Introduction:
Wasp and bee are members of the order Hymenoptera. They are largely available in Bangladesh mainly in forest area and different field. Wasp and bee stings are associated with a variety of reactions, ranging from mild local reactions like erythema, edema and urticaria to fatal systemic complications like anaphylactic shock, rhabdomyolysis, acute kidney injury (AKI), acute myocardial infarction (AMI), acute hepatic failure and encephalitis. AKI is usually caused by intravascular hemolysis, rhabdomyolysis, shock and direct toxic effect of venom. AMI is associated with mast cell activation involving allergic or hypersensitivity reactions which may level as Kounis syndrome. The allergic reaction can be triggered by a single sting, and the greater the number of stings, the worse the prognosis. The mortality of patient who experienced AKI due to wasp sting has been reported to be as high as 25%.
Here we report a series of bee and wasp sting induced AKI with multi organ involvement , its management and in hospital outcome to disseminate the adverse effects of this common envenomation.
Methods:
This is a case series. The demographic, clinical and laboratory data , imaging findings and outcome of the cases of wasp and bee sting encountered in two tertiary care hospitals of the capital of Bangladesh from 2021 to 2024 were recorded and analyzed
Results:
Total number of cases were 4. All were male and mean age was (69.25± 2) years. Three of them had hypertension and diabetes mellitus. All were referred cases from local care and they were referred (3.5 ±2) days after insect bite (longest 7 days). Two cases were shifted on next day as they developed anuria and one had hypotension. Mean serum creatinine was 7.75±2 mg/dl (5.1-12.5mg/dl). Three cases had multiple bee sting and one case had two attacks of wasp sting five days apart and developed AKI after 2nd attack. His creatinine phosphokinase(CPK) was not done but aspartate aminotransferase (AST) was high (1046 IU/L). All other cases had biochemical evidence of rhabdomyolysis and highest CPK was 60,669 U/L. Hyponatremia was the commonest electrolyte imbalance. Three of the cases had altered liver function test. Short course of steroid was given in 3 cases. All of them required hemodialysis. Hemodialysis could be discontinued in one case but unfortunately other three cases had sudden death probably due to AMI.
Conclusions:
AKI is a serious complication of bee and wasp sting and it is severe enough to require dialysis. Acute coronary syndrome is another disastrous complication. Early referral and careful monitoring is needed as it may cause multi organ failure causing high mortality rate.
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I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.