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In India, bee stings are very common, seen mainly in farmers and honey collectors. Usually, it presents with local reactions and anaphylaxis. It rarely requires urgent hospitalisation. Other major complications seen are acute renal failure, intravascular coagulation, rhabdomyolysis and acute pulmonary oedema. Stroke as a presentation is uncommon. We report a case of a 45-year-old man presenting with right-sided hemiplegia and aphasia due to multiple bee stings. Diffusion MRI showed left middle cerebral artery territory hyperacute infarct.

Background: Although exposure to stings has been identified as the leading risk factor for anaphylaxis due to Hymenoptera venom allergy, professional beekeepers receive hundreds of stings yearly without developing systemic reactions. Objective: This study aims to analyze the mechanisms underlying bee venom tolerance in beekeepers. Methods: A cross-sectional study was conducted. Participants were recruited and classified into 3 groups: allergic patients (APs), who experienced systemic reactions after bee stings, with a positive intradermal test and specific IgE (sIgE) to Apis mellifera venom (AmV); tolerant beekeepers (TBKs), who received ≥50 stings/year; and healthy nonexposed controls (HCs). We measured serum levels of sIgE and specific IgG4 (sIgG4) to AmV, rApi m 1, rApi m 2, rApi m 3, Api m 4, rApi m 5, and rApi m10, as well as AmV-induced basophil degranulation, percentage of T-cell subsets, regulatory T cells (Treg), and IL-10 production. Results: Compared with TBKs, APs had high levels of sIgE to AmV and all its allergic components (P

BACKGROUND Based on the promising results from preclinical studies, bee venom has been investigated as a neuroprotective agent in Parkinson's disease. OBJECTIVE To assess if longstanding exposure to bee venom is associated with decreased risk for Parkinson's disease among beekeepers. METHODS Questionnaire gathering information about diagnosis of Parkinson's disease and exposure to bee stings was posted to 6500 members of Slovenian beekeepers' organisation. RESULTS We received 1298 responses (response rate 20.1%). Twenty beekeepers, all older than 60 years, were diagnosed with Parkinson's disease. The prevalence of Parkinson's disease in beekeepers aged ≥60 years was 3.9%, which is above the reported 0.6-1.3% prevalence of PD in this age group in European population. There was no difference in parameters reflecting bee venom exposure between beekeepers with and without Parkinson's disease. CONCLUSIONS Continuous exposure to bee venom does not affect neurodegeneration to the extent where it could prevent the expression of Parkinson's disease. © 2021 International Parkinson and Movement Disorder Society.

Bee stings are common in the tropics and cause minor problems but may occasionally cause severe anaphylactoid reactions.

Bee stings are commonly encountered worldwide [1]. Various manifestations after bee sting have been described. Local reactions such as pain, wheal, flare, edema and swelling are common and generally self-limiting. Uncommonly manifestations like vomiting, diarrhea, dyspnea, generalized edema, acute renal failure, anaphylactic shock, myocardial infarction, hypotension, collapse, pulmonary hemorrhage, acute hemorrhagic pancreatitis, atrial fibrillation, vasculitis, serum sickness, neuritis and encephalitis may occur [2]. We report a case of a 27-year-old male who developed right sided hemiparesia and dysphasia following multiple bee stings.

A hybrid species of Brazilian bee has proliferated on the South American continent since 1956. We describe a “killer bee” swarm attack on a 2-year-old girl in French Guiana. The patient weighed 10 kg, and approximately hundreds of bees’ stingers were removed, that is, 10 stings/kg. Our patient survived without long-term sequelae. The management of her condition required admission into intensive care for renal failure due to acute tubular necrosis and severe rhabdomyolysis. We emphasize the importance of early medical intervention, clinical surveillance, and biological monitoring at the hospital to prevent a toxic chain reaction that could prove fatal within 72 hours.

Arthropod bites are a common problem worldwide that are capable of inflicting injury, inciting allergic reactions, and transmitting systemic disease. Members of the Hymenoptera order in particular are of importance as they are nearly ubiquitous in nature and few such as bees, are also used for commercial purposes. These insects have stinging apparatus that deliver venom to the affected tissues during a bite. Hymenopteran venoms contain a mixture of proteins, peptides, and small organic molecules that produce varied effects. Stings from bees, wasps, and ants produce a wide array of clinical manifestations that can be local or systemic. Additionally, these stings may cause life-threatening allergic reactions. Anaphylaxis following a Hymenoptera sting is the most common serious systemic complication. Local reactions can be immediate or delayed. In a few instances, local or disseminated infections have also been reported following bee stings; although very rarely have proved fatal in severe cases. Infection rates are found to be higher in immunodeficiency states. Infections at site of a bee sting can result in the localized pustular lesion with peripheral induration or in severe cases deep necrotizing fascia infection with sepsis and multisystem organ failure. Here we report a case of a bee sting in the upper lip leading to the painful swelling with abscess formation successfully treated with antibiotics, incision, and drainage. Numerous mechanisms for infection in arthropod stings have been described; in our case report, we would like to highlight the importance of timely identification and appropriate management of the infections that may have a significant impact on the overall outcome.

Background Twenty-six years after the arrival of “killer bees” in Arizona, the entire state with the exception of high elevations in the north is populated with this bee variety and 11 people have died at the scene of massive bee attacks. Methods Because of the aggressive behavior of these bees we studied bee stings reported to the Arizona Poison and Drug Information Center. The center received 399 calls regarding 312 victims of bee stings from January 2017 to June 2019. Calls originated from private residences and emergency centers. Results Stings occurred at victims’ home residences in 272 (84.7%) of cases and 24 (7.5%) in public areas; 251 people suffered 1 sting; 42 individuals, 2-10 stings, 4 had 11-49 stings, and 13 individuals had >50 stings (so-called massive stinging). Three individuals were admitted to intensive care units (ICU) and one 35-year-old man died of anaphylaxis after 1 sting; moderate clinical effects occurred in 32 individuals including 6 admitted to the hospital but not in the intensive care unit. Anaphylaxis occurred in 30 (9.6%) of individuals, 16 receiving 1 sting. Toxic effects, tachycardia, elevated creatinine, or rhabdomyolysis occurred in 13 (4.2%) individuals. Conclusions In the past, individuals stung more than 50 times were beekeepers working with European honeybees, whereas, in the current era, single as well as massive stings are the result of feral “killer bees.” This change in epidemiology requires a new approach to sting victims: those with massive stinging should be evaluated and observed for anaphylaxis and serial laboratory values obtained for days to detect the toxic effects of envenomation.

The findings of massive Africanized honeybee stings in two hair sheep and a mare are reported. One sheep died 15 h after attack, and the survivors developed skin necrosis on the sting sites. Pathological evaluation revealed necrosis in the dermis, degeneration of the tubular epithelial cells, and multifocal hemorrhages in heart and spleen. The massive attack by Africanized honeybees induced lesions in the skin, heart, muscles, kidneys, and lungs.

BACKGROUND Bee venom (BV) hypersensitivity can be severe and potentially life-threatening. Beekeepers heavily exposed to bee stings and are thus at a high-risk group. The data on bee sting reactions among beekeepers in Thailand is limited. OBJECTIVE To determine the prevalence, clinical and immunological characteristics, and the knowledge of BV hypersensitivity in Thai beekeepers. METHODS A self-reported questionnaire survey about BV reactions in beekeepers were conducted. Further blood test for immunological parameters: serum BV-specific IgE (BV sIgE), phospholipase A2-specific IgE (Api m1 sIgE), and BV-specific IgG4 (BV sIgG4) were compared between non-allergic beekeepers, patients with a history of bee sting anaphylaxis and the non-allergic control group. RESULTS A total of 202 out of 447 questionnaires (response rate 45%) were returned. The median age was 46.7 years. Systemic reactions were documented in 6.4%. Younger than 45 years was found to be a factor associated with systemic reactions (OR, 4.35; 95% CI, 1.16-16.31). The BV sIgE and Api m1 sIgE were significantly higher in the anaphylaxis group (p = 0.001). The median of BV sIgG4 was significantly higher in non-allergic beekeepers (p = 0.001). For the knowledge of BV hypersensitivity, 56.4% recognized that BV hypersensitivity could be fatal but only 6% knew about epinephrine auto-injector device. CONCLUSIONS The prevalence of systemic reactions after stings among Thai beekeepers was not high, which might be due to the tolerance induced by natural exposure via sIgG4. The level of knowledge of BV hypersensitivity among beekeepers was insufficient, more education must be provided.

We report the case of a 54-year-old male who presented with complaints of decreased vision in the left eye (LE). He gave a history of multiple bee stings following which he had an episode of allergic anaphylaxis to the face and neck region for which he was admitted and treated with steroids. On examination, he was found to have LE central retinal artery occlusion (CRAO) which was the cause of his reduced vision. This is the first report of a bee sting venom as a cause for CRAO.

Multiple bee stings are associated with intravascular hemolysis (IVH), rhabdomyolysis, hypotension, renal tubule injury, and all causing acute kidney injury. Evidence in support of hemolysis includes anemia, hyperbilirubinemia, hemoglobinemia, hemoglobinuria, low haptoglobin (Hp) levels, elevated lactate dehydrogenase, and Coomb's test (if antibody mediated). However, under certain circumstances, hemoglobinemia and hemoglobinuria may be the only evidence of IVH depending on the etiological factors in association with the environment inside the body. Bee venom is known to have deleterious actions on different tissue types (neurotoxin, muscle paralytic, hematotoxic, epithelial damage, etc.). Altogether, they determine the outcome and presentation. Apart from this, there are several conditions that determine the binding of oxygen and Hp to hemoglobin (Hb). Arterial blood gases (ABGs) play a very important role in this. Hence, it is important for the pathologists to have an understanding of ABG as well to know how even simple tests (Hb, bilirubin, and Hp) can get affected by them. We describe one such occurrence in a patient with multiple hornet bee stings and formulate the likely causes and pathogenesis.

Background: We aimed to determine the epidemiology of anaphylaxis to bee stings in the rural areas of Gorgan City, Iran. Objectives: Anaphylaxis is a severe, life-threatening, diffuse or systemic hypersensitivity reaction with rapidly progressive problems such as airway (throat or laryngeal edema) or bronchospasm, tachypnea and hypotension .The systemic response to bee stings is 1% in children and 3% in adults. Anaphylaxis due to bee stings is very dangerous in many cases, and may even be fatal at the initial stage. Methods: In this cross-sectional study, we analyzed some of the epidemiological characteristics of the study participants, such as demographic information, bee type, the cause of anaphylaxis, the time of bee sting, the onset of symptoms of anaphylaxis after a bee sting, the number of bee stings, symptoms during anaphylaxis, and therapeutic and prophylactic measures. Results: In total, 201 patients were diagnosed with anaphylaxis caused by bee stings. Of these, 129(64%) were male, and 72(36%) were female with the Mean±SD age of 34.33±32 and 35.25±34 years, respectively. Anaphylaxis incidents occurred in 108 men, and 103 women out of 100000; 169 of whom were adults and 46 were children. Anaphylaxis occurred in 105(52.2%) cases in

Background: Bee stings can lead to mild to severe allergic reaction . Serious complications of bee stings include hypersensitivity to the venom, which can develop after a single sting, and acute renal failure which has been reported mostly secondary of intravascular hemolysis developing after multiple bee stings. We report here a child who developed multiorgan system involvement. Case presentation: A-3 years-old-girl was admitted to Kariadi Hospital with multiple bee stings and referred due to acute kidney injury stage failure by local hospital. Clinical finding were anasarca edema, gastrointestinal bleeding, oliguria (0.8ml/kgBW/hours), stage II hypertension (124/99mmHg), flaccid paraparesis inferior. Laboratory finding were hypoalbuminemia (2.4g/dL), anemia (6g/dl), leukocytosis (35.800/mm3), electrolyte imbalance (hypocalsemia:1.66mg/dL) and estimated glomerular filtration rate (eGFR) 8.09 ml/min/1.73m2. Chest-X ray showed pulmonary edema and duplex pleural effusion. The renal function recovered with supportive management including four sessions of haemodialysis. Patient discharged from the hospital on the nineteenth day. Conclusions: Multiple bee stings can lead multiorgan system involvement Keyword: Bee sting, acute kidney injury, hemodialisys

Patient: Male, 24 Final Diagnosis: Bee sting conjunctival injury Symptoms: Eye pain • red eye Medication: — Clinical Procedure: Ablation of the bee sting Specialty: Ophthalmology Objective: Unusual clinical course Background: Ocular bee stings have been rarely described in the literature, and their management is controversial. A case of conjunctival bee sting with retention of the stinger for 48 hours is presented with a review of the literature on the complications and management of ocular bee sting injury. Case Report: A 22-year-old beekeeper presented to the Emergency Department with mild symptoms from a conjunctival bee sting that he had received 48 hours previously. The stinger was removed in the Emergency Department, and topical antibiotic and anti-inflammatory treatment with corticosteroid were given. There were no complications in this case. However, review of the literature has shown that although the outcome from ocular bee stings can be mild, as in this case, ocular bee stings can result in severe visual symptoms that require amniotic membrane transplant (AMT). Management commonly includes removal of the stinger and both topical and systemic treatment with corticosteroids. The main complications include cataracts, inflammation of the anterior chamber, optic neuropathies, and changes in ocular pressure. Conclusions: Ocular bee stings have been rarely described in the literature, and the management remains controversial. As this case has shown, removal of the stinger and the use of topical treatment with antibiotics and corticosteroids can prevent potentially serious complications that may affect vision. Early and regular follow-up with ocular imaging may be required when symptoms persist.

Background and purpose: Apitherapists promote the medical use of products from the beehive (bee venom, propolis, pollen, honey, royal jelly, dead bees, apilarnil, wax, wax moths), the use of beehive air or therapeutic sleep on a beehive. However, little is known about how far such treatment options are perceived as acceptable by patients. Methods Patients visiting either a family doctor in Kehl or a gynecologist in Weilburg (both in Germany) were asked to rate their knowledge of apitherapy as well as their readiness to use apitherapeutic measures. Results Honey and propolis represent the best-known bee products whereas beehive air and apilarnil are greatly unknown to the patients. Only honey seems to be an acceptable treatment option whereas propolis, pollen and royal jelly seem to be less acceptable. Bee venom was not considered an interesting treatment possibility and, in particular, live bee stings were considered less desirable. This study found that gender and acquaintance with a beekeeper influenced the patients’ ratings but age, education and current medical condition did not. Conclusion Live bee stings, apilarnil or the inhalation of beehive air are not appealing to the majority of patients. Before apitherapeutic methods are promoted, it seems to be important to know about patients’ willingness to tolerate such treatments. Perhaps therapy modifications can be offered which seem more acceptable.

Introduction Hymenoptera venom allergy (HVA) in some patients occurs with general symptoms involving respiratory and cardiovascular system with anaphylactic shock with constitutes a significant threat to life. Aim Assessment of the prevalence of HVA in our own material. Material and methods There were 498 patients after a general reaction to wasp and/or bee venom. The survey included questions: the type of stinging insect, body parts stung by insects, profession, frequency of stings by wasps and bees depending on professional activity, places of stings, clinical symptoms using the scale according to Muller, and the treatment following the sting. Among 498 patients, there were 281 women and 217 men. Results Wasp stings were more frequent and affected 382 (77%) persons, while bee stings affected 116 (23%) persons. Limbs constituted the most common area of the body stung by both wasps and bees. The sting was more frequent in rural areas and during summer rest. A severe systemic reaction (class III and IV according to Muller) occurred more often in people stung by bees. The most common medications included intravenous glucocorticosteroids, calcium preparations and antihistamines. Intramuscular Adrenaline injection was used in 48% of patients, while only 15% received its prescription as an emergency medication. Bee stings were the most common cause of severe systemic symptoms. Conclusions The treatment after the sting in a significant percentage of episodes still deviates from the recommendations of the guidelines, especially in the field of adrenaline recommendations for patients in case of a resting by an insect.

Wasp and bee stings are common in Sri Lanka, and systemic envenomation causes a spectrum of clinical manifestations that includes simple local allergic reaction to life-threatening multiple organ injury or failure. However, wasp toxin-induced acute myocardial infarction is very rare in the literature. Here, we describe a pregnant lady with mass wasp stings who developed toxin-induced acute myocardial infarction with multiorgan injury. The treating physician should anticipate the complications of massive envenomation following multiple wasp stings.

A 1.5-year-old male castrated dog was presented in anaphylactic shock after suffering an apparent bee sting. Immunotherapy with bee venom was initiated based upon history, skin testing and serological testing for allergen-specific immunoglobulin (Ig)E. The dog was maintained on venom immunotherapy for five years and showed no signs of adverse effects from therapy or from repeated bee stings.

Patient: Male, 60-year-old Final Diagnosis: Gas gangrene Symptoms: Pain Medication: — Clinical Procedure: Fasciotomy • surgical debridement Specialty: Critical Care Medicine • Infectious Diseases Objective: Rare disease Background: Clostridial myonecrosis, also known as gas gangrene, is a highly lethal necrotizing soft tissue infection. While commonly associated with trauma, clostridial myonecrosis may be the result of parenteral injection of medications. Epinephrine is the most commonly reported medication leading to gas gangrene. Case Report: A 60-year-old man presented to the Emergency Department (ED) with “the worst pain in his life” to the right thigh near the site at which he auto-injected epinephrine after multiple bee stings 10–11 h prior to arrival. Initial heart rate was 112 beats/min but all other vital signs were unremarkable at presentation. Due to extreme pain, a computed tomography (CT) scan was ordered, revealing prominent gas within the anterior compartment of the right thigh, mostly involving the vastus lateralis and rectus femoris, suggesting necrotizing fasciitis. Antimicrobials were initiated immediately and the patient was taken for surgical debridement within 70 min after obtaining the CT results. Clostridium perfringens was cultured from the patient’s tissue. After several surgical debridement’s, appropriate antimicrobial therapy, supportive care, and wound care, the patient’s limb remained intact and he was discharged after 11 days. Conclusions: With millions of epinephrine auto-injectors prescribed yearly in the United States, awareness of clostridial gas gangrene following epinephrine auto-injection for the provider may help guide decision-making in patients presenting with extreme pain, redness, or swelling near the injection site after epinephrine injection.

A 51-year-old female patient was admitted to our hospital for medical evaluation and treatment of a syncopal episode following multiple bee stings. The syncopal episode was attributed to an allergic reaction and the patient was treated with intravenous hydration and anti-histamines. Twenty-four hours later, the patient manifested an acute coronary syndrome with chest discomfort, electrocardiographic disorders, and myocardial enzyme motility (including troponin). Coronary angiography was performed without revealing pathological findings and she was diagnosed with Kounis syndrome type I. The management of the patient included administration of single antiplatelet therapy combined with a calcium channel blocker (CCB). The patient follow-up was uncomplicated. In patients with Kounis syndrome type I undergoing a normal coronary angiography, in the absence of specific guidelines, single antiplatelet therapy and CCB may be a reasonable approach.

Usually, bee sting systemic envenomation is self-limited mild allergic reaction rarely associated with systemic manifestations such as anaphylaxis, myocardial injury, encephalitis, acute kidney injury and serum sickness. Kounis syndrome also known as allergic myocardial infarction is uncommon clinical feature and reported cases are scarce in literature. Herein, we described a hypothetical case of Kounis syndrome diagnosed in a 74-year-old man initially presenting for anaphylactic reaction.

INTRODUCTION: Envenomation remains a neglected public health problem in most tropical countries. Epidemiological studies on accidents caused by venomous animals are scarce in the Northeast region of Brazil, mainly in the state of Ceará. The present study aimed to describe the epidemiological features of envenomation cases involving venomous animals in the State of Ceará, Northeastern Brazil, from 2007 to 2019. METHODS: The online Notifiable Diseases Information System was consulted for data on all envenomation cases involving venomous terrestrial animals. Data collected were evaluated for the number of accidents/year, number of accidents/zoological group, antivenom therapy, zone of occurrence, sex, age-group distribution, and deaths. RESULTS: A total of 54,980 cases were recorded, with the highest incidence being that of scorpion stings (67.2%), predominantly in women (52.4%; odds ratio=3.6; 95% confidence interval=3.5-3.8), equally affecting people aged 10-19 years and 40-59 years (21.4%), in the urban areas (odds ratio=10.3; 95% confidence interval=9.9-10.8), especially in the rainy months. Snakebites (16.7%) had an incidence of 8.1/100,000 inhabitants, but the highest case-fatality rates were observed in bee stings (1.3%) and spider bites (0.5%). Regarding therapeutic variables, a small percentage of people had access to serotherapy (5.3%). CONCLUSIONS This study highlights the accidents caused by terrestrial venomous animals as a public health problem that must be monitored in Ceará. Thus, our findings suggest that preventive actions against scorpion and bee stings should be intensified during the months of higher incidence to improve public policies for patient care.

Bee sting envenomation results in alteration of hematological parameters but in Yola, information regarding effect of bee sting envenomation on hematological parameters of children is not well documented. This study therefore aims to examine the effect of bee sting envenomation on children in Yola. 133 subjects participated in this study, comprising of 64(female = 21, male = 43) children with mean age of 48±3.8months having bee sting envenomation and 69(female = 31, male 38) apparently healthy children without bee stings with mean age of 47±6.1months. Hematological parameters of all subjects were determined using Sysmex XN550 hematology analyzer. Mean red cell count of subject was 4.39±0.3 X106/µl while red cell count of control group was 4.31±0.3 X106/µl at P3/µl and 8.9±1.6 X103/µl respectively and neutrophil counts of children with bee sting envenomation was 23.9±2.7 X103/µl while neutrophil count of control group was 3.5±2.9 X103/µl. Neutrophil count and total white cell count showed a significant value increase while P-LCR and MPV had a lower value in subject when compare to the control group in this locality.&nbsp

A survey on 5115 beekeepers and 121 patients treated with bee venom by an apitherapy clinic in the Hubei province, the epicenter of COVID-19 in China, reported that none of the beekeepers developed symptoms associated with COVID-19, the new and devastating pandemic. The hypothesis that immunity to bee venom could have a preventive effect was expressed and the authors of the Chinese survey suggested that the next step should be animal experiments on monkeys. We believed that before starting such studies, a second independent survey should verify the findings and define the hypothesis more clearly. Thus we asked all German beekeepers to complete an assessment form which would summarize their experiences with COVID-19. In contrast to the Chinese study we found that two beekeepers had died from a SARS-CoV-2 infection and forty-five were affected. The reaction to bee stings (none; mild swelling; severe swelling) correlated with the perceived severity of the SARS-CoV-2-infection-associated symptoms - exhaustion and sore throat. Beekeepers comorbidity correlated with problems with breathing at rest, fever, and diarrhea. Our results did not confirm the findings of the Chinese study. However, since the antiviral effects of bee venom have been found in several studies, we cannot exclude that there could be a direct preventive or alleviating effect when bee venom is administered during the infection., Highlights • Among German beekeepers, we found two coronavirus-associated deaths and 45 cases of coronavirus infection. • Previous exposure to bee venom does not seem to reduce susceptibility to SARS-CoV-2. • Reaction to bee stings correlates with the perceived severity of the SARS-CoV-2 symptoms: exhaustion and sore throat.

Envenoming syndrome is an uncommon condition associated with significant morbidity and mortality following multiple Hymenoptera stings. We review the case of a 90-year-old male who presented after receiving greater than 100 bee stings and was found to have rhabdomyolysis with concomitant acute kidney injury. Physicians should consider envenoming syndrome in all patients presenting with greater than 50 bee stings, despite hemodynamically stability upon initial presentation.

Background: Thrombotic Thrombocytopenic Purpura (TTP) is a rare and life-threatening disorder characterized by severe thrombocytopenia, microangiopathic hemolytic anemia, fever, renal dysfunction, and neurological deficient. TTP leads to the formation of blood clots in small blood vessels throughout the body. TTP is associated with many risk factors such as pregnancy, HIV, cancer, lupus, and infections. Recently there have been few published case reports of bee sting associated TTP.Methods: A 67-year-old man from a rural area of the Southwest Province of Iran, Ilam, was referred to the academic general hospital because of fever, chills, sweating, vomiting and dizziness following the honeybee sting on his body. Results: this study showed that,multiple co-morbidities including CVD and diabetes, along with coagulation abnormalities after honeybee stings, seriously exacerbated patient hemodynamic status.Conclusion: TTP, as a major complication due to the toxic reaction of a large number of bee stings with underlying diseases in patients, should be given more attention.

Bee venom has been used to treat many diseases because of its anti-inflammatory and analgesic effects. However, the secretions of bee venom can also cause life-threatening adverse reactions. The objective of this paper was to review the clinical effectiveness of bee venom and adverse events induced by bee venom, regardless of the disease. Four electronic databases were searched in April 2020. The reference lists of the retrieved articles and previous review articles were also hand-searched. Randomized controlled trials (RCTs) using any type of bee venom other than live bee stings for the clinical treatment of any disease other than cancer were included. The studies were selected, the data were extracted, and the quality of the studies was assessed by two authors. Risk of bias was assessed using the Cochrane risk of bias standards. Twelve RCTs were included in this review—three on Parkinson’s disease, four on arthralgia, four on musculoskeletal disorders, and one on polycystic ovary syndrome. The types of bee venom used were acupuncture injections, ultrasound gel, and an ointment. Six studies reported adverse events, and skin reactions such as pruritus and swelling were the most common. The large-scale clinical trials of bee venom therapy are needed to verify the statistical difference, and the reporting system for adverse events is also required to increase the safety of bee venom therapy.

To study the epidemiology and outcome of acute kidney injury (AKI) caused by venomous animals.A retrospective study of patients admitted at Indira Gandhi Medical College Hospital, Shimla, with AKI due to venomous animals over a period of 15 years (January 2003-December 2017). Medical records were evaluated for patient information on demographic factors, clinical characteristics, complications, and outcome. Outcomes of requirement for intensive care unit (ICU) support, treatment with dialysis, survival, and mortality were analyzed. The survival and non-survival groups were compared to see the difference in the demographic factors, laboratory results, clinical characteristics, and complications.One hundred and eighty-one patients were diagnosed with AKI caused by venomous creatures. Mean age was 44 ± 15.4 years, and the majority (54.1%) was women. Snakebite (77.9%) and wasp stings (19.9%) were the leading causes of AKI. Clinical details were available in 148 patients. The median duration of arrival at hospital was two days. 81.8% had oliguria, and 54.7% had a history of hematuria or having passed red or brown colored urine. The hematological and biochemical laboratory abnormalities were as follows: anemia (75%), leukocytosis (75.7%), hyperkalemia (35.8%), severe metabolic acidosis (46.6%), hepatic dysfunction (54.7%), hemolysis (85.8%), and rhabdomyolysis (65.5%). Main complications were as follows: gastrointestinal bleed (9.5%), seizure/encephalopathy (10.8%), and pneumonia/acute respiratory distress syndrome (ARDS) (11.5%). 82.3% of the patients required dialysis. 154 (85.1%) patient survived, and 27 (14.9%) patients died. As compared to the survival group, the white blood cell count, serum bilirubin, aspartate aminotransferase, alanine aminotransferase, creatine kinase, and lactate dehydrogenase were significantly higher, and serum albumin levels were significantly lower in patients who died. The proportion of patients with leukocytosis, hyperkalemia, metabolic acidosis, pneumonia/ARDS, seizure/encephalopathy, need for ICU support, and dialysis was significantly higher in patients who died.Snakebite and multiple Hymenoptera stings (bees and wasps) were the leading causes of AKI due to venomous animals. AKI was severe, a high proportion required dialysis, and the mortality was high.

Allergic angina and allergic myocardial infarction (MI) are renowned as Kounis syndrome (KS) [1]. KS was initially described by Kounis and Zavras in 1991 [2-4]...

To compare the outcomes of ocular injuries of hornets and paper wasps’ stings. Retrospective case series. Patients diagnosed with ocular injuries sustained by bee stings at Miyata Eye Hospital (Miyazaki, Japan) between August 2000 and July 2016 were enrolled. Retrospective data regarding type of bee, visual acuity, and treatment were collected from medical records. Outcomes of the hornet and wasp groups were compared. Five eyes of 5 patients (3 men, 2 women; mean age 44.6±21.2 years [range 9–62 years]) were enrolled. The mean follow-up period was 50.6 ± 57.6 months (range 4 days to 121 months). The causative bee was hornet in 3 cases and wasp in 2. The anterior chamber was irrigated in 2 patients, both from the hornet group. The best-corrected visual acuity at the final visit was no light perception, light perception, and (0.02) in the hornet group, (1.5) and (1.2) in the wasp group. The hornet group exhibited significantly worse prognosis than the wasp group. Identifying the type of bee is important in establishing prognosis.

Minor infections, allergies, insect bites, and bee stings are commonly reported causes of nephrotic syndrome (NS). Herein, we report, to the best of our knowledge, the first case of NS relapse due to Kawasaki disease (KD). An 8-year-old boy presented with high fever of 4-day duration. He had developed steroid-dependent NS at the age of 4 years and remained in remission after steroid and mizonbin therapy. Renal biopsy, performed at the age of four, showed minimal change (MC) disease. Upon examination, the patient fulfilled 5 of 6 criteria for KD under the Japanese diagnostic guidelines, with positive proteinuria. He was diagnosed with NS relapse caused by KD. Proteinuria resolved after treatment with intravenous immunoglobulin and cyclosporine A. We present the case of an 8-year-old boy, whose NS relapsed due to KD. To the best of our knowledge, this is the first case report. It is necessary to recognize that KD can trigger relapse of MCNS.

Allergic reactions from insect bites are mostly observed with bee stings. Bee sting reactions can be classified into 3 main headings: local, systemic, and rare reactions. Vascular thrombosis is considered both in rare and systemic reactions. The wild bee venom induces the secretion of many inflammatory mediators, including histamine, phospholipase A1, and thromboxane, leading to vasoconstriction and thrombosis. Inflammatory cytokines also cause endothelial injury and deterioration of the microcirculation. In the literature, rare reactions have been reported including various central and arterial vascular pathologies such as aortic thrombosis, cerebral infarction, and myocardial infarction; however, there is rare publication concerning peripheral deep vein thrombosis (DVT). Although DVT produces good results with effective and rapid treatment, it can be fatal because of causes such as pulmonary embolism in the absence of timely intervention. Herein, for the first time in the literature, we present a pediatric case of peripheral DVT after a wild bee sting.

Introduction: Camping and hiking are popular worldwide recreational activities. All age groups, elderly or young, immunocompetent or immunosupressive people may engage in these activities. During these activities, individuals may get injured or be exposed to pathogens. There is also a strong possibility of experiencing mosquito, lice, or tick bites, bee stings, or being bitten by scorpions, snakes, rodents, wild or feral animals. This study reviewed the current literature regarding tick-borne infections encountered during recreational activities.Methods: PubMed and the Web of Science databases were searched for the keywords “campers,” “hikers,” and “tick borne infections.” Major reviews, research papers, and case series on campers and hikers were reviewed, and current articles for tick-borne infections were selected and summarized.Results: People who engage in recreational activities are potentially at risk for infection from environmental sources. A group of important vector-borne diseases is tick-borne infections, the major agents of which are Babesia spp., Borrelia spp., Rickettsia spp., Ehrlichia spp., Francisella tularensis, Coxiella burnetii, Crimen-Congo Hemorrhagic Fever (CCHF), and Tick-Borne Encephalitis (TBE) viruses. These infections have a widespread geographical distribution.Conclusion: Participating in outdoor recreational activities is increasing all over the world. While partaking in these activities, humans are frequently exposed to ticks and are potentially at risk for infection. To prevent infection, public and medical awareness is necessary.

Introduction: We are reporting a deadly case of massive bee stings observed in a 7-year-old child in Ouagadougou. Observation: The first symptoms, which appeared two hours after the stings of about 200 bees, motivated a consultation in a nearby dispensary in which the child received intravenous betamethasone before being referred to the University Hospital Center Yalgado Ouedraogo (CHUYO). Seven hours after the accident, a rapid deterioration in the general condition was noted with hemorrhage, respiratory distress, coma, and shock. A grade 3 anaphylaxis was diagnosed. The patient didn’t survive despite of the cardiopulmonary resuscitation using adrenaline in intensive care. Conclusion: The massive bee stings have caused a severe biphasic anaphylactic reaction which could not be reversed by the adrenaline administered in the second phase. The development of a protocol would contribute to a better management of the cases.

Wasps and bees are insects that belong to the order Hymenoptera. Hymenopteran sting can lead to renal failure, secondary to acute tubular necrosis. Acute tubulo interstitial nephritis is an uncommon, perhaps underdiagnosed clinical manifestation resulting from delayed hypersensitivity reaction to the venom. The first patient, an elderly woman, sustained a single Indian wasp sting ( Vespa affinis ) on the left index finger. She noticed mild redness, swelling and pain over the finger. The patient herself removed the sting, and an indigenous remedy (turmeric paste) was applied to the area. There was no history of administration of any oral or parenteral medications following the sting. The patient had no previous comorbidities and was not on any other long-term medications. There was no previous history of stings as well. Five days later, the patient started noticing pedal oedema which gradually increased over a few days. Along with oedema, she also noticed a gradual reduction in the urine output. The patient was referred to our hospital on the 10th day after sustaining the sting. On admission, there was bilateral pedal oedema; no pallor, icterus, bleeding manifestations or rashes. Her blood pressure was 190/80 mm Hg, and the systemic examination was unremarkable. The blood urea nitrogen was 31.7 mmol/L, and creatinine was 1225.6 μmol/L. Abdominal imaging showed normal-sized kidneys.The other laboratory parameters are given in table 1. View this table: Table 1 Laboratory parameters The patient was initiated on haemodialysis. A kidney biopsy was performed on the sixth day after admission. Kidney biopsy showed 14 glomeruli of which 7 were normal and 7 were sclerosed. Interstitium was edematous and widened with infiltration of dense inflammatory cells comprising lymphocytes, plasma cells and plenty of eosinophils (figure 1, arrows 1A-1D). There was no tubulitis or granuloma formation. Few eosinophil and occasional neutrophil cast were present in the tubules. The tubular epithelium appeared flattened and denuded. Blood vessels showed medial …

Ocular bee stings are known to cause corneal melts, corneal infiltrates, cataracts, and secondary glaucoma. Our patient presented with scleritis, corneal infiltrates, and endophthalmitis after a ocular bee sting. Topical treatment led to resolution of anterior segment inflammation, but the scleritis and vitreous inflammation worsened. Vitrectomy with intravitreal antibiotics was done and scrapings from the scleral abscess showed growth of Aspergillus fumigatus on culture. Repeat vitrectomy with silicone oil was needed for retinal detachment. Oral and intravitreal antifungals led to resolution of inflammation with attached retina. This is the first reported case of bee sting-induced fungal endophthalmitis with scleritis.

Bee stings are a rare form of ocular trauma with the ocular sequelae attributable to the mechanical effects of the stinger as well as the inflammatory and neurotoxic effects of the venom. This research reports on a case of a retained corneal bee stinger and the technique used for removal of the stinger. This case report is of a patient that presented with a retained corneal bee stinger to St John Eye Hospital, Soweto. A 45-year-old male presented with a retained bee sting in the anterior chamber angle of the eye. A combination ab-externo technique was used to remove the sting. We present the case of a honey bee sting to the cornea that was removed using an ab-externo technique to maintain globe integrity and preserve vision.

The agricultural sector suffers from high risk of injury and damage to human health. There is considerable research not only identifying these risks but also finding ways to mitigate them. Beekeeping or apiculture, recognised as part of this sector, has many risk factors such as heavy lifting, high degree of manual materials handling, twisting, and awkward positioning common to all agriculture areas. It also has some unique risks such as those resulting from bee stings and smokers. However, there is much less attention focused on the health and safety of apiculture to the human beekeepers, and much more attention focused on bee health and safety. An ergonomics case study on beekeeping inspection tasks involving three independent, local beekeepers showed that many tasks involve awkward positions of the body, arms and hands, excessive lifting well beyond recommended weight limits, eye strain, and chemical and sting exposure. In addition, beekeepers are more interested in bee and hive health rather than reducing human-centred risk factors such as those due to excessive lifting. Standard ergonomics interventions such as a magnifier inspection and lift assist systems as well as interventions unique to beekeeping such as a smokeless method of calming bees are recommended. The beekeeping industry seems to have been forgotten in the modernisation of technology and agricultural practices. This paper offers some initial insights into possible points for research, development and improvements.

International audience; Apitherapy is an alternate therapy that relies on the usage of honeybee products, most importantly bee venom for the treatment of many human diseases. The venom can be introduced into the human body by manual injection or by direct bee stings. Bee venom contains several active molecules such as peptides and enzymes that have advantageous potential in treating inflammation and central nervous system diseases, such as Parkinson's disease, Alzheimer's disease, and amyotrophic lateral sclerosis. Moreover, bee venom has shown promising benefits against different types of cancer as well as anti-viral activity, even against the challenging human immunodeficiency virus (HIV). Many studies described biological activities of bee venom components and launched preclinical trials to improve the potential use of apitoxin and its constituents as the next generation of drugs. The aim of this review is to summarize the main compounds of bee venom, their primary biological properties, mechanisms of action, and their therapeutic values in alternative therapy strategies.

Kounis syndrome (KS) refers to acute coronary syndrome secondary to a hypersensitivity reaction as a result of exposure to various allergens. Multiple bee stings as a cause of KS is rarely reported in the literature. Its diagnosis in allergic reactions is of utmost importance, as it leads to an entirely different line of management. We report a series of six cases who presented with the diagnosis of KS due to multiple bee stings.

Although bee stings can cause local reactions, neurovascular complications are rare. The venom toxins of honeybee cause anaphylactic allergic reactions and both cerebral infarction and hemorrhage. Diverse pathophysiological mechanisms have been postulated for the occurrence of these strokes. A 50-year-old man developed a focal neurologic deficit 6 h after a bee sting, which was confirmed to be acute cerebral infarction on magnetic resonance imaging scan.

Multiple bee stings commonly cause allergic and anaphylactic reactions, but it can also cause serious complications such as intravascular hemolysis, rhabdomyolysis, acute kidney injury (AKI), and even death. Mortality related to AKI following multiple bee stings can be as high as 25%. Hence, patients should be monitored for rhabdomyolysis and AKI during the first few days following the stings. We report the case of a 3-year-old boy who developed AKI due to rhabdomyolysis following multiple bee stings. He required pediatric intensive care support including mechanical ventilation and renal replacement therapy in the form of multiple sessions of hemodialysis. His renal function improved gradually. He was discharged after 3 weeks with normal renal function and he remained well on 6 months follow up. The treatment of multiple bee stings should be considered as a medical emergency, and these cases should be admitted in a pediatric intensive care unit and monitored for at least 48 h for the occurrence of rhabdomyolysis, myoglobinuria, and AKI.

Wasp and bee stings are common among the rural population of Sri Lanka. It is known to cause local reaction and rarely anaphylaxis. Bee sting associated rhabdomyolysis leading to acute kidney injury (AKI) is a rare complication and was not reported from Northern Sri Lanka. This case report illustrates a patient who developed rhabdomyolysis following multiple bee stings and made a complete clinical recovery with prompt and optimal supportive care.