Multiple Wasp Stings Research Articles

Machine-learning based prediction model for acute kidney injury induced by multiple wasp stings

Acute kidney injury (AKI) following multiple wasp stings is a severe complication with potentially poor outcomes. Despite extensive research on AKI's risk factors, predictive models for wasp sting-related AKI are limited. This study aims to develop and validate a machine learning-based clinical prediction model for AKI in individuals with wasp stings. In this retrospective cohort study, conducted at a tertiary teaching hospital in Yichang, China, from July 2013 to April 2023, 214 patients with wasp sting injuries were analyzed. Using least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression, prognostic variables for AKI were identified. A nomogram incorporating these four variables was constructed. The model's performance was assessed through internal validation, leave-one-out cross-validation, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). Among 214 patients affected by wasp stings, 34.6% (74/214) developed AKI. Following LASSO regression and multivariate logistic regression, the number of stings, presence of gross hematuria, systemic inflammatory response index (SIRI), and platelet count were identified as prognostic factors. A nomogram was constructed and evaluated for its predictive accuracy, showing an area under the curve (AUC) of 0.757 (95% CI 0.711 to 0.804) and a concordance index (C-index) of 0.75. Validation confirmed the model's reliability and superior discrimination ability over existing models, as demonstrated by NRI, IDI, and DCA. The developed nomogram effectively predicts AKI risk in wasp sting patients, facilitating early identification and management of those at risk.

Wasp sting-induced rhabdomyolysis and acute liver injury in a young, healthy patient: An uncommon case.

Wasp stings represent a significant environmental hazard in Sri Lanka. While the majority of individuals experience only localized symptoms, a subset may exhibit allergic reactions of varying severity. In rare instances, these reactions can escalate to life-threatening complications. Rhabdomyolysis, a severe consequence of muscle injury induced by wasp venom, necessitates early diagnosis and prompt intervention to mitigate potential fatalities. We present the case of a 32-year-old male with no prior health issues who was admitted following multiple wasp stings. On the second day of admission, he developed rhabdomyolysis and hepatic injury. With appropriate fluid management, the patient made a full recovery. This case underscores the importance of timely intervention in managing the severe complications of wasp stings.

Suboptimal capability of individual machine learning algorithms in modeling small-scale imbalanced clinical data of local hospital.

In recent years, artificial intelligence (AI) has shown promising applications in various scientific domains, including biochemical analysis research. However, the effectiveness of AI in modeling small-scale, imbalanced datasets remains an open question in such fields. This study explores the capabilities of eight basic AI algorithms, including ridge regression, logistic regression, random forest regression, and others, in modeling a small, imbalanced clinical dataset (total n = 387, class 0 = 27, class 1 = 360) related to the records of the biochemical blood tests from the patients with multiple wasp stings (MWS). Through rigorous evaluation using k-fold cross-validation and comprehensive scoring, we found that none of the models could effectively model the data. Even after fine-tuning the hyperparameters of the best-performing models, the results remained below acceptable thresholds. The study highlights the challenges of applying AI to small-scale datasets with imbalanced groups in biochemical or clinical research and emphasizes the need for novel algorithms tailored to small-scale data. The findings also call for further exploration into techniques such as transfer learning and data augmentation, and they underline the importance of understanding the minimum dataset scale required for effective AI modeling in biochemical contexts.

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

BackgroundWasp stinging, a neglected tropical entity can have a myriad of local and systemic effects. We present a case of multi-organ injury following multiple wasp stings and a review of literature on the systemic manifestations of wasp stings.Case presentationA 48-year-old Sri Lankan male who suffered multiple wasp stings, developed an anaphylactic shock with respiratory failure, which was treated with adrenaline and mechanical ventilation. Within the next 2 days the patient developed acute fulminant hepatitis, stage III acute kidney injury, rhabdomyolysis, haemolysis and thrombocytopenia. The patient was treated in the intensive care unit with ionopressors and continuous renal replacement therapy (CRRT). Haemoadsorbant therapy was used in adjunct with CRRT. There was a gradual recovery of the organ functions over the 1st week. However, the patient succumbed to fungal sepsis on the 16th day despite treatment. We conducted a literature review to identify the various clinical manifestations of wasp stinging. Wasp venom contains enzymes, amines, peptides and other compounds. These proteins can cause type 1 hypersensitive reactions ranging from local skin irritation to anaphylactic shock. Furthermore, the toxins can cause direct organ injury or delayed hypersensitivity reactions. The commonly affected organs are the kidneys, liver, and muscles. The effect on the haematological system manifests as coagulopathy and/or cytopenia. The heart, nervous system, lungs, intestines and skin can be affected rarely. Treatment is mainly supportive.ConclusionIn conclusion, wasp envenomation can result in multi-organ injury and attention should be paid in doing further research and establishing evidence-based treatment practices.

Multiple Wasp Stings Leading to Rhabdomyolysis Induced Acute Kidney Injury with Incidental Ectopic Kidney: A Case Report

acute kidney injury; case reports; creatine kinase; hymenoptera; rhabdomyolysis.

Multiple Organ Dysfunction Syndrome Secondary to Multiple Wasp Stings: A Case Report

Wasp sting is common in resource-limited countries like Viet Nam. Symptoms can range from mild (itching, urticaria, and angioedema) to severe (multiorgan dysfunction), which increases mortality. Rhabdomyolysis and acute respiratory distress syndrome are rare complications but yield a high risk of death, thus requiring emergent interventions. We present a case of a 32-year-old man suffering from multiple wasp stings. The patient manifested several swollen, erythematous, and tender stings, and then developed a high fever, dyspnea, and reddish urine. He was diagnosed with multiple organ dysfunction syndrome, including severe hemolysis, acute kidney injury, liver injury, and acute respiratory distress syndrome.

Development and validation of a model to predict acute kidney injury following wasp stings: A multicentre study

ObjectiveTo establish and validate a model to predict acute kidney injury (AKI) following wasp stings. MethodsIn this multicentre prospective study, 508 patients with wasp stings from July 2015 to December 2019 were randomly divided into a training set (n = 381) and a validation set (n = 127) for internal and external validation. Risk factors were identified, and a model was established to predict the probability of AKI following multiple wasp stings using an individual nomogram and a predictive formula. The performances of the model were assessed by using the area under the curve (AUC), accuracy (ACC) of the receiver operating characteristic curve and decision curve analysis. ResultsThe number of stings, aspartate aminotransferase >147 U/L, lactate dehydrogenase >477 U/L, time from stings to admission >12 h and activated partial thromboplastin time >49 s were demonstrated to be independent risk factors for AKI following wasp stings (all P value < 0.05) and were incorporated into the model. The performances of the model were validated (AUC = 0.950 [95% CI: 0.923 to 0.969], ACC = 0.916 and AUC = 0.953 [95% CI: 0.900 to 0.982], ACC = 0.906 in the training set and validation set, respectively). The predictive formula and the nomogram of the model could be utilized to predict AKI following wasp stings, which have sufficient accuracies, good predictive capabilities and good net benefits. ConclusionThe predictive formula and the individual nomogram of the model might serve as promising predictive tools to assess the probability of AKI following wasp stings.

Acute kidney injury following rhabdomyolysis due to multiple wasp stings

Wasp stings are a common form of envenomation in tropical countries. Multiple wasp stings may cause fatal complications such as anaphylactic reactions, intravascular hemolysis, rhabdomyolysis, acute kidney injury (AKI), or even death also. Here we report a 9-year-old boy who was admitted to a tertiary care hospital in Bangladesh with complaints of multiple wasp stings all over the body 15 days back. He had oliguria and generalized edema for 7 days. The urine test was negative for red blood cells and his renal function was gradually deteriorating. His serum creatinine phosphokinase was gradually rising. Intermittent hemodialysis through a central venous catheter was started immediately. Renal biopsy revealed myoglobin cast nephropathy. On the basis of history, clinical manifestations, and laboratory investigation, he was diagnosed as AKI following rhabdomyolysis due to multiple wasp stings. Clinical and biochemical picture started to improve including urine output was normalized on seventh day of post-admission. Timely initiation of dialysis and supporting therapy can improve renal survival in case of AKI due to wasp stings.

Wasp sting-related allergic encephalitis

A 48-year-old man presented with a headache and disorientation after multiple wasp stings. Following admission, he developed seizures and was intubated. We provisionally diagnosed wasp sting-related allergic encephalitis and treated...

Brachial artery thrombosis following multiple wasp stings

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Asian wasp envenomation and acute renal failure: a report of two cases

Acute renal failure is an unusual complication of wasp stings. We report two cases of renal failure after multiple wasp stings (Vespa affinis). Both patients had evidence of intravascular haemolysis, hepatic dysfunction, oligo-anuria and azotaemia and required dialysis. The first patient had severe hemolysis, rhabdomyolysis, pigment and venom nephropathy and died on the 8th day in hospital. The second patient, who recovered completely in 3 weeks time with steroid and antihistaminic therapy, had interstitial nephritis. Although acute renal failure after wasp stings is typically caused by acute tubular necrosis (ATN) in the setting of haemolysis or rhabdomyolysis, in some patients, acute renal failure may result from a direct nephrotoxic effect or acute interstitial nephritis from a hypersensitivity reaction.

Plasma exchange and hemodialysis for severe manifestations of multiple wasp stings in a child

Wasp stings occur frequently in developing countries and often lead to fatal outcomes due to the effects of wasp venom. Hemolysis and rhabdomyolysis often complicate wasp stings and result in acute kidney injury (AKI). We report a case of multiple wasp stings leading to AKI and multiple organ dysfunction syndrome (MODS) in a 9-year-old Indonesian girl. Kidney biopsy revealed acute tubular necrosis and acute interstitial nephritis. Despite delayed admission, she recovered in 33 days after 3 days of intravenous steroid administration, eight sessions of intermittent hemodialysis, and two sessions of plasma exchange (PE). Complete recovery of kidney function, indicated by normal diuresis, normal estimated glomerular filtration rate, and negative albuminuria, was reached within 12 weeks. This case showed that immediate admission following multiple wasp stings (particularly &gt;10 stings) to initiate early dialysis is important to promptly remove toxins and preserve kidney function. The case also showed that PE can be beneficial in cases of hemolysis and rhabdomyolysis complicated by MODS.

Risk factors of acute kidney injury induced by multiple wasp stings

In Asia, acute kidney injury (AKI) induced by wasp stings is common; however, the pathophysiological mechanisms involved remain unclear. To evaluate the mechanisms associated with AKI induced by wasp stings, we conducted a retrospective cohort study that assessed blood and urinary samples from 112 patients with hospital admissions resulting from wasp stings. These samples were divided into those with AKI and without AKI as described in the Kidney Disease Improving Global Outcomes (KDIGO) database. Of the patients, 48.2% presented with an elevated number of leukocytes (median 19.9 vs. 15.8 × 109/L), serum creatinine (median 122.0 vs. 66.0 μmol/L), alanine aminotransferase (ALT) (median 176 vs. 32 U/L), aspartate aminotransferase (AST) (median 402 vs. 37 U/L), lactate dehydrogenase (LDH) (median 3076.0 vs. 300.0 U/L), creatine kinase (CK) (median 9990.0 vs. 261.0 U/L), creatine kinase myocardial band (CK-mb) (median 200.0 vs. 29.5 U/L), activated partial thromboplastin time (APTT) (median 70.0 vs. 42.5s), prothrombin time (PT) (median 15.0 vs. 12.5s), myoglobin (median 2200.0 vs. 78.0 ng/mL), proteinuria (51.9% vs. 17.2% ≥ 1+), and urinary monocyte chemotactic protein-1 (MCP-1) (median 432.0 vs. 177.0 pg/mL), and subsequently developed AKI. As determined by multivariate logistic regression analysis, elevated leukocytes (>10 × 109/L) [OR 1.12 (95% CI 1.02–1.23)], high myoglobin (>1200 ng/mL) [OR 18.51 (95% CI 1.51–132.27)], and high urinary MCP-1 (>200 pg/mL) [OR 5.42 (95% CI 1.27–30.39)] on admission were independent risk factors for AKI. At admission, baseline values for ALT, aspartate aminotransferase (AST), LDH, CK-mb, APTT, PT, and proteinuria were higher for those who later died as well as for those who developed end-stage renal disease (ESRD). No patients without AKI died or developed ESRD. The present study explored the pathophysiology of AKI induced by wasp stings based on the findings of risk factors as well as factors related to outcomes. An understanding of AKI induced by wasp stings allows better treatment options and clinical management for wasp stings patients.

Rhabdomyolysis and acute kidney injury following multiple wasp stings.

Rhabdomyolysis and acute kidney injury following multiple wasp stings.

Clinical and pathological analysis of 9 cases of acute kidney injury following multiple wasp stings

目的 观察群蜂蜇伤后急性肾损伤患者临床表现及肾组织病理改变，进一步认识蜂毒对肾脏的损伤。 方法 回顾分析2013年6月至2017年11月在本院就诊的群蜂蛰伤后出现急性肾损伤并行肾穿刺活检患者9例的临床资料。 结果 7例患者肾组织呈现急性肾小管坏死表现，临床表现少尿型急性肾功能衰竭，随访中肾功能完全恢复；2例表现为急性肾小管间质肾炎，其中1例呈现少尿型急性肾功能衰竭，另1例无明显少尿，随访过程中前者肾功能恢复，后者进展为慢性肾脏病。 结论 群蜂蛰伤后急性肾损伤的组织病理改变多见急性肾小管坏死，无少尿和尿量恢复而肾功能不能及时恢复患者行肾穿刺活检，以明确病理改变、指导治疗，改善患者愈后。

Ischemic stroke following a wasp sting \u2013 a rare complication: a case report

BackgroundWasp stings are commonly encountered worldwide and result in a variety of clinical manifestations including local and systemic reactions. Neurological and vascular complications are rarely reported following a wasp sting.Case presentationA 69-year-old Sri Lankan Tamil man presented to our hospital with focal neurological deficit following multiple wasp stings; the deficit was confirmed to be an acute infarction on magnetic resonance imaging scan. He was screened for metabolic risk factors which were negative and he had a normal two-dimensional echocardiogram and normal carotid arteries in carotid duplex which excluded potential sources of thromboembolism.ConclusionTreating physicians should be aware of the rare but possible complication of ischemic stroke following a case of wasp sting.

Acute Kidney Injury Following Wasp Stings - A Case Report and Literature Review

The manifestations of wasp stings are usually benign and localized at the site of stings but susceptible individuals may present with multisystem and potentially fatal complications like hemolytic anaemia, acute renal failure and shock. We report here a child who developed acute kidney injury seven days after multiple wasp stings. The renal functions recovered with supportive management including two sessions of peritoneal dialysis. This case report highlights that management of some of the wasp stings should be done in consultation with centre which has facilities for dialysis. The management of wasp sting should be started as early as possible and when progressive renal failure ensues, intensive dialysis support results in good renal recovery in majority of survivors.Bangladesh J Child Health 2018; VOL 42 (2) :98-101

Rhabdomyolysis and Acute Respiratory Distress Syndrome Secondary to Multiple Wasp Stings

Background: Wasp stings usually cause local reactions such as itching, urticaria, angioedema and anaphylaxis. Life-threatening complications following multiple wasp stings are relatively rare and unexpected. However, rhabdomyolysis and acute respiratory distress syndrome following wasp stings are possible. Case presentation: A middle-aged male worker was stung by a swarm of wasps all over his body while attacking a wasp’s nest. He had pain, a swollen face and multiple blisters on his entire body. He initially received the standard treatment of intravenous antihistamine, anesthetic and steroid medications. On admission day, his urine output progressively decreased in volume and turned from clear to bloody in appearance, with the color tending to become progressively darker. A serum creatinine of 0.87 mg/dL and a creatinine phosphokinase of 1403 IU/L at admission confirmed rhabdomyolysis. The following day, his serum creatinine and creatinine phosphokinase rose, with the development of tachypnea with desaturation; a chest radiograph showed bilateral diffuse lung infiltration. He was subsequently diagnosed with acute respiratory distress syndrome (ARDS). A medical record review revealed that he had received only 1150 ml of intravenous fluid in 8 hours. Consequently, his ARDS may have been caused by an anaphylactic reaction to the wasp toxin rather than by a cardiogenic cause or volume overload. He was intubated and transferred from the general ward to the intensive care unit for close clinical monitoring. Mechanical ventilation and intravenous fluid support were given to achieve a minimum urine output of 1 ml/kg/hr. His clinical and biochemical pictures started to improve and normalize from the fourth day after ICU admission. Conclusions:Wasp stings may cause both rhabdomyolysis and acute respiratory distress syndrome. Early detection and immediate supportive treatment is the mainstay to reduce morbidity and mortality in such cases.

Onset of psoriatic arthritis associated with multiple wasp stings

Onset of psoriatic arthritis associated with multiple wasp stings

Wasp stings (Vespa affinis) induced acute kidney injury following rhabdomyolysis in a 25-year-old woman

Wasp sting is a relatively common arthropod assault. This usually results in pain and mild allergic reactions, but sometimes may cause severe systemic reaction and multiorgan dysfunction including rhabdomyolysis, hemolysis, coagulopathy, hepatic, renal and cardiac complications. Along with several other pathomechanisms, rhabdomyolysis is a distinguished cause of acute kidney injury (AKI) in patients with wasp sting. We herein report a case in which the patient developed rhabdomyolysis followed by AKI due to multiple wasp stings. The offending wasp was brought to the hospital and the species was confirmed by a zoologist (Vespa affinis).