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Envenoming resulting from Apis honeybee stings pose a neglected public health concern, with clinical complications ranging from mild local reactions to severe systemic manifestations. This review explores the mechanisms underlying envenoming by honeybee sting, discusses diagnostic approaches, and reviews current pharmacological interventions. This section explores the diverse clinical presentations of honeybee envenoming, including allergic and non-allergic reactions, emphasizing the need for accurate diagnosis to guide appropriate medical management. Mechanistic insights into the honeybee venom's impact on physiological systems, including the immune and cardiovascular systems, are provided to enhance understanding of the complexities of honeybee sting envenoming. Additionally, the article evaluates emerging diagnostic technologies and therapeutic strategies, providing a critical analysis of their potential contributions to improved patient outcomes. This article aims to provide current knowledge for healthcare professionals to effectively manage honeybee sting envenoming, thereby improving patient care and treatment outcomes.

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We describe three clinical cases of Surinamese children with rhabdomyolysis with diverse clinical presentation and course. The first patient had rhabdomyolysis because of toxins caused by multiple beestings and developed acute kidney injury. The other two patients had rhabdomyolysis following acute infection with chikungunya and influenza A/H1N1 virus. These cases emphasize that the diverse etiology of rhabdomyolysis should be considered in children in tropical settings.

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Abstract INTRODUCTION: Hymenoptera injuries are commonly caused by stinging insects. In Amazonas state, Brazil, there is no information regarding distribution, profile, and systemic manifestations associated with Hymenoptera injuries. METHODS: This study aimed to identify risk factors for systemic manifestation using the Brazilian Notifiable Diseases Surveillance System (2007 to 2015). RESULTS: Half of Hymenoptera injuries were caused by bee stings. Hymenoptera injuries were concentrated in Manaus, and 13.36% of cases displayed systemic signs. Delayed medical assistance (4 to 12 hours) presented four times more risk for systemic manifestations. CONCLUSIONS: Simple clinical observations and history of injury are critical information for prognostic improvement.

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La neuritis óptica es la inflamación aguda del nervio óptico y su forma atípica se produce por la inflamación del nervio óptico como parte de un proceso de causa infecciosa, inmune, granulomatosa, o por contigüidad. Las picaduras por himenópteros (abejas, avispas, hormigas) han sido asociadas con diferentes cuadros clínicos, que van desde manifestaciones locales hasta cuadros sistémicos como anafilaxis, glomerulonefritis y afectación del sistema nervioso central (lesiones vasculares e isquémicas, neuritis óptica y lesiones desmielinizantes). Desde 1960 se han documentado casos de neuritis ópticas asociadas a las picaduras de himenópteros, que adoptan las formas de neuritis óptica anterior isquémica e inflamatoria. Se presenta el caso de una paciente, mujer de 62 años de edad, que luego de tres días de haber sufrido picadura por abeja en párpado inferior izquierdo, presentó disminución de la agudeza visual de ambos ojos y escotoma central, concomitante con cefalea y dolor ocular bilateral exacerbado con los movimientos oculares. Al examen oftalmológico la agudeza visual se encontraba disminuida (visión en bultos). En el fondo de ojo se evidenció de forma bilateral discos ópticos de bordes borrados. En la resonancia magnética ocular se observó engrosamiento hiperintenso del nervio óptico izquierdo. Por las características clínicas y el antecedente epidemiológico se planteó el diagnóstico de neuritis óptica bilateral. Se inició pulsos de metilprednisolona, con posterior mejoría de la clínica.

Optic neuritis is an acute inflammation of the optic nerve and, in its atypical form, is caused by inflammation of the optic nerve as part of infectious, immune, granulomatous, or contiguity processes. Hymenoptera stings (bees, wasps and ants) have been associated with different clinical presentations, ranging from local events to systemic manifestations, such as anaphylaxis, glomerulonephritis and central nervous system involvement (ischemic vascular lesions, optic neuritis and demyelinating lesions). This is a report of the case of a 62-year-old woman that after three days of being stung by a bee in the left lower eyelid, showed decreased visual acuity of both eyes and central scotoma, concomitant bilateral headache and eye pain, exacerbated by eye movements. The ophthalmological examination showed that visual acuity was decreased and the bilateral fundus examination revealed blurred optic disks edges. Hyperintense thickening of the left optic nerve was observed with an ocular MRI. Due to the clinical manifestations and epidemiological history, the diagnosis of bilateral optic neuritis was established. Treatment with pulses of 1g/daily of methylprednisolone was initiated, for three days, with clinical improvement within 24 hours after receiving the first dose. Since 1960, cases of optic neuritis associated with hymenoptera stings have been documented, which take the form of anterior optic neuritis. A case of a patient who presented clinical features of bilateral optic neuritis after been stung by a bee, with a good clinical outcome after treatment with methylprednisolone is reported.

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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)

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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)

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Hymenopteran stinging events are frequent cause of disease and death in domestic animals, but rarely reported in the literature. This paper reports six cases of envenomation by bee (Apis mellifera) sting in dogs with fatal outcome. The main clinical signs were icterus and hemoglobinuria. Other findings included anorexia, apathy, vomiting, diarrhea, and dyspnea. Necropsy findings in five dogs included icterus, red-orange discoloration of the liver, dark-red kidneys with an red-wine aspect to the urine. Histologically, there were centrolobular necrosis in the liver and hemoglobinuric nephosis, typical lesions of intravascular hemolysis.

Acidentes causados por himenópteros são freqüentes em animais domésticos, mas apenas raramente reportados na literatura. Este relato descreve seis casos fatais de reação tóxica sistêmica decorrente de acidente por abelhas (Apis mellifera) em cães. Os principais sinais clínicos foram icterícia e hemoglobinúria. Outros achados incluíram anorexia, apatia, vômito, diarréia e dispnéia. Na necropsia, cinco dos seis cães apresentavam icterícia, fígado vermelho-alaranjado, rins intensamente enegrecidos e urina com coloração semelhante à do vinho tinto. Na histologia, havia necrose hepática centrolobular e nefrose hemoglobinúrica, lesões típicas de crise hemolítica intravascular.

RESUMO

Hymenopteran stinging events are frequent cause of disease and death in domestic animals, but rarely reported in the literature. This paper reports six cases of envenomation by bee (Apis mellifera) sting in dogs with fatal outcome. The main clinical signs were icterus and hemoglobinuria. Other findings included anorexia, apathy, vomiting, diarrhea, and dyspnea. Necropsy findings in five dogs included icterus, red-orange discoloration of the liver, dark-red kidneys with an red-wine aspect to the urine. Histologically, there were centrolobular necrosis in the liver and hemoglobinuric nephosis, typical lesions of intravascular hemolysis.

Acidentes causados por himenópteros são freqüentes em animais domésticos, mas apenas raramente reportados na literatura. Este relato descreve seis casos fatais de reação tóxica sistêmica decorrente de acidente por abelhas (Apis mellifera) em cães. Os principais sinais clínicos foram icterícia e hemoglobinúria. Outros achados incluíram anorexia, apatia, vômito, diarréia e dispnéia. Na necropsia, cinco dos seis cães apresentavam icterícia, fígado vermelho-alaranjado, rins intensamente enegrecidos e urina com coloração semelhante à do vinho tinto. Na histologia, havia necrose hepática centrolobular e nefrose hemoglobinúrica, lesões típicas de crise hemolítica intravascular.