Bee sting envenomation severe cases in Manaus, Brazilian Amazon: clinical characteristics and immune markers of case reports

Abstract

Bee venom is a natural toxin composed of several peptides. Massive envenoming causes severe local and systemic reactions. We report two cases of severe bee envenomation, of which one was fatal. We also describe clinical characteristics and immune markers. Both victims suffered from respiratory distress, renal failure, rhabdomyolysis, and shock. They required invasive mechanical ventilation, vasoactive drugs, and renal replacement therapy. Moreover, serum levels of chemokines, cytokines, and cell-free circulating nucleic acids demonstrated an intense inflammatory process. Massive envenoming produced systemic injury in the victims, with an uncontrolled inflammatory response, and a more significant chemotactic response in the fatal case.

FIGURE 1:. Clinical presentation of the patients. 1(A): Case 1 on admission; photo shows bee stings to the head. 1(B): Case 2 intubated in pediatric ICU; Patient presented tachypnea, swollen face, eyelids and lip edema, myalgia, and hardened edema in his chest.

FIGURE 2:. Follow-up of Case 2. Rhabdomyolysis is a well-known cause of acute kidney injury and renal failure. Details of laboratory tests are presented in Supplementary material: Table 2.

FIGURE 3:. Serum levels of chemokines, cytokines and cell-free nucleic acids in severe bee sting cases at hospital admission. 3(A): Case 1. 3(B): Case 2. The gray boxes represent serum levels of a control group, that consisted of 20 healthy subjects, ages ranging from 22 to 36 years (median = 27 years).