Case reports

Vespa orientalis
Multiple stings
Gosh et al. 1988: 1 case with 60 stings; 6-year-old child.
Sakhuja et al. 1988: 5 cases with multiple stings (55, 46, 22, 63, 24 stings).
Weizman et al. 1985: 1 case with 42 stings; 19-month-old child.

Vespa sp.
Single sting
Van Antwerben et al. 1988: 1 case; 12-year-old child.
Jones and Joy 1988: 1 case.

Multiple stings
Barss 1989: 3 cases (Vespa affinis or Vespa tropica).

Vespula germanica
Single sting
Van der Linden et al. 1993: 138 patients who had a history of an anaphylactic reaction to hymenoptera stings were re-exposed to a sting from the same hymenoptera species (Apis mellifera, Vespula germanica) under controlled clinical conditions.

 

Multiple stings

Bousquet et al. 1984: 1 case with 175 stings.

Signs & symptoms

Autopharmacological effects

Vespa sp.

Single sting

Autopharmacological reactions upon re-exposure (see Apoidea).

Reversible myeloradiculitis 1 week after the wasp sting (interpretation: delayed neurological hypersensitivity reaction with immunologically mediated demyelination of central and peripheral myelin) (Van Antwerpen et al. 1988).

Acute myocardial infarction within 4 h after the bite in a patient with a known wasp allergy and ischaemic heart disease (interpretation: differential diagnosis anaphylactic reaction, effect of toxins on the coronary arteries, therapeutic intervention with adrenaline) (Jones and Joy 1988).

Vespula germanica

Multiple stings

Initial immediate-type allergic symptoms (Bousquet et al. 1984).

Local effects

Vespa orientalis

Multiple stings

Local pain and swelling (Gosh et al. 1988).

 

Vespula germanica

Multiple stings

Local swelling and pain (Bousquet et al. 1984).

Haemostatic and haemolytic effects

Vespa orientalis
Multiple stings

Haemolysis associated with anuria within a few hours after multiple stings (Gosh et al. 1988); haemolysis associated with acute renal failure 5/5 (Sakhuja et al. 1988).

Vespula germanica
Multiple stings

Icterus associated with oliguria, onset 57 h after multiple stings (haemolysis) (Bousquet et al. 1984).

Muscular effects

Vespa orientalis
Multiple stings
Myalgia (Gosh et al. 1988); rhabdomyolysis associated with acute renal failure (2/5, in 3/5 this was not investigated) (Sakhuja et al. 1988).

Vespula germanica
Multiple stings
Severe myalgia associated with oliguria, onset 57 h after multiple stings (Bousquet et al. 1984).

Renal effects

Vespa orientalis/Vespula germanica
Multiple stings

Acute renal failure in the context of haemolysis and rhabdomyolysis (exclusively secondary renal failure or additional primary renal effect of the venom?) (Bousquet et al. 1984, Gosh et al. 1988).

Oliguria 5/5, onset 24–48 h after multiple stings, duration 11–22 days (Sakhuja et al. 1988).

Other signs & symptoms

Vespa orientalis
Multiple stings

Hepatomegaly, encephalopathy (interpretation: hepatic coma, see below) (Weizman et al. 1985).

Morbidity

Multiple stings
Acute renal failure, anaemia due to haemolysis (Bousquet et al. 1984, Gosh et al. 1988, Sakhuja et al. 1988).

Case fatality rate

Multiple stings
2/3 (Barss 1989), 2/5 (Sakhuja et al. 1988).

Laboratory and physical investigations

1. Haemostasis
Vespa orientalis
Multiple stings
Platelets 40,000/mm³ with no signs of disseminated intravascular coagulation (Gosh et al. 1988).
Platelets 40,000/mm³ with no signs of disseminated intravascular coagulation (2/5) (Sakhuja et al. 1988).

 

Vespula germanica
Multiple stings
Platelets 15,000/mm³ with no plasma coagulation defect (Bousquet et al. 1984).

2. Haemoglobin, haptoglobin, bilirubin
Vespa orientalis
Multiple stings
Haemoglobin 6.6 g/dl within hours (Gosh et al. 1988).

Haemoglobin 4.4–7.6 g/dl (5/5), laboratory findings of haemolysis (5/5) (Sakhuja et al. 1988).

 

Vespula germanica
Multiple stings
Laboratory findings of haemolysis (Bousquet et al. 1984).

3. Myoglobinuria, CPK, LDH
Vespa orientalis
Multiple stings
Laboratory findings of rhabdomyolysis (Gosh et al. 1988; Sakhuja et al. 1988: 2/5, in 3/5 this was not investigated).

Vespula germanica
Multiple stings
Laboratory findings of rhabdomyolysis (Bousquet et al. 1984).

4. Creatinine, serum potassium
Vespa orientalis
Multiple stings
Laboratory findings of renal failure (Gosh et al. 1988); 5/5 (Sakhuja et al. 1988).

 

Vespula germanica

Multiple stings
Laboratory findings of renal failure (Bousquet et al. 1984).

5. Renal biopsy
Vespa orientalis
Multiple stings

Histology available for 3/5: acute tubular necrosis with extensive necrosis of the tubular epithelium, regenerative foci and interstitial oedema, pigmented casts in the tubular lamina (3/5) (Sakhuja et al. 1988).

6. Liver function
Vespa orientalis
Multiple stings

Elevated serum transaminases and alkaline phosphatase 2/5 (Sakhuja et al. 1988); 1/1, in addition decreased prothrombin time, serum ammonia, arterial 248 mg% (normal range 40–60 mg%) (interpretation: hepatic coma stage C) (Weizman et al. 1985).

7. Liver biopsy
Vespa orientalis
Multiple stings

Carried out in 1 of 5 patients, who died: centrilobular necrotic foci (Sakhuja et al. 1988). Microvesicular fatty infiltration and diffuse mitochondrial changes (Weizman et al. 1985).

Treatment (symptomatic)

Vespa orientalis/Vespula germanica
Multiple stings

• Dialysis for a period of approx. 2 weeks until renal function is restored (Bousquet et al. 1984, Gosh et al. 1988). Dialysis 5/5, 2–7 times (Sakhuja et al. 1988).
• Blood transfusions (Bousquet et al. 1984, Gosh et al. 1988).