Bee Sting Research Articles

Rhabdomyolysis Following Multiple Wasp Stings: A Case Report

Hymenoptera stings can result in severe systemic reactions, including rhabdomyolysis—a condition characterized by skeletal muscle breakdown. This report describes a case of rhabdomyolysis following multiple wasp stings and underscores the critical role of prompt treatment.A 63-year-old farmer was admitted to the Emergency Department following multiple wasp stings on the head, face, trunk, and upper limbs. He presented with pain at the sting sites and gastrointestinal symptoms like diarrhoea, but no signs of systemic allergic reactions or previous significant health issues. Initial tests revealed mild liver enzyme elevation, with normal kidney function. By Day 3, the patient exhibited muscle pain and significantly elevated creatine phosphokinase (CK) levels (12,597 U/L), confirming rhabdomyolysis. Aggressive fluid resuscitation, including forced alkaline diuresis, was administered. The patient remained hemodynamically stable, with normal renal function throughout his hospital stay. CPK and liver enzyme levels gradually normalized, and he was dscharged after 5 days with advice for continued hydration. Follow-up confirmed recovery without residual complications.Rhabdomyolysis should be considered in patients with muscle pain following wasp stings. Early diagnosis and aggressive fluid therapy are crucial in preventing severe complications, such as acute kidney injury. Further research is needed to elucidate the mechanisms of wasp venom-induced rhabdomyolysis and refine treatment strategies.

Clinical Management of Wasp Stings Using Large Language Models: Cross-Sectional Evaluation Study

BackgroundWasp stings are a significant public health concern in many parts of the world, particularly in tropical and subtropical regions. The venom of wasps contains a variety of bioactive compounds that can lead to a wide range of clinical effects, from mild localized pain and swelling to severe, life-threatening allergic reactions, such as anaphylaxis. With the rapid development of artificial intelligence (AI) technologies, large language models (LLMs) are increasingly being used in health care, including emergency medicine and toxicology. These models have the potential to assist health care professionals in making fast and informed clinical decisions. This study aimed to assess the performance of 4 leading LLMs—ERNIE Bot 3.5 (Baidu), ERNIE Bot 4.0 (Baidu), Claude Pro (Anthropic), and ChatGPT 4.0—in managing wasp sting cases, with a focus on their accuracy, comprehensiveness, and decision-making abilities.ObjectiveThe objective of this research was to systematically evaluate and compare the capabilities of the 4 LLMs in the context of wasp sting management. This involved analyzing their responses to a series of standardized questions and real-world clinical scenarios. The study aimed to determine which LLMs provided the most accurate, complete, and clinically relevant information for the management of wasp stings.MethodsThis study used a cross-sectional design, creating 50 standardized questions that covered 10 key domains in the management of wasp stings, along with 20 real-world clinical case scenarios. Responses from the 4 LLMs were independently evaluated by 8 domain experts, who rated them on a 5-point Likert scale based on accuracy, completeness, and usefulness in clinical decision-making. Statistical comparisons between the models were made using the Wilcoxon signed-rank test, and the consistency of expert ratings was assessed using the Kendall coefficient of concordance.ResultsClaude Pro achieved the highest average score of 4.7 (SD 0.603) out of 5, followed closely by ChatGPT 4.0 with a score of 4.5. ERNIE Bot 4.0 and ERNIE Bot 3.5 received average scores of 4 (SD 0.600) and 3.8, respectively. In analyzing the 20 complex clinical cases, Claude Pro significantly outperformed ERNIE Bot 3.5, particularly in areas such as managing complications and assessing the severity of reactions (P<.001). The expert ratings showed moderate agreement (Kendall W=0.67), indicating that the assessments were consistently reliable.ConclusionsThe results of this study suggest that Claude Pro and ChatGPT 4.0 are highly capable of providing accurate and comprehensive support for the clinical management of wasp stings, particularly in complex decision-making scenarios. These findings support the increasing role of AI in emergency and toxicological medicine and suggest that the choice of AI tool should be based on the specific needs of the clinical situation, ensuring that the most appropriate model is selected for different health care applications.

Bee Sting Rhabdomyolysis: A Clinical Case Study Investigating Elevated Procalcitonin Levels Amidst Biochemical Muscle Injury

Bee stings, although a nuisance, seem easy to deal with, causing only mild symptoms in the majority of people, but severe systemic reactions, like anaphylaxis or rhabdomyolysis, can rarely happen. Here is an unusual case report of a 75-year-old man with over a hundred bee stings, which resulted in elevated creatinine phosphokinase (CPK) levels, acute kidney injury (AKI), and increased markers of inflammation like C-reactive protein (CRP), white cell count and procalcitonin levels (PCT). Here, we highlight particular attention to procalcitonin, a marker sensitively used to differentiate between bacterial infections and other causes of inflammation. It was significantly elevated to 350 times above its normal upper range despite the patient not exhibiting any signs or symptoms of the disease. The patient made a complete recovery with supportive care, and all his biochemical markers of muscle injury and inflammation and AKI improved to baseline. Here, the authors highlight that clinicians should be aware that PCT can be spuriously elevated in rhabdomyolysis and does not automatically equate to a bacterial infection, re-iterating the need for reasonable antimicrobial use in this situation.

Neutrophil green inclusions combined with hemophagocytosis in peripheral blood after bee sting a case report and literature review.

Neutrophils green inclusions serve as sensitive biomarkers for acute liver failure and lactic acidosis, demonstrating a strong correlation with short-term mortality, commonly referred to as "death inclusions." The combination of macrophage phagocytosis with neutrophil green inclusion is rarely reported, and this article discusses the clinical association and prognostic value of these 2 critical phenomena. A 76-year-old female patient and an 82-year-old male patient both developed acute hepatic and renal failure, lactic acidosis, and multiple organ dysfunction syndrome following bee stings. Green inclusions in the cytoplasm of neutrophils and hemophagocytosis were detected in peripheral blood smears during hospitalization in both cases. Notably, both patients were elderly and had a poor prognosis. Multiple organ dysfunction syndrome due to bee sting. Give endotracheal intubation ventilator-assisted respiration, perform plasma exchange to remove poison, perform continuous renal replacement therapy for blood purification to correct acidosis, use hormone anti-inflammation to stabilize cell membranes and the internal environment, implement fluid resuscitation and blood product transfusion, replenishment of albumin and parenteral nutritional support, and other therapies. The conditions of both patients deteriorated rapidly following the discovery of neutrophils green inclusions, and resuscitation efforts were eventually abandoned by their families, leading to their discharge from the hospital. The co-occurrence of neutrophils green inclusions and macrophage phagocytosis in peripheral blood smears indicates systemic cytokine storm and hepatic dysfunction, serving as an early prognostic marker for multiorgan dysfunction syndrome. Enhanced detection of these morphological abnormalities and their prompt clinical reporting are critical for assessing disease severity and outcomes. We propose integrating dynamic peripheral blood smear monitoring into the standard diagnostic protocol for critical cases of bee venom envenomation.

A Rare Presentation of Pancreatic Panniculitis-like Reaction After a Wasp Sting.

Localized skin necrosis after bee and wasp stings is an exceptionally rare phenomenon, with few reported cases documented in the literature. Hymenoptera stings, including those from wasps, bees, and stinging ants, are common worldwide and typically result in localized reactions such as pain, erythema, and swelling. Although systemic complications, including anaphylaxis and multiorgan damage, are well recognized, localized skin necrosis remains poorly understood. In this study, we present a rare case of localized dermal necrosis in a 75-year-old woman with no systemic involvement after a yellow jacket sting. Notably, histopathologic examination revealed a lobal panniculitis with fat saponification with calcium deposition and ghost adipocytes-findings strikingly similar to pancreatic panniculitis. No infectious organisms or retained arthropod parts were identified. Wasp venom components include enzymes, proteins, and amines that cause type I hypersensitivity reactions and cause direct toxin-mediated tissue damage, yet the direct mechanism behind cutaneous damage is not well understood. This case represents the first reported instance of a pancreatic panniculitis-like reaction after a wasp sting, and contributes to the limited literature on wasp venom-induced skin necrosis.

A Case of a Bee Sting Resulting in Anoxic Brain Injury

A Case of a Bee Sting Resulting in Anoxic Brain Injury

Stroke in Bee Sting: An Uncommon Complication of a Common Sting

Abstract Bee stings, typically cause symptoms ranging from local allergic reactions to severe anaphylaxis, can also lead to neurological complications, including stroke. Here, we present a case of a middle-aged woman, with no known comorbidities, who initially experienced pain, facial swelling, and hypotension after being stung by multiple bees and later developed weakness in the right upper and lower limbs, slurred speech, and drowsiness. Neurological examination revealed right-sided hemiplegia and a left gaze preference with global aphasia. Magnetic resonance imaging showed multifocal acute infarcts with hemorrhagic foci in the left cerebral hemisphere. The patient was treated with antiplatelet agents and statins. The patient showed significant improvement, highlighting the need for prompt recognition and treatment of stroke as a rare complication of bee stings.

44/m Unconscious after wasp sting : Medical examination: Preparation for ENT specialisation Part 44

44/m Unconscious after wasp sting : Medical examination: Preparation for ENT specialisation Part 44

Risk Factors for Acute Kidney Injury in Children

The incidence of acute kidney injury (AKI) in children has shown a recent increase. Several contributing factors include the emergence of new diseases such as COVID-19 and the use of nephrotoxic drugs. This literature review aims to identify the risk factors associated with AKI in pediatric populations. The method used was a literature review conducted across three databases: ScienceDirect, PubMed, and Google Scholar, using the search keywords "children," "acute kidney injury," and "risk factors." A total of 10 primary articles were selected for review. The findings indicate that risk factors for AKI in children include comorbidities such as diabetes mellitus with diabetic ketoacidosis, COVID-19, acute gastroenteritis, malaria, post-cardiac surgery, liver transplantation, wasp stings, critical illnesses requiring intensive care, the use of nephrotoxic substances such as ethylene glycol and diethylene glycol, and blood transfusions. The increasing prevalence of these risk factors has significant implications for nursing care. Nurses are expected to enhance their understanding of AKI to improve management strategies and reduce morbidity and mortality related to acute kidney injury in children.

Oropharyngeal Bee, Hornet, Yellow Jacket, and Wasp Stings: A National Electronic Injury Surveillance System Analysis and Scoping Review.

IntroductionIt is estimated that up to 94.5% of the adult population has received at least 1 Hymenoptera sting in their lifetime, which includes stings from bees, hornets, yellow jackets, or wasps. This study describes the epidemiology of oropharyngeal stings due to bees, hornets, yellow jackets, and wasps in the United States between 2004 and 2023.MethodsThis study used data from the National Electronic Injury Surveillance System to describe patients with stings who presented to US hospitals for treatment. It then contextualized these findings through a scoping review of case reports of oropharyngeal stings published on Scopus and PubMed, with particular attention to the hospital disposition of cases.ResultsThe National Electronic Injury Surveillance System analysis found that an estimated 5% of all stings involved the oropharyngeal region. The rate of oropharyngeal stings has varied over time, and an estimated 2% of victims were admitted to the hospital for any reason. This finding stands in contrast to the review of case reports, in which 64% of victims were hospitalized.ConclusionsOropharyngeal stings present a unique risk of airway compromise and merit conservative treatment, which may include hospitalization.

The hidden sting: unmasking corneal ice rink sign in a bee sting injury.

The hidden sting: unmasking corneal ice rink sign in a bee sting injury.

Beekeepers as guardians of apitherapeutic knowledge in Estonia, SW Ukraine, and NE Italy

BackgroundBees have been important to people in Europe in many ways. Honey was the only sweetener available for a long time. The introduction of frame hives allowed for the collection of various hive products and better production of honey and wax. Only a few ethnomedicinal studies on apitherapy have been published in Europe, highlighting hive products that are collected, sold, or used by beekeepers. The aim of this article is to provide a general overview of apitherapy practiced by beekeepers in different corners of Europe, namely Estonia, Ukraine, and Italy.MethodsWe analyzed material from field studies conducted in three selected countries. From 2020 to 2024, we interviewed 17 beekeepers in each country. The average beekeeper interviewed was 55 years old, had approximately 45 beehives and approximately 22 years of experience, and did beekeeping as a part-time job. We also made observations at regional fairs and markets, as well as noted products originating from beekeeping in shops and pharmacies.ResultsThe most well-known and popular apitherapy products in all three countries were honey, pollen, propolis, and royal jelly. Due to the increasing market demand for health-promoting products, beekeepers have started to enhance their products by mixing beekeeping products into honey, making tinctures, performing bee sting treatments, etc. However, strict regulations prohibit beekeepers from labeling their products with health-promoting information. In addition, a completely new trend has emerged: apitherapy tourism. However, Italian beekeepers did not collect or use specific products made in Ukraine and Estonia, such as dead bee tincture, honeycomb moth larva tincture, and drone brood homogenates, and did not make honey moonshine.ConclusionsThe development of apitherapy in Europe has depended on the development of beehive types, the advancement of beekeeping technology, and new knowledge about the health-giving properties of beekeeping products (promoted in the literature and by institutions). As beekeeping is closely related to market demand, apitherapy tourism has emerged as a completely new economic branch and apitherapy is becoming increasingly important in providing relief from mental health issues. However, this requires an entirely new approach from beekeepers and clients using apitherapy.

Old Questions, new answers: real-world long-term efficiency of hymenoptera venom immunotherapy: prevalance of venom-induced anaphylaxis, risk factors, and field sting reactions.

Hymenoptera venom allergy is a potentially life-threatening allergic reaction. Venom immunotherapy (VIT) is recommended to prevent severe allergic reactions. Field stings indicate the effectiveness of immunotherapy. The aim of this study was to investigate the prevalence of venom-induced anaphylaxis, risk factors, and field sting reactions during or after the completion of VIT. In this study, the records of patients who underwent VIT between 2015 and 2023 at one of the largest referral hospitals in Turkey were retrospectively analysed. The protocol followed during the initiation of immunotherapy, adverse reactions, clinical characteristics of the patients (including demographic characteristics, allergic diseases, laboratory findings), and field sting reactions during and after completion of immunotherapy were analysed. A total of 194,526 unique patient files evaluated in the Allergy Outpatient Clinic between 2015 and 2023 were analysed. Of these, 384 patients were admitted with an allergic complaint following a bee sting. Among them, 113 patients (29.4%) were eligible for VIT. A total of 79 patients were included (F/M: 41/38). VIT was performed with honeybee venom in 39 patients, vespid venom in 36 patients, and both venoms in 4 patients. 62.0% (n=49) of the patients had been stung by a bee in the head and neck region. 69.6% (n=55) of the patients had a stage 3 reaction before VIT. The cluster scheme was applied to 54.4% (n=43) of all patients. There was no statistically significant difference in the number of field stings or the use of adrenaline autoinjectors between the VIT groups (p>0.05). Stage 3-4 reactions developed in 87.8% of patients stung in the head and neck region, compared to 53.3% of patients stung in other regions. During and after VIT, field stings were reviewed both from patient files and by follow-up inquiries during control visits. During VIT, field stings were observed in 19 patients. Systemic allergic reactions developed in 5 patients, and local allergic reactions developed in 6 patients; no allergic complaints were observed in 8 patients. After VIT was discontinued, 56 field sting reactions developed in 25 patients. Local allergic reactions developed in 9 patients, but no systemic allergic reactions were observed. Mastocytosis was diagnosed in a patient whose tryptase level was 42.4 and whose c-kit mutation was positive following haematological evaluation. This study confirms that the prevalence of venom-induced anaphylaxis was calculated to be 0.058%. Being stung in the head and neck region was identified as a risk factor for the development of stage 3-4 (severe allergic reactions).

Modern Apitherapy in the Treatment of Lyme Arthritis

Today there is a danger of spreading Ixodes ticks, which can cause Lyme disease, which is characterized by polysystemic lesions. As a rule, treatment involves antibiotic therapy. We studied the effectiveness of apitherapy by bee sting method in the complex treatment of patients with Lyme arthritis. Patients were prescribed a course of bee stings from 1 to 15 bee stings once every other day, a total of 102 stings. After a course of apitherapy, patients had significantly reduced or eliminated pain in the spine and joints, there was a significant decrease in IgM during bee stings between courses of antibiotic therapy and IgG in tests performed after a course of treatment with bees. Apitherapy can have a pronounced antibacterial effect over the next 2 years. In addition to these findings, further observations indicated that the immunomodulatory effects of bee venom may play a crucial role in mitigating inflammatory responses. Patients not only experienced relief from pain but also reported improved mobility and overall quality of life. The gradual reduction in specific antibody levels suggests that the bee sting treatment may help recalibrate the immune system over time. This additional benefit, coupled with the direct antibacterial properties of the venom, positions apitherapy as a promising complementary treatment approach. Continued research into the long-term effects is warranted to better understand its full therapeutic potential. Moreover, the observed improvements were supported by both subjective patient reports and objective clinical measurements. The treatment appeared to modulate the inflammatory cascade associated with Lyme arthritis, leading to fewer flare-ups and a reduction in joint stiffness. This innovative method also showed potential in preventing further joint degradation, thereby extending its benefit beyond immediate pain relief. Future studies are needed to explore the optimal dosing, frequency, and possible synergies with conventional antibiotic therapies, ensuring that patients receive the most effective comprehensive care.

Predictive value of the systemic inflammatory response index and APACHE II score for acute respiratory distress syndrome caused by wasp stings.

Predictive value of the systemic inflammatory response index and APACHE II score for acute respiratory distress syndrome caused by wasp stings.

Soluble microneedle acupuncture patches containing melittin liposomes for the percutaneous treatment of rheumatoid arthritis.

Soluble microneedle acupuncture patches containing melittin liposomes for the percutaneous treatment of rheumatoid arthritis.

Kounis Syndrome Following a Wasp Sting.

Kounis Syndrome Following a Wasp Sting.

Intensive Care Management of Anaphylactic Shock Secondary to Wasp Stings: A Case Report

Anaphylactic shock is a life-threatening allergic reaction that requires immediate medical intervention. Wasp stings are a common trigger for anaphylaxis, and rapid administration of epinephrine is crucial in preventing fatal outcomes. This case report describes the successful intensive care management of a patient who developed anaphylactic shock following multiple wasp stings. A 51-year-old female presented to the emergency department with anaphylactic shock after being stung by multiple wasps. She exhibited severe angioedema, hypotension, and tachycardia. Immediate treatment included intramuscular epinephrine, intravenous corticosteroids, antihistamines, and fluid resuscitation. The patient was transferred to the intensive care unit (ICU) for close monitoring and supportive care. In conclusion, this case highlights the importance of prompt recognition and treatment of anaphylactic shock, particularly the administration of epinephrine. It also emphasizes the role of ICU monitoring in managing severe allergic reactions and preventing complications.

Emergency Treatment and Management Strategies for 79 Patients Involved in a School Mass Bee Sting Incident

Objective: To analyze the emergency treatment and triage strategies for patients involved in a mass bee sting incident at a school and to evaluate the effectiveness of optimizing emergency procedures through scoring-based assessment criteria. The aim is to reduce the incidence of severe complications and improve the efficiency of emergency response during mass casualty events. Methods: A retrospective analysis was performed on the clinical data of 79 patients affected by bee stings during a mass incident at a school. Demographic information, clinical presentations, scoring results, classifications, and treatment measures were collected and analyzed. The severity of each patient’s condition was assessed using the Quick Sequential Organ Failure Assessment (qSOFA) score and an allergy response score. Based on these scores, patients were categorized as mild, moderate, or severe, with emergency treatment tailored accordingly. Mild cases presented with skin symptoms, moderate cases involved respiratory distress or mental disturbance, and severe cases showed multiple organ damage or anaphylactic shock. Emergency interventions, including triage labeling, intravenous access, anti-allergic medication, corticosteroid administration, and dynamic monitoring, were applied based on condition severity. Treatment outcomes and the value of the scoring system were subsequently analyzed. Results: The application of scoring-based assessments made emergency triage more systematic and rational. Severe cases received priority interventions such as intravenous access, vasopressor administration, and oxygen therapy to maintain vital signs. Moderate cases were treated with anti-allergic medications and symptomatic management following intravenous access establishment, whereas mild cases were managed through observation and symptomatic relief. Most patients experienced significant symptom improvement after graded treatment, with a few severe cases requiring hospitalization, all of which exhibited favorable outcomes. Conclusion: The implementation of scoring-based assessments for graded emergency treatment significantly enhances the efficiency of emergency responses in mass bee sting incidents and effectively reduces the risk of complications. This approach provides a scientific basis and a feasible strategy for managing similar mass casualty events in the future.

Ocular bee sting with retained stinger

Aims/Purpose: Ocular bee stings are a rare but can lead to severe inflammatory complications. Some cases have been described, but stinger retention is exceptional. We report the case of a young patient with a limbal bee sting, with stinger retention.Methods: A male 19‐year‐old, presented a painful red eye following an accidental bee sting. Examination found a visual acuity of 20/20, conjunctival hyperaemia, a clear cornea, calm anterior chamber, and a perilimbal foreign body, which corresponded to the bee stinger.We performed a conjunctival peritomy and removed the stinger using McPherson forceps under topical anesthesia. The sclera being intact, we sutured the conjunctiva and prescribed antibiotiotics and steroid drops. Evolution was marked with improvement and disappearance of symptoms.Results: Bee sting wounds can penetrate tissues like a harpoon, complicating the stinger's removal, along with possible sequelae: mechanical like corneal abrasion or intrastromal retention, and toxic effects. The venom contains phospholipase A2 and mellitin, leading to membrane lysis and pain, as well as apamin, which causes mast cells degranulation and histamine release. It can cause conjunctivitis, corneal infiltrates, cataract, uveitis, hyphema, lens subluxation, retinal lesions, optic neuropathy or choroidal detachment.Conclusions: Ocular bee stings are rare and can induce severe inflammation. Extraction of the stinger and topical antibiotic associated with steroids are the treatment of choice, in addition to close monitoring of possible complications.References Gudiseva H, Uddaraju M, Pradhan S, Das M, Mascarenhas J, Srinivasan M, Prajna NV. Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes. Indian J Ophthalmol. 2018 Feb; 66(2): 262‐268. Chilibeck, C., Wang, N., &amp; Murphy, C. (2021). Making a bee‐line for the eye: a limbal sting and retained honey bee. Clinical and Experimental Optometry, 104(4), 538–540.