Q J Med 1994; 87: 269-282
© 1994 Association of Physicians
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Severe and fatal mass attacks by ‘killer’ bees (Africanized honey bees—Apis mellifera scutellata) in Brazil: clinicopathological studies with measurement of serum venom concentrations
1Hospital Vital Brazil, Instituto Butantan São Paulo 2Hospital das Clmicas, University of São Paulo 3Hospital Servidor Publico Estadual São Paulo 4Hospital Universitário da Universidade de São Paulo Brazil 5Department of Haematology, University of Liverpool 6Liverpool School of Tropical Medicine UK 7Centre for Tropical Medicine, University of Oxford UK
Address correspondence to Professor D.A. Warrell, Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Headington, Oxford OX3 9DU
Received 26 January 1994 Accepted for publication 24 February 1994.
In S
Paulo State, Brazil, five males, aged between 8 and 64 years, were attacked by ‘Africanized’ honey bees (Apis mellifera scutellata). The estimated number of stings received by each patient ranged from >200 to >1000. All five were transferred to intensive care units in Sáo Paulo City. Clinical features included intravascular haemolysis, respiratory distress with ARDS, hepatic dysfunction, rhabdo-myolysis (with myoglobinaemia and myoglobinuria), hypertension and myocardial damage (perhaps explained by release of endogenous catecholamines by venom phospholipase A2 and mellitin), shock, coma, acute renal failure and bleeding. Laboratory findings included gross neutrophil leucocytosis, elevated serum enzymes [AST, ALT, LDH, CPK (predominantly CPK-MM)] and creatinine. Clotting times were slightly prolonged. Despite treatment with antihistamines, corticosteroids, bronchodilators, vasodilators, bicarbonate, mannitol and mechanical ventilation, three of the patients died between 22 and 71 h after the attacks, with histopathological features of ARDS, hepatocellular necrosis, acute tubular necrosis, focal subendocardial necrosis and disseminated intravascular coagulation. Whole bee venom and phospholipase A2 (PLA2) antigen concentrations were measured in serum and urine for the first time, using enzyme immunoassay. High venom and PLA2concentrations were detected in serum and urine for more than 50 h after the stings in two fatal cases, in one of which the total circulating unbound whole venom was estimated at 27 mg, one hour after the attack. An antivenom should be developed to treat the increasing numbers of victims of mass attacks by Africanized ‘killer’ bees in USA, Middle and South America.
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