Wasp stings and plasma exchange

Abstract

Invasive species related to climate change and/or globalization may be associated with novel forms of kidney disease. This is the case for wasps. Several species of Asian wasps are increasingly found in America (e.g. Asian giant hornet, Vespa mandarinia) and Europe (e.g. yellow-legged Asian hornet, V. velutina; black shield hornet; V. bicolor and Oriental hornet, V. orientalis). Some of these species have been associated with human deaths and acute kidney injury. The literature on wasps and acute kidney injury is scarce and mostly originating from Asia, so nephrologists outside Asia are not familiar with this health problem. In a recent issue of ckj, Liu et al describe a simple, 4-item Wasp Sting Severity Score (WSS) developed from 1131 wasp sting patients. V. mandarinia and V. velutina were among those causing hospitalization, although most cases were caused by the black-bellied hornet (V. basalis). Liu et al propose that a WSS ≥3 should guide early (<24h after stings) plasma exchange, as plasma exchange was associated with lower mortality in severely affected patients but continuous venovenous hemofiltration (CVVH) and hemoperfusion were not. The WSS will require external validation. This manuscript should raise awareness about the potentially fatal consequences of stings by wasp species making their way into America and Europe.

Wasp venom-induced acute kidney injury: current progress and prospects

“…[ 79 ] found that TPE treatment significantly decreases the mortality rate of wasp sting patients compared with those not treated with TPE; however, CRRT and hemoperfusion did not significantly reduce mortality [ 79 ]. According to these results, the TPE + CRRT combination appears to be a more suitable therapy option for wasp venom-induced AKI [ 11 , 79 ]. Nevertheless, doctors and nurses should be aware of the adverse events of TPE, such as hemorrhage, particularly in the case of wasp sting patients with abnormal coagulation.…”

“…Another study indicated that wasp stings generally inflict more severe outcomes than bee stings [ 10 ]. The progression of wasp venom-induced AKI is rapid and delayed admission is an independent risk factor for AKI following a wasp sting [ 11 , 12 ], which can seriously impact clinical progress. In a retrospective cohort study of 112 patients with wasp stings, no patients without AKI died [ 13 ].…”

“…Wasp venom-induced AKI has attracted increasing attention in recent years, with studies related to wasp venom-induced AKI rapidly increasing [ 11 ], especially in the past 10 years ( Figure 1 ).…”