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Zache E, Cajueiro J, Andrade Neto A, Almeida L, Colares R, Afonso J, Souza M, Arenales A. Anaphylactic shock with pulmonary eosinophilic infiltration due to honeybee attack in a donkey: case report. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT A case of a donkey attacked by Africanized honeybee is reported here with clinical signs of agitation, dehydration, congestion of the ocular mucous membranes, tongue edema, tachycardia and inspiratory dyspnea, and progression to death. At necropsy, diffuse, severe subcutaneous edema at face and cervical regions and severe diffuse pulmonary hyperemia with abundant edema without parenchymal collapse were observed. Microscopically, marked, diffuse deep dermis and panniculus carnosus edema and marked diffuse alveolar edema, with moderate population of eosinophils predominantly around larger caliber vessels were noted. The final diagnosis of anaphylactic shock was supported by history, clinical signs, and anatomic pathology findings. This is the first report of a honeybee attack with pulmonary eosinophilic infiltration in a mammal.
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Affiliation(s)
- E. Zache
- Universidade Federal Rural de Pernambuco, Brazil
| | | | | | - L. Almeida
- Universidade Federal Rural de Pernambuco, Brazil
| | - R.R. Colares
- Universidade Federal Rural de Pernambuco, Brazil
| | | | - M.I. Souza
- Universidade Federal Rural de Pernambuco, Brazil
| | - A. Arenales
- Universidade Federal Rural de Pernambuco, Brazil
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Barbosa AN, Ferreira RS, de Carvalho FCT, Schuelter-Trevisol F, Mendes MB, Mendonça BC, Batista JN, Trevisol DJ, Boyer L, Chippaux JP, Medolago NB, Cassaro CV, Carneiro MTR, de Oliveira APP, Pimenta DC, da Cunha LER, Dos Santos LD, Barraviera B. Single-Arm, Multicenter Phase I/II Clinical Trial for the Treatment of Envenomings by Massive Africanized Honey Bee Stings Using the Unique Apilic Antivenom. Front Immunol 2021; 12:653151. [PMID: 33841437 PMCID: PMC8025786 DOI: 10.3389/fimmu.2021.653151] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/05/2021] [Indexed: 12/17/2022] Open
Abstract
We evaluated the safety, optimal dose, and preliminary effectiveness of a new-approach Africanized honeybee (Apis mellifera) Antivenom (AAV) in a phase I/II, multicenter, non-randomized, single-arm clinical trial involving 20 participants with multiple stings. Participants received 2 to 10 vials of AAV depending on the number of stings they suffered, or a predefined adjuvant, symptomatic, and complementary treatment. The primary safety endpoint was the occurrence of early adverse reactions within the first 24 h of treatment. Preliminary efficacy based on clinical evolution, including laboratory findings, was assessed at baseline and at various time points over the four following weeks. ELISA assays and mass spectrometry were used to estimate venom pharmacokinetics before, during, and after treatment. Twenty adult participants, i.e., 13 (65%) men and 7 (35%) women, with a median age of 44 years and a mean body surface area of 1.92 m2 (median = 1.93 m2) were recruited. The number of stings ranged from 7 to > 2,000, with a median of 52.5. Symptoms of envenoming were classified as mild, moderate, or severe in 80% (16), 15% (3), and 5% (1) of patients, respectively; patients with mild, moderate, or severe envenoming received 2, 6, and 10 vials of AAV as per the protocol. None of the patients had late reactions (serum sickness) within 30 d of treatment. There was no discontinuation of the protocol due to adverse events, and there were no serious adverse events. One patient had a moderate adverse event, transient itchy skin, and erythroderma. All participants completed the intravenous antivenom infusion within 2 h, and there was no loss to follow-up after discharge. ELISA assays showed venom (melittin and PLA2) concentrations varying between 0.25 and 1.479 ng/mL prior to treatment. Venom levels decreased in all patients during the hospitalization period. Surprisingly, in nine cases (45%), despite clinical recovery and the absence of symptoms, venom levels increased again during outpatient care 10 d after discharge. Mass spectrometry showed melittin in eight participants, 30 d after treatment. Considering the promising safety results for this investigational product in the treatment of massive Africanized honeybee attack, and its efficacy, reflected in the clinical improvements and corresponding immediate decrease in blood venom levels, the AAV has shown to be safe for human use. Clinical Trial Registration: UTN: U1111-1160-7011, identifier [RBR-3fthf8].
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Affiliation(s)
- Alexandre Naime Barbosa
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil
| | - Rui Seabra Ferreira
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Clinical Research, Center for the Study of Venoms and Venomous Animals (CEVAP) and Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Francilene Capel Tavares de Carvalho
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Fabiana Schuelter-Trevisol
- Clinical Research Center, Nossa Senhora da Conceição Hospital, Tubarão, Brazil.,Graduate Program in Health Sciences, University of Southern Santa Catarina at Tubarão, Tubarão, Brazil
| | - Mônica Bannwart Mendes
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil
| | - Bruna Cavecci Mendonça
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - José Nixon Batista
- Clinical Research Center, Nossa Senhora da Conceição Hospital, Tubarão, Brazil
| | - Daisson José Trevisol
- Clinical Research Center, Nossa Senhora da Conceição Hospital, Tubarão, Brazil.,Graduate Program in Health Sciences, University of Southern Santa Catarina at Tubarão, Tubarão, Brazil
| | - Leslie Boyer
- VIPER Institute, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Jean-Philippe Chippaux
- MERIT, IRD, Université Paris 5, Sorbonne Paris Cité, Paris, France.,CRT, Institut Pasteur, Paris, France
| | - Natália Bronzatto Medolago
- Clinical Research Unit (UPECLIN), Botucatu Medical School, São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Claudia Vilalva Cassaro
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Márcia Tonin Rigotto Carneiro
- Clinical Research Unit (UPECLIN), Botucatu Medical School, São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Ana Paola Piloto de Oliveira
- Clinical Research Unit (UPECLIN), Botucatu Medical School, São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Daniel Carvalho Pimenta
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Biochemistry and Biophysics Laboratory, Butantan Institute, São Paulo, Brazil
| | | | - Lucilene Delazari Dos Santos
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Clinical Research, Center for the Study of Venoms and Venomous Animals (CEVAP) and Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
| | - Benedito Barraviera
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Botucatu Medical School (FMB), São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil.,Graduate Program in Clinical Research, Center for the Study of Venoms and Venomous Animals (CEVAP) and Botucatu Medical School (FMB), São Paulo State University (UNESP-Univ Estadual Paulista), Botucatu, Brazil
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Abstract
Fatalities among avian species due to multiple bee stings are rare. Sixteen pigeons on a
farm in Bangladesh each suffered multiple bee stings. Ten of the pigeons died before
treatment, 5 (4–11 stings) died within 12 hr after treatment, and 1 pigeon (only 3 stings)
survived. Body temperature, heart rate, respiratory rate, hematocrit, hemoglobin,
erythrocytes, thrombocytes, MCV, MCH and MCHC decreased significantly after the incident,
but leucocytes, heterophils, basophils, eosinophils, monocytes, ALT, AST, LDH, CK,
creatinine, BUN and UA increased markedly. Overall, the hematological and biochemical
changes in the bee-stung pigeons were similar to those of mammals; however, avian species
may be more sensitive to bee stings than mammals.
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Affiliation(s)
- Md Mahbubur Rahman
- Highly Pathogenic Avian influenza Active Surveillance Network Program, FAO and Department of Livestock Service, Upazila Veterinary Hospital, Faridpur Sadar, Faridpur, Bangladesh
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Mughal MN, Abbas G, Saqib M, Muhammad G. Massive attack by honeybees in a German shepherd dog: description of a fatal case and review of the literature. J Venom Anim Toxins Incl Trop Dis 2014; 20:55. [PMID: 25584045 PMCID: PMC4290391 DOI: 10.1186/1678-9199-20-55] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 12/09/2014] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Mudassar Niaz Mughal
- Department of Clinical Medicine and Surgery (CMS), Faculty of Veterinary Sciences (FVS), University of Agriculture Faisalabad (UAF), Faisalabad, 38040 Punjab Pakistan
| | - Ghazanfar Abbas
- Department of Clinical Medicine and Surgery (CMS), Faculty of Veterinary Sciences (FVS), University of Agriculture Faisalabad (UAF), Faisalabad, 38040 Punjab Pakistan
| | - Muhammad Saqib
- Department of Clinical Medicine and Surgery (CMS), Faculty of Veterinary Sciences (FVS), University of Agriculture Faisalabad (UAF), Faisalabad, 38040 Punjab Pakistan
| | - Ghulam Muhammad
- Department of Clinical Medicine and Surgery (CMS), Faculty of Veterinary Sciences (FVS), University of Agriculture Faisalabad (UAF), Faisalabad, 38040 Punjab Pakistan
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