by Some reports from other developing countries, including India, Vietnam, Thailand, Malaysia, and Nepal, also indicate that victims attacked by wasps in swarms probably undergo a life-threatening toxic reaction in response to the venom [7]C[11]. was beneficial Mouse monoclonal to MYST1 for patients with 20 stings and delayed hospital admission of patients (4 hours after sting). Conclusions In China, most patients with multiple wasp stings presented with toxic reactions and multiple organ dysfunction caused by the venom rather than an anaphylactic reaction. AKI is the prominent clinical manifestation of wasp stings with toxic reaction. High creatinine levels, shock, oliguria, and anemia were risk factors for death. Introduction Wasps are critically important in natural bio-control and in preserving an ecological balance in agriculture. Wasp stings are not uncommon worldwide. In developed countries, almost all patients who have suffered from one or a few stings have had allergic reactions of varying degrees [1]. Therefore treatment is focused on anti-anaphylaxis and desensitization [2], [3]. However, in comparison with the occasional incidence reported previously, wasp sting induced injuries have been occurring more frequently in recent years in China, which has caused considerable mortality among victims and become an increasingly serious public health problem [4]C[6]. Some reports from other developing countries, including India, Vietnam, Thailand, Malaysia, and Nepal, also indicate that victims attacked by wasps CPA inhibitor in swarms probably undergo a life-threatening toxic reaction in response to the venom [7]C[11]. Although wasp stings have become a serious public health problem, they has been greatly underestimated and have received little attention. Some reports with small sample sizes have shown that wasp stings might lead to multiple organ dysfunctions [7], [8]. However, there is no systematic analysis on the clinical features, treatment strategies, and prognosis of severe wasp sting patients with large sample sizes. Hubei is a large province with a population of over 60 million, located in the central part of China, which has a subtropical monsoonal climate with distinct contrast between the eastern plain and the western mountainous area. In the present study, the clinical data of hospitalized wasp sting patients from 2009C2011 in the Hubei Province, China, were investigated. The results provided a novel insight into the epidemiology and clinical characteristics of wasp sting and helped develop strategies of prevention and treatment. Materials and Methods Clinical data collection and analysis Between 2004 and 2011, the annual number of patients with wasp stings admitted to 35 hospitals and medical centers including 12 tertiary care hospitals and 23 secondary care hospitals in the Hubei Province, China, were calculated. Among them, the cases admitted between 2009 and 2011 were enrolled with detailed data and this part of the study is retrospective. From Nov. 2011 on, all hospitalized patients with wasp stings from these 35 hospitals were included CPA inhibitor in a small prospective study to test for the serum venom-specific IgE and lymphocyte subsets and various inflammation mediators. There were 25 consecutive cases involved until the end of 2011. The diagnosis of wasp stings was based on clinical history and findings on physical examinations. A standard wasp sting management protocol was followed for the emergent management [12]. Detailed history was recorded and clinical examinations and investigations were performed to provide complete clinical characteristics. CPA inhibitor Not all clinical data from the laboratory analyses or overall patient evolution were available, resulting in the number of observations for calculating means to be less than 1091 in some variables. When this occurred, the corresponding number of observations was given. The study was approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology. Eligible patients were given a copy of written informed consent and those who signed the informed consents were recruited into this study. For the minors/children participants, written informed consents were signed by the guardians on the behalf of them. Clinical characteristics We documented the following information: presence of hematuria, hypotension or oliguria/anuria upon admission, number of stings, time between sting and hospitalization, duration of oliguria/anuria and other clinical manifestations including vomiting, hematemesis, arrhythmia, heart failure, pneumonic edema, consciousness, and other complications. We also documented duration of hospital stay, in-hospital mortality, and cause of death. Laboratory exam The related laboratory examinations were acquired soon after the individuals were admitted. Using these laboratory findings combined with medical manifestations, the following diagnoses could be made: hemolysis: anemia with elevated free hemoglobin in blood; rhabdomyolysis: blood serum CK ten instances higher than normal and elevated free myohemoglobin in blood; liver injury: elevated ALT; kidney injury: elevated Cr; coagulopathy: PT 17.5 s or APTT 55.0 s; anaphylactic.
