Africanized honeybee stings: how to treat them

Abstract

Introduction:In 1956, Africanized honeybees (AHB) migrated from Brazil to other regions of the Western Hemisphere, including South, Central, and North America, except for Canada. Despite being productive, they are highly aggressive and cause fatal accidents. This study aimed to evaluate patients at the Clinical Hospital of Botucatu Medical School (HC-FMB) and to propose treatment guidelines. Methods: From 2005 to 2006, the clinical and laboratorial aspects of 11 patients (7 male and 4 female) and the anatomopathological aspects of one patient who had died in 2003 were analyzed. Results: The age of the surviving patients varied from 5 to 87 years, with a mean of 42.5 years. The majority of accidents occurred in the afternoon, and the number of stings ranged from 20 to 500. The principal signs and symptoms were pain and local inflammatory signs, nausea, tachycardia, and vomiting. Biochemical findings presented increased levels of creatine phosphokinase, lactate dehydrogenase, and aspartate/alanine aminotransferase. An 11-year-old male patient died upon entering the attic of a two-storey building where he was attacked by a swarm, receiving more than 1,000 stings. He was sent to HC-FMB where he was treated, but he died 24h later. Observed at the autopsy were erythematous-purpuric skin lesions besides necrosis at the sting locations, rhabdomyolysis, focal myocardial necrosis, tubular hydropic degeneration and focal tubular acute necrosis of the kidneys, myoglobinuria, and centrolobular necrosis in the liver. Conclusions: Accidents caused by multiple AHB stings always constitute a medical emergency. As there is no specific antivenom, we have developed guidelines, including first aid, drugs, and the proper removal of stingers.

Deadly Envenomation by Massive Bee Stings in a 7-Year Old Child in Ouagadougou

“…Systemic effect may be observed in case of prior sensitization to bee venom or following massive stings leading to the inoculation of a huge quantity of venom [2]. Apart from these circumstances, the reaction is generally a local or locoregional inflammation.…”

“…The hyperleukocytosis observed is common in envenomed patients [2] and is explained by the inflammatory response.…”

“…The effect of bee venom is due to its multiple components, comprised of more than twenty including histamine, melitin, apamine, hyaluronidase, phospholipases, serine protease protein, etc., having histamines liberator, vasodilator, hemolytic, neurotoxic and necrotic effects [2]. The consequences of massive stings, described during an autopsy, are cutaneous, muscular, renal, cardiac, hepatic cell necrosis [2].…”

“…The consequences of massive stings, described during an autopsy, are cutaneous, muscular, renal, cardiac, hepatic cell necrosis [2]. The subsequent manifestations may be impossible to distinguish from anaphylaxis and are then called anaphylactoids.…”

A Case of Flax Seed Induced Rhabdomyolysis

“…But high doses of statins [6], Diabetes and hypothyroidism may cause rhabdomyolysis. Rare cases of rhabdomyolysis have been reported after insect stings [7] (ex-stings of wasps, bees and ants).…”