Fatal acute pulmonary oedema and acute renal failure following multiple wasp/hornet (Vespa affinis) stings in Sri Lanka: two case reports

Journal of Medical Case Reports

Senanayake AM Kularatne²  Kosala Weerakoon³  Roshitha Waduge¹  Aruni Jayasekera⁴  Ajith Jayasena⁴  Thamara Kannangare⁴  Keerthi Kularatne⁴ 

[1] Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka;Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka;Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka;District General Hospital, Matale, Sri Lanka

关键词: Vespa affinis;    Sri Lanka;    Pulmonary oedema;    Acute renal failure;   

Others  :  814342
DOI  :  10.1186/1752-1947-8-188

 received in 2014-01-03, accepted in 2014-03-31,  发布年份 2014

【 摘 要 】

Introduction

Vespa affinis is a hornet widely distributed in Sri Lanka and it is responsible for the highest number of deaths related to Hymenoptera stings. Apart from the early reactions, victims often die in hospital many hours later due to complications such as myocardial infarction and multiple organ failure. Increased microvascular permeability and acute pulmonary oedema as the primary pathology is less known in hornet envenoming.

Case presentation

Here, we report clinical and postmortem findings of two Sinhalese patients, a 48-year-old husband and his 46-year-old wife, who both died following a massive attack by hornets 32 hours and 9 hours after the incidence respectively. At postmortem examination, both patients had pleural effusions, acute pulmonary oedema and red cell casts in their urine. Their coronary arteries and histology of myocardium were normal.

Conclusion

Early recognition of acute pulmonary oedema in hornet stings is needed with implementation of crucial treatments to avert deaths.

【 授权许可】

   
2014 Kularatne et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 7.

Figure 8.

【 参考文献 】

• [1]Akre RD, Reed HC: Ants, wasps and bees. In Medical and Veterinary Entomology. Edited by Garry M, Lance D. London: Academic Press; 2002:383-408.
• [2]Goulet H, Huber JT: Hymenoptera of the World: An Identification Guide to Families. Ottawa: Canada Communication Group; 1993.
• [3]Kularatne SAM, Gawarammana IB, De Silva PHJG: Severe multi-organ dysfunction following multiple wasp (Vespa affinis) stings. CMJ 2003, 48:146-147.
• [4]Pick T: Wasp kinins and kinin analogues. In Animal Toxins; Facts and Protocols. Edited by Rochat H, Martin MF. Basel: Birkhauser; 2000:100-103.
• [5]Gelder C, Harris J, Williams D: Allergy to bee and wasp venom. Br J Hosp Med 1996, 55(6):349-352.
• [6]Levine HD: Acute myocardial infarction following wasp sting. Report of two cases and critical survey of the literature. Am Heart J 1976, 91(3):365.
• [7]Maltzman JS, Lee AG, Miller NR: Optic neuropathy occurring after bee and wasp sting. Ophthalmology 2000, 107(1):193-195.
• [8]Ling Z, Yi T, Fang L, Yu-ying S, Yo C, Huan XU, Ping FU: Multiple organ dysfunction syndrome due to massive wasp stings: an autopsy case report. Chin Med J 2012, 125:2070-2072.
• [9]Pumphrey RSH, Roberts ISD: Postmortem findings after fatal anaphylactic reactions. J Clin Pathol 2000, 53:273-276.
• [10]Das RN, Mukerjee K: Asian wasp envenomation and acute renal failure: a report of two cases. Mcgill J Med 2008, 11:25-28.
• [11]Xuan BHN, Mai HL, Thi TXN, Thi MTH, Nguyen HN, Rabebour RA: Swarming hornet attacks: shock and acute kidney injury – a large case series from Vietnam. Nephrol Dial Transplant 2010, 25:1146-1150.
• [12]Gunasekara WDVN, Ratnatunga NVI, Abeygunawardana AS: Acute renal failure following multiple wasp bites. Sri Lanka J Child Health 2007, 36:67-68.
• [13]Pumphrey RS: Lessons for management of anaphylaxis from a study of fatal reactions. Clin Exp Allergy 2000, 30(8):1144-1150.