Toxic systemic reaction after bee stings in a bitch

Background: Bee sting poisonings are common in dogs, and toxic systemic presentation may represent a life-threatening condition. Apis mellifera venom is a complex mixture of melitin, apamine, phospholipase, hyaluronidase and degranulating peptides, that causes local injury at the site of inoculation and multiple organ complications, including hemolysis, kidney injury, muscular damage, cardiovascular and respiratory complications. The present work reports a complete and detailed description of a dog's systemic toxic reaction to bee stings, including history, clinical signs, laboratory findings, emergency care and development, as well as possible association with later immunomediated arthritis. Case: A 6-year-old female German Shepperd suffered multiple bee stings. First care was conducted by a veterinary at the site, where he only received promethazine, meloxicam and dexamethasone. After 24 h and significant progression of symptoms, the animal was forwarded to a specialized veterinary hospital. The patient was evaluated throughout 9 days, and presented intense edema, respiratory distress, tongue necrosis and grade II of acute kidney injury. Extensive laboratory exams were conducted throughout the hospitalization. Main laboratory findings included polycythemia, leukocytosis by neutrophilia and monocytosis, thrombocytopenia and azotemia. Urinalysis evidenced turbid aspect, dark yellow color and intense proteinuria, reinforcing kidney damage. Abdominal ultrasound examination identified blood clots in the bladder, and liver with reduced echogenicity and echotexture, suggesting acute inflammation. Therapy aimed to stabilize the patient, control kidney damage and avoid anaphylaxis. Treatment included intensive care support, promethazine, hydrocortisone, dexamethasone, dipyrone, methadone, metronidazole, ampicillin, clindamycin and tramadol. Following successful treatment, the animal presented immunomediated polyarthritis, possibly associated to both the poisoning and later diagnosed hemoparasitosis (both Erlichia and Babesia). Discussion: Massive bee attacks can cause severe complications, however, data regarding emergency care records are scarce. Based on clinical signs and laboratory findings, the patient presented toxic systemic reaction, including grade II of acute kidney injury and significant cardiorespiratory distress. Another important complication was tongue necrosis, that demanded attention and special supportive care, including feeding tube and specific feed. Treatment also focused in reducing edema and control possible anaphylaxis, providing analgesia and antibiotic therapy. Laboratory findings have been previously described, with evidence of immune-mediated reaction. Follow-up consultations revealed normal parameters, and an unusual presentation of claudication. Investigation concluded that polyarthritis could be responsible for such finding and may be a result of the deposition of immunomediated complexes in the joints, due in this case to the bee poisoning and later positive diagnosis for both Erlichia and Babesia. Systemic reactions to bee stings are complex, and full clinical and laboratory profile aid in both the prognosis and treatment options. Special attention must be given to tongue damage and supportive care is essential for maintaining feeding conditions. Arthritis should be considered as possible complication, reinforcing the importance of follow-up consultations.

Massive attack by honeybees in a German shepherd dog: description of a fatal case and review of the literature

In the present study, a fatal case caused by honeybee (Apis cerana) stings was documented in a female German shepherd dog that was presented at the Veterinary Teaching Hospital, University of Agriculture Faisalabad, Pakistan. Characteristic clinical signs included hematuria, hematemesis, incoordination and convulsions along with evidence of massive honeybee attack supported the diagnosis of envenomation. The dog was treated with dexamethasone and diphenhydramine, but it did not respond to therapy and died. This outcome could be avoided if we had a bee antivenom available for treating envenomated patients.(AU)

Massive attack by honeybees in a German shepherd dog: description of a fatal case and review of the literature

In the present study, a fatal case caused by honeybee (Apis cerana) stings was documented in a female German shepherd dog that was presented at the Veterinary Teaching Hospital, University of Agriculture Faisalabad, Pakistan. Characteristic clinical signs included hematuria, hematemesis, incoordination and convulsions along with evidence of massive honeybee attack supported the diagnosis of envenomation. The dog was treated with dexamethasone and diphenhydramine, but it did not respond to therapy and died. This outcome could be avoided if we had a bee antivenom available for treating envenomated patients.(AU)

Massive attack by honeybees in a German shepherd dog: description of a fatal case and review of the literature

In the present study, a fatal case caused by honeybee (Apis cerana) stings was documented in a female German shepherd dog that was presented at the Veterinary Teaching Hospital, University of Agriculture Faisalabad, Pakistan. Characteristic clinical signs included hematuria, hematemesis, incoordination and convulsions along with evidence of massive honeybee attack supported the diagnosis of envenomation. The dog was treated with dexamethasone and diphenhydramine, but it did not respond to therapy and died. This outcome could be avoided if we had a bee antivenom available for treating envenomated patients.

Reação tóxica sistêmica causada por picadas de abelhas em cães / Systemic toxic reaction due bee stings in dogs

Background: Toxic reactions due bee stings in human, companion animals, food animals and wild animals are sporadically reported. Accidents involving bees have been occurring in urban and rural areas since 1956, when African bees were introduced in Brazil, forming populations of aggressive hybrid Africanized bees. Their sting cause local and systemic reactions, which include dermatologic reactions, anaphylactic reactions and toxic systemic reactions before death. The aim of this article is to describe the clinical and pathological aspects of the toxic systemic reactions of two dogs that suffered a massive bee attack in the Federal District, Brazil.Cases: A 8-year-old female Brazilian mastiff, and one female 6-year-old Belgian shepherd were locked in the kennel when they suffered a massive bee attack. The dogs presented ‘apathy, congested mucous membranes, dyspnea, epistaxis, hemoglobinuria, icterus (one of them) and convulsions. Clinical pathology results showed a strong hemolyzed plasma, azotemia, leukocytosis with neutrophilia and monocytosis. Both animals were euthanized due to their critical conditions. At necropsy the dogs showed severe subcutaneous edema in the face, moderate congestion of mucous membranes, hematochezia and hematuria. Both dogs presented kidneys dark brown to blackened colored, urinary bladder replete with dark red fluid, lungs severely congested, intestines with severe mural edema and hyperemia containing bloody fecal matter inside, and the liver of one of the dog moderately icteric. The main histologic findings were the moderate diffuse degeneration of the kidney tubular epithelium with small focal areas of necrosis, countless casts of hemoglobin, granular and hyaline casts inside the renal tubules.[...]

Reação tóxica sistêmica causada por picadas de abelhas em cães / Systemic toxic reaction due bee stings in dogs

Background: Toxic reactions due bee stings in human, companion animals, food animals and wild animals are sporadically reported. Accidents involving bees have been occurring in urban and rural areas since 1956, when African bees were introduced in Brazil, forming populations of aggressive hybrid Africanized bees. Their sting cause local and systemic reactions, which include dermatologic reactions, anaphylactic reactions and toxic systemic reactions before death. The aim of this article is to describe the clinical and pathological aspects of the toxic systemic reactions of two dogs that suffered a massive bee attack in the Federal District, Brazil.Cases: A 8-year-old female Brazilian mastiff, and one female 6-year-old Belgian shepherd were locked in the kennel when they suffered a massive bee attack. The dogs presented ‘apathy, congested mucous membranes, dyspnea, epistaxis, hemoglobinuria, icterus (one of them) and convulsions. Clinical pathology results showed a strong hemolyzed plasma, azotemia, leukocytosis with neutrophilia and monocytosis. Both animals were euthanized due to their critical conditions. At necropsy the dogs showed severe subcutaneous edema in the face, moderate congestion of mucous membranes, hematochezia and hematuria. Both dogs presented kidneys dark brown to blackened colored, urinary bladder replete with dark red fluid, lungs severely congested, intestines with severe mural edema and hyperemia containing bloody fecal matter inside, and the liver of one of the dog moderately icteric. The main histologic findings were the moderate diffuse degeneration of the kidney tubular epithelium with small focal areas of necrosis, countless casts of hemoglobin, granular and hyaline casts inside the renal tubules.[...](AU)

Vasoconstrictor effect of Africanized honeybee (Apis mellifera L. ) venom on rat aorta

Background : Apis mellifera stings are a problem for public health worldwide, particularly in Latin America due to the aggressiveness of its Africanized honeybees. Massive poisoning by A. mellifera venom (AmV) affects mainly the cardiovascular system, and several works have described its actions on heart muscle. Nevertheless, no work on the pharmacological action mechanisms of the AmV in isolated aorta has been reported. Thus, the present work aimed to investigate the actions of AmV and its main fractions, phospholipase A2 (PLA2) and melittin, on isolated aorta rings and a probable action mechanism. Results : AmV and the complex PLA2 + melittin (0.1-50 μg/mL) caused contraction in endothelium-containing aorta rings, but neither isolated PLA2 nor melittin were able to reproduce the effect. Endothelium removal did not change the maximum vasoconstrictor effect elicited by AmV. Ca2+-free medium, as well as treatment with phentolamine (5 μM), verapamil (10 μM), losartan (100 μM), and U-73122 (10 μM, a phospholipase C inhibitor), eliminated the AmV-induced contractile effects. Conclusions : In conclusion, AmV caused contractile effect in aorta rings probably through the involvement of voltage-operated calcium channels, AT1 and α-adrenergic receptors via the downstream activation of phospholipase C. The protein complex, PLA2 + melittin, was also able to induce vasoconstriction, whereas the isolated proteins were not.(AU)

Odynophagia following retained bee stinger

Nearly half of Hymenoptera stings affect the head and neck region of victims, but reports on oropharyngeal bee stings are very few. We describe the case of a patient with odynophagia and suffocation in mass envenomation. He had a retained bee stinger whose removal was delayed for more than 24 hours following the sting, due to persisting angioedema. Odynophagia receded after removal of the stinger and treatment with paracetamol, steroids and metronidazole. The patient also developed rhabdomyolysis, renal failure and hepatitis that were treated with conservative therapy. Oropharyngeal stings can simulate symptoms of persisting angioedema in victims of mass envenomation.(AU)

Odynophagia following retained bee stinger

Nearly half of Hymenoptera stings affect the head and neck region of victims, but reports on oropharyngeal bee stings are very few. We describe the case of a patient with odynophagia and suffocation in mass envenomation. He had a retained bee stinger whose removal was delayed for more than 24 hours following the sting, due to persisting angioedema. Odynophagia receded after removal of the stinger and treatment with paracetamol, steroids and metronidazole. The patient also developed rhabdomyolysis, renal failure and hepatitis that were treated with conservative therapy. Oropharyngeal stings can simulate symptoms of persisting angioedema in victims of mass envenomation.(AU)