Massive European wasp envenomation of a child

Abstract

Envenomation is a unique area of emergency medicine which interfaces acute emergency care with zoological research and public education. A considerable amount is known about envenomation by the snakes and spiders of Australia, which are among the most venomous in the world. There is little known, however, about massive envenomation by the European wasp (species Vespula germanica, family Vespidae), a recently introduced, aggressive and venomous vespid wasp. Allergy to bee, wasp and ant venom (order Hymenoptera) is well reported in the literature but there has been no documentation of systemic allergic reactions following massive vespid envenomation. Massive envenomation by vespid wasps in Australia has not been reported, although there are international reports of serious morbidity and a number of fatalities. This paper reports a massive European wasp envenomation in Melbourne and reviews the international literature. In this case, in contrast to the literature on massive vespid wasp envenomation, there is predominance of central nervous system toxicity with no major metabolic disturbance. The management of massive vespid envenomation includes standard supportive care and close laboratory monitoring for early evidence of haemolysis, rhabdomyolysis and metabolic derangement, which may significantly precede any clinical deterioration. Serious complications may be delayed and it is advised to follow up patients for 72 hours. There is potential for further research into vespid wasp venom and a need for increased public awareness of preventative strategies in Australia.

Mass envenomation of a mare and foal by bees

“…At times, the mare appeared to show behavioural abnormalities such as compulsive eating and overt aggression towards handlers, and it was difficult to differentiate between a pain response and possible central neurological disease. There are several reports of central neurological signs in other species after mass envenomation, including seizures, mental obtundation, hallucinations, obsessive compulsive behaviour and coma …”

“…There are several reports of central neurological signs in other species after mass envenomation, including seizures, mental obtundation, hallucinations, obsessive compulsive behaviour and coma. 9,10,13,16,19,21,24 Laboratory monitoring is an important part of the recommended management protocol in human patients. Laboratory testing in the current case was restricted somewhat by financial constraints; however, simple clinical observations combined with readily-available laboratory tests provided an adequate assessment of progress ( Table 2).…”

An unusual neurological consequence of massive wasp stings

“…Massive envenomation by Hymenoptera is reported to cause acute and delayed reactions such as encephalopathy, haemolysis, rhabdomyolysis and acute renal failure. Death as result of these complications or due to cardiac complications, especially in children, are also reported 14 15…”

“…Levick et al 15 describe a 3.5-year-old boy with massive (>120) vespula germanica envenomation with predominant neurological symptoms and no major metabolic disturbance. Within 40 minutes of being stung, the child became moderately cerebral irritated.…”

Multiple bee stings

“…Customs Services of Australia use specially‐trained dogs to check all incoming luggage and freight for the presence of unwanted bees, which are readily detectable (DC Somerville: personal communication). Despite these measures including fines associated with breach of quarantine regulations, the European wasp was introduced into Australia via cargo ship to Tasmania in 1967 and then into Melbourne in 1977 10 . Africanised bees were imported into California and Texas as stowaways on construction machinery and other products from Southern and Central America 11 Thus, Australia remains at risk.…”