Clinical manifestation of multiple wasp stings with details of whole transcriptome analysis

Abstract

Introduction: Multiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings. Patient concerns: Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps ( Vespa basalis ). Diagnosis: Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings. Interventions: Both 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17. Outcomes: Both patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2. Conclusion: In conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.

Clinical manifestations of wasp stings: a case report and a review of literature

“…The cytokine levels correlated positively with the white blood cell counts, serum creatinine and the C-reactive protein levels [24]. Whole transcriptome analysis following wasp stinging demonstrated evidence of highly expressed pro-inflammatory responses, including leucocyte activation, neutrophilic degranulation, and humoral immune responses [25]. The immune activation results in a systemic inflammatory response leading to multi-organ dysfunction.…”

“…A minority can present with gross haematuria [4,26]. There are case reports where heavy protein on dipstick was detected [25].…”

“…Nephrotoxicity of the wasp venom was demonstrated in animal studies [34]. Renal biopsies have shown evidence of isolated tubular cell necrosis, [35] although haemoglobin and myoglobin pigment casts are usually seen in addition [25]. Haemolysis and rhabdomyolysis release haemoglobin and myoglobin into the blood.…”

“…A transcriptome analysis of the kidney done after 2 weeks of developing AKI following wasp stinging demonstrated increased expression of SULF2, JCHAIN, and PARKAR2B. Although the implications of these gene expressions are not clear, they might reflect the regeneration of the renal cells during recovery [25].…”

Unusual Reactions to Hymenoptera Stings: Current Knowledge and Unmet Needs in the Pediatric Population

“…The primary principles of Hymenoptera massive sting management are (i) correcting hypovolemia to prevent renal ischemia; (ii) enhancing the clearance of heme proteins, toxins, or toxic wastes out of the systemic or renal circulation; and (iii) reducing the risk of direct venom toxicity, toxic waste, electrolyte imbalance, and heme protein in the kidney and other organs (35). In this context, hemodialysis and plasma exchange represent possible therapeutic approaches (35,44,45).…”