Acute kidney injury after massive attack of Africanised bees

Abstract

Acute kidney injury (AKI) is a well-documented complication of massive attack by Africanised bees and can be observed 48-72 h after the accident. We report a case of Africanised bees attack followed by severe and lethal AKI. A 56-year-old man was admitted to emergency department after a massive attack of Africanised bees (>1000 bee stings). He was unconscious, presenting with hypotension and tachycardia. Mechanical ventilation, volume expansion and care for anaphylaxis were instituted. The patient was transferred to the intensive care unit (ICU) and after 48 h he developed rhabdomyolysis, oliguria, increased creatinine levels, hyperkalaemia and refractory acidosis. A diagnosis of AKI secondary to rhabdomyolysis and shock was made. The patient was treated with a prolonged course of haemodialysis. However, he progressed to refractory shock and died 5 days after admission.

Acute kidney injury in a Tanzanian boy following multiple bee stings in resource-limited setting: a case report

“…Early management of anaphylaxis with IM epinephrine (adrenaline), significantly reduces the complications, as they appear 48–72 h after the attack [ 2 – 4 , 6 , 7 , 12 ].…”

“…The stinging insects of order hymenoptera, of medical importance are bees, wasps, hornets, yellow jackets and ants [ 2 , 3 ]. African bees ( Alpis mellifera scutella, Alpis mellifera monticola ) are extremely aggressive and attack victim in swarm [ 4 ]. The complication of the stings ranges from local reaction (skin reaction) to anaphylaxis and multiple organ failure(systemic sting reaction).…”

“…The complication of the stings ranges from local reaction (skin reaction) to anaphylaxis and multiple organ failure(systemic sting reaction). Evenomation by bee sting of >500 are sufficient to cause significant damage and even death [ 2 , 4 , 5 ]. Bee sting triggers immediate allergic reaction mediated by Immunoglobin E with large local reaction such as urticaria, flushing and angioedema while hypotension, dyspnea and dizziness can progress to loss of consciousness, shock and even cardiopulmonary arrest.…”

“…These manifestations are moderate to severe reactions [ 1 ]. Severe reaction cause multiorgan damage like acute kidney injury (AKI) and myocardial infarction [ 2 – 4 , 6 , 7 ]. AKI in children following multiple bee stings is uncommon complication in Africa and there is limited literature, especially in children.…”

Two Cases of Acute Kidney Injury Due to Multiple Wasp Stings

“…The early pharmacological intervention incorporates the volume replacement and alkaline diuresis in order to prevent the factors that lead to AKI, such as dehydration and renal hypoperfusion, intratubular cast formation and tubular obstruction, aciduria, and free radical release. 3,[5][6][7]12 Indeed, some of the early-treated patients may not require dialysis as was seen in both the cases who were treated with alkaline diuresis as they arrived early (1-9 hours after being stung) and recovered without dialysis. However, in patients with established AKI the only reliable therapeutic intervention is extracorporeal blood purification such as intermittent hemodialysis, continuous renal replacement therapy, peritoneal dialysis, and plasmapheresis (whenever indicated).…”