Persisting Hypolipoproteinaemia Following Multiple Wasp Stings

Background Severe allergic reactions and life-threatening multiple organ injury or failure are common after severe stings. However, reports on wasp stings complicated with continual hypolipoproteinaemia are scarce in the literature and there is no consensus for its therapeutic management. Methods This case is a 49-year-old female patient who developed severe allergic reaction and multiple organ failure after severe wasp stings and complicated with sustained hypolipoproteinaemia. Her clinical characteristics and the change of lipid levels are described. During the hospitalization, we did not perform any intervention for dyslipidemia. Results The patient’s blood lipid levels were decreased after numerous wasp stings. In particular, the HDL-C was linear over all five days(nadir, 0.21mmol/L on day 5), and the level gradually recovered to normal till day 17. At the same time, the patient occurs severe inflammatory response and multiple organ dysfunction syndrome, especially liver failure. The 3 months follow-up of the patient was remarkable with normal lipid level and she was doing well in normal daily activities. Conclusion We highlight the hypolipoproteinaemia that might occur in the patient who after severe wasp stings. This study initially confirmed that there is some correlation between abnormal blood lipid metabolism and the evolution of the condition. Whether dyslipidemia in wasp stings is associated with hemolysis and inflammatory reaction is unclear, and further investigation would be required. As far as we know, this is the first report of persisting hypolipoproteinaemia after wasp stings. The clinical research and prolonged follow-up are yet to be concluded, and large-scale clinical studies need to be performed.

Prediction of death after multiple wasp stings with a clinical prognostic model

Background We aimed to assess the utility of the poisoning severity score (PSS) as early prognostic predictors in patients with wasp stings, and to explore a reliable and simple predictive tool for short-term outcomes. Methods From January 2016 to December 2018, 363 patients with wasp stings in Suining Central Hospital were taken as research subjects. In the first 24h of hospital admission, the PSS and Chinese expert consensus on standardized diagnosis and treatment of wasp stings (CECC) were used as the criterion for severity classification, and their correlation was analyzed. The patients were divided into survival and death groups according to the state of discharge. The factors that affect outcome were analyzed by logistic regression analysis. A clinical prognostic model of death was constructed according to the risk factors, and 1000 times repeated sampling was done to include the data to verify the model internally. Results The mortality of wasp sting patients was 3.9%. There was a correlation between PSS and CECC (r=0.435, P<0.001) for severity classification. Sex, age, number of stings, and PSS were independent risk factors for death. Based on the 4 independent risk factors screened by the above regression analysis, a nomogram model was constructed to predict the risk of death in wasp sting patients. The predicted value C-index was 0.962, and the internally verified AUC was 0.962(95%C.I. 0.936-0.988, P<0.001). Conclusions PSS is helpful in the early classification of the severity of wasp stings. Sex, age, number of stings, and PSS were independent risk factors for death in wasp sting patients. The nomogram model established in this study can accurately predict the occurrence of the risk of death.

Development and internal validation of a wasp severity score to assess severity and indicate blood purification in persons with Asian wasp stings

Background In recent years, the incidence of wasp sting has increased annually in China. Organ damage and high mortality due to mass wasp envenomation remain major challenges. Timely and appropriate medical intervention can improve survival. However, there are currently no normalized tools for early assessment of severity. Methods The clinical data of wasp sting patients hospitalized from 2011 to 2019 were used as a training set. Logistic regression was used to explore major risk factors for the development of a severe case of wasp stings (SC). The Wasp Sting Severity Score (WSS) was determined considering these risk factors to identify SCs and was tested in a validation dataset that was prospectively collected in 2020. Results The data of 1131 wasp sting patients from 2011–2019 were included in the training set. Logistic regression analysis showed that tea-colored urine (TCU), number of stings, and lactate dehydrogenase (LDH) and total bilirubin (TBIL) levels were risk factors for developing a SC. The WSS was developed considering these four risk factors, and the total possible WSS was 20 points. The WSS was tested using the validation dataset, comprising the data of 153 patients, in 2020, and we found that a WSS ≥3 points was an important indication for blood purification, with a sensitivity of 71.9%, specificity of 92.6% and an area under the curve (AUC) of 0.918 (95% CI 0.873–0.962). Among patients with more than 30 stings, mortality in those who underwent plasma exchange (PE) within 24 hours after admission was significantly lower than that in those who did not receive PE treatment (14.3% vs. 46.9%, P = 0.003). However, continuous venovenous hemofiltration (CVVH) (P = 0.317) and hemoperfusion (HP) (P = 0.869) did not significantly reduce mortality. Conclusions Patients with WSS scores ≥ 3 should be considered for blood purification as early as possible in addition to routine treatment. In addition, PE is better than CVVH and HP at reducing mortality in patients suffering from severe wasp stings.

Prediction of Death After Multiple Wasp Stings with a Clinical Prognostic Model

Background: We aimed to assess the utility of the poisoning severity score (PSS) as early prognostic predictors in patients with wasp stings, and to explore a reliable and simple predictive tool for short-term outcomes.Methods: From January 2016 to December 2018, 363 patients with wasp stings in Suining Central Hospital were taken as research subjects. In the first 24h of hospital admission, the PSS and Chinese expert consensus on standardized diagnosis and treatment of wasp stings (CECC) were used as the criterion for severity classification, and their correlation was analyzed. The patients were divided into survival and death groups according to the state of discharge. The factors that affect outcome were analyzed by logistic regression analysis. A clinical prognostic model of death was constructed according to the risk factors, and 1000 times repeated sampling was done to include the data to verify the model internally.Results: The mortality of wasp sting patients was 3.9%. There was a correlation between PSS and CECC (r=0.435, P<0.001) for severity classification. Sex, age, number of stings, and PSS were independent risk factors for death. Based on the 4 independent risk factors screened by the above regression analysis, a nomogram model was constructed to predict the risk of death in wasp sting patients. The predicted value C-index was 0.962, and the internally verified AUC was 0.962(95%C.I. 0.936-0.988, P<0.001).Conclusions: PSS is helpful in the early classification of the severity of wasp stings. Sex, age, number of stings, and PSS were independent risk factors for death in wasp sting patients. The nomogram model established in this study can accurately predict the occurrence of the risk of death.

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 this with intravenous methylprednisolone and intravenous immunoglobulin. He recovered uneventfully over several days.

HYMENOPTERA TOXINS: BIOLOGICAL ACTIVITY, PHARMACEUTICAL AND THERAPEUTIC USES

The present review article explains the salient features of hornet venom toxins, their physiological, biological and pharmacological effect on animals and man. Hornets sting very fast and inflict venom, which is more dangerous than those of bees. Hornet venom contains both proteinaceous and non-proteinaceous peptides i.e. scapin, adolapin, mellitin, mastoparans and enzymes, mainly phospholipase and hyaluronidase, which show multiple biological effects i.e. cytolytic, hemotoxic, neuro-inhibitor, anticancer, anti-parasitic, immune hypersensitive, inflammatory, antimicrobial and anti-insect activities. Hornet stings are more painful to humans than typical wasp stings because hornet venom contains a large amount (5%) of acetylcholine. Hornet toxin components interact with receptors, ion channels and gated channels and affect the permeability functions of cells. Heavy envenomation shows quick pathophysiological lethal effects in man and pet. This article emphasizes the use of various hornet venom components for the production of disease-modifying anti-rheumatic and analgesic, anticancer drugs and insecticides. Hornet venom allergens could be used to prepare the rational design of component-resolved diagnosis of allergy and venom immunotherapy of inflicting patients.

Acute kidney injury due to multiple wasp stings: a case report

The skin is the most commonly affected organ. Wasp venom causes both local and systemic reactions, but acute kidney injury (AKI) is the most serious complication, with a 20% mortality rate. Acute kidney injury can occur from single or multiple stings. Diagnosis depends on history, clinical findings, and investigations. Treatment protocol is same as other causes of AKI, including dialysis, and prognosis is good with early treatment.