance, analogous to the vasoconstrictive effects of adrenaline. In the two cases presented, the MAST suit reversed significant hypotension caused by Hymenoptera envenomation. Both patients recovered fully. Based on the suit's effectiveness in bee-sting anaphylaxis, it would seem that extended indications exist for using the MAST suit in other forms of low-resistance shock.
Accidental sea urchin stings do not usually have any pathological consequences. However, cutaneous, synovial or toxic diseases can develop in some predisposed subjects, or under predisposing circumstances. The diagnosis, sometimes very delayed, can be difficult. Four personal cases of reactive arthritis or tenosynovitis, three of which affected the hand, are reported. All patients were cured after one or several surgical excisions. Antibiotics were not effective. The main clinical presentations, particularly delayed synovitis, are described. The various pathogenic hypotheses are in favour of an immunological reaction to the envelope protein of the sea urchin spikes.
Glioblastoma (GBM) is a malignancy with a complex tumour microenvironment (TME) dominated by GBM stem cells (GSCs) and infiltrated by tumour-associated macrophages (TAMs) and exhibits aberrant metabolic pathways. Lactate is a critical glycolytic metabolite that promotes tumour progression; however, the mechanisms of lactate transport and lactylation in the TME of GBM remain elusive. Here we show that lactate is transported from TAMs to GSCs via MCT4-MCT1. TAMs provide lactate to GSCs, promoting GSC proliferation and inducing lactylation of the non-homologous end joining protein KU70 at lysine 317 (K317), which inhibits cGAS-STING signalling and remodels the immunosuppressive TME. Inhibition of lactate transport or targeting the lactylation of KU70, in combination with the immune checkpoint blockade, demonstrates additive therapeutic benefits in immunocompetent xenograft models. This study unveils TAM-derived lactate and lactylation as critical regulators in GSCs to enforce an immunosuppressive microenvironment, opening avenues for developing combinatorial therapy for GBM.
A markedly elevated serum level of mast cell tryptase (77.6 microg/L; 95th percentile in normals 13.5 microg/L) was detected in a patient treated for 5 years with wasp venom immunotherapy because of severe anaphylaxis following a wasp sting. Retrospective analysis of stored serum samples taken during the course of immunotherapy revealed that the tryptase level had been elevated for at least 3 years. Despite several dermatological examinations, skin changes of mastocytosis had been missed. Re-examination of the patient revealed sparse macules on the thorax and thighs; Darier's sign was negative. Histologically, mast cell accumulation in these lesions was demonstrable. No signs of systemic mastocytosis were detected. The most appropriate diagnosis was telangiectasia macularis eruptiva perstans. Even in patients with highly elevated tryptase levels, mastocytosis may go undiagnosed. As mastocytosis predisposes to severe anaphylaxis, the condition should be looked for in patients with such reactions by clinical examination and measurement of serum tryptase levels.
BACKGROUND: The soluble bee venom phospholipase A2 (PLA) represents the major allergen/antigen for allergic and hyperimmune individuals following bee sting. A number of studies implicate enzymes, and PLA in particular, as potent allergens. We have studied specific activation of T cells by enzymatically active and inactive mutants of PLA, and secretion of cytokines regulating IgE and IgG4 antibody formation. METHODS: Recombinant (r) wild type PLA (rPLA-WT) and an enzymatically inactive rPLA (rPLA-H34Q) were produced in Escherichia coli. Eleven bee venom allergic patients and three hyperimmune, healthy individuals were included in the study. After specific stimulation of PBMC with the rPLA variants, proliferative response, IFNgamma, IL-2, IL-4, IL-5, and IL-13 production, as well as total and PLA-specific IgE and IgG4 production, were analysed. RESULTS: Similar levels of specific B cell recognition, proliferative and cytokine responses were observed after stimulation with either enzymatically active or inactive rPLA. In addition, equal amounts of antigen-specific and total IgE and IgG4 antibodies were produced by stimulation with both forms of rPLA. CONCLUSIONS: The enzymatic activity of PLA does not influence the specific activation and cytokine production by T cells from bee venom-sensitized or hyperimmune individuals, or the IgE/IgG4 antibodies synthesis by B cells in vitro.
BACKGROUND: Patients who receive immunotherapy for systemic reaction to insect stings are told that once they reach maintenance dose they are almost 100% protected against future systemic reactions. However, we have observed that some patients continued to perceive themselves as highly debilitated by the allergy, and this perception had a significant impact on their quality of life. OBJECTIVE: To validate this clinical observation and to explore possible reasons for such an undesired psychological reaction. METHODS: The study group consisted of 97 patients who regularly attended an allergy outpatient clinic for venom immunotherapy, and who had been under medical surveillance for up to 8 years. They completed a questionnaire measuring debilitating beliefs, preoccupation with the systemic reaction event, emotional distress, perceived restriction by allergy, and perceived quality of life. We also recorded the duration of immunotherapy, physician-graded severity of the systemic reaction and the frequency at which immunotherapy was administered. The reference group consisted of patients who had not reached maintenance dose and were still at risk of recurrent systemic reactions. RESULTS: As many as one-third of the patients held self-imposed debilitating beliefs, were preoccupied with the systemic reaction event, perceived a moderate to severe impairment in their quality of life, and manifested symptoms of emotional distress. These psychological responses did not correlate with the immunotherapy dosage that had been reached. Patients who reached a full maintenance dose were doing no better psychologically than those in the reference group. Moreover, the length of time on immunotherapy did not result in attenuation of the psychological responses. CONCLUSION: This study demonstrates for the first time, the long-lasting psychological impact of a threatening systemic reaction. It suggests a need for intervention aimed at dispelling patients' unfounded and persisting debilitating beliefs.
We describe a patient stung by an unknown jellyfish species offshore in Far North Queensland. The sting caused immediate and severe pain, multiple whip-like skin lesions and constitutional symptoms. The jellyfish tentacular nematocysyts were similar to, but distinct from, those of Carukia barnesi, a cause of the 'Irukandji' syndrome. The patients symptoms largely resolved over seven months and were associated with elevated cardiac troponin levels, in the absence of other evidence of cardiac disease. This case highlights the envenomation risks associated with marine recreation, and the need for critical evaluation of cardiac troponin assays and for further research in marine toxicology.
A 27-year-old man suffering from severe swelling and pain in his right arm was referred to our hospital. He showed signs of acute renal failure (ARF) with severe dermatitis of his right arm. Three days before being admitted, he accidentally touched some kind of marine organism with his right hand while snorkeling in the Sulu Sea around Cebu Island. Within a few minutes, he was experiencing severe pain in his right hand. Then his right hand gradually became swollen. The marine creature responsible for this injury was thought to have been a sea anemone, which is a type of coelenterate. Histologic findings of a renal biopsy indicated that acute tubular necrosis (ATN) had caused ARF in this patient's case. Supportive therapies improved renal function of this patient, and steroid pulse therapy attenuated the severe skin discoloration. The ATN was thought to have been caused by the poison from a sea anemone because there were no other conceivable reasons for the patient's condition. This is the first time that a marine envenomation case has been reported in which the sting of a sea anemone has caused ATN without the failure of any other organs.
An allergic reaction after an insect sting is most common. However an inflammation of the optic nerve as a result is rare. The following case reports about a 20-year-old patient who suffered a temporary loss of sight after being stung by a wasp.
String-rays are found in the coastal regions of the oceans and in some rivers especially of South America. Their poisonous sting may cause very painful injuries in divers and fishermen which may sometimes lead to shock-like states. Death is not rare, usually the result of secondary infection. The treatment of such poisoning is symptomatic, concentrated primarily on pain elimination.
BACKGROUND: Up to 50% of patients with stinging-insect allergy have double-positive RAST results to honeybee and yellow jacket (YJ) venom. True double sensitization and crossreactivity through venom hyaluronidases are considered main reasons for this multiple reactivity. OBJECTIVE: We investigated the role of antibodies against cross-reactive carbohydrate determinants in venom double positivity. METHODS: CAP inhibition experiments were performed with crude oilseed rape (OSR) and timothy grass pollen extracts and a neoglycoprotein construct displaying a MUXF glycan, as present in pineapple-stem bromelain (MUXF-BSA). CAP to OSR was used as a rough measure for carbohydrate-specific IgE in individual sera. RESULTS: CAP results to OSR pollen were positive in 2 of 14 single-positive honeybee venom sera, 2 of 16 single-positive YJ venom sera, and 33 (80.5%) of 41 double-positive sera (P < .00001, chi(2) test). CAP inhibition was performed in 16 selected patients with a CAP class of 3 or higher to both venoms. In 9 of 11 patients with a highly positive CAP result to OSR (CAP score to OSR > CAP score to second venom), pollen extracts, MUXF-BSA, or both were able to completely inhibit IgE binding to one of the venoms, whereas this was not the case in 5 patients with a negative or weakly positive CAP result to OSR (CAP score to OSR < CAP score to second venom). CONCLUSIONS: The data suggest that carbohydrate-specific IgE is a major cause for the double positivity to honeybee and YJ venom seen in patients with Hymenoptera allergy. Because these antibodies may have low clinical relevance, they may severely impede the correct diagnosis of Hymenoptera venom allergy.
The incidence of anaphylaxis from insect stings is about 0.4%, most commonly caused by Hymenoptera species. Diagnosis is aided if the patient can reliably identify the insect, and more specific diagnosis depends on venom skin testing for individual sensitivity. Radioallergosorbent testing is also used but fails to identify about 15% to 20% of sensitivities. Avoidance of high-risk situations is the best approach for patients with known sensitivity. Treatment includes relief of local symptomatic reactions, pharmacologic arrest of anaphylaxis, and venom immunotherapy.
Allergy to insect venom is a major health problem for a significant number of people. Immunotherapy can reduce the risk of subsequent reaction from about 60% to less than 5%. Standard preventive care should include (1) advice concerning avoidance of insects, (2) prescription of an epinephrine kit or syringe for self-administration (unless medically contraindicated), and (3) referral for evaluation. Results of several studies from various regions of the country raise concern about the preventive care and advice given these patients and suggest a need for continuing medical education to improve preventive management of allergy to insect stings.
A total of 780 children with scorpion stings were admitted to a referral hospital in Saudi Arabia over a 7-year period. A similar number was managed in the outpatient department. The mortality was 4.8% initially, but no death occurred in the last 2 years of the study period. The reduction in mortality is attributed to the use of antivenom and improvement in case management.
Occasionally, insect bites producing systemic complications are the reason for admission to paediatric intensive care. We report an interesting case of multiple bee stings in a 2-year-old boy. The boy, who was stung more than 200 times by honey bees, had a severely deranged coagulation profile with marked elevation of the hepatic enzymes. This complication has not been reported to date. Prompt intensive supportive care led to the child's total recovery.
A 41-yr-old, previously healthy male was stung once by a hornet. The patient had no history of allergy or hornet stings. Physical examination revealed swelling of the right side of his body with blister formation on the extremities. Rhabdomyolysis developed. Treatment included corticosteroids, antihistamines, and cyproheptadine. The patient was discharged without sequellae after being hospitalized for 7 days.