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Abstract
RÉSUMÉ
Introduction. Les piqûres d'abeilles peuvent être responsables d’un syndrome toxique avec des signes systémiques. Nous rapportons le cas létal d’un choc anaphylactique compliquant une envenimation massive faisant suite à des piqûres d’abeilles. Observation. Il s'agit d'un patient de 39 ans, sans antécédents pathologiques, référé pour piqûres de plusieurs abeilles. Admis deux heures après l'attaque, l'examen a retrouvé un patient conscient mais agité, hyperalgique, apyrétique, tachycarde avec un pouls radial faiblement perçu, hypotendu à 73/40 mm Hg, SpO2 = 95% à l’air ambiant avec une polypnée, une oligurie avec urines d’aspect «coca-cola» et la présence d'environ 200 sites de piqûres sur le corps entier. L’évolution défavorable a été marquée par le décès. Conclusion. Les piqûres massives d’abeilles sont potentiellement graves par leurs complications systémiques et fatales si la prise en charge est tardive. L'intensité de l'envenimation et le pronostic sont liés au nombre de piqûres d'abeilles.
ABSTRACT
Background. Bee stings can be responsible for a toxic syndrome with systemic signs. We report the lethal case of anaphylactic shock complicating massive envenomation following bee stings. Presentation of case. A 39-year-old patient, with no relevant medical history, was referred for bites of several bees. He was admitted two hours after the attack. On physical examination, the patient was conscious but agitated, hyperalgic, afebrile, tachycardic with a weakly perceived radial pulse. Blood pressure was low (73/40 mmHg). Other pertinent findngs were: SpO2 = 95% in the ambient air, polypnea, oliguria with urine of "coca-cola" appearance. He had about 200 sites of bites on the whole body. The patient died 21 hours after the bites. Conclusion. Massive bee stings are potentially serious and may be fatal because of their systemic complications if the management is late. The intensity of the envenomation and the prognosis are related to the number of bee stings.
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References
- F. Rancé. Traitement du choc et bon usage de l’adrénaline. Revue française d’allergologie et d’immunologie clinique 44 (2004) 336–341.
- Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second Symposium on the Definition and Management of Anaphylaxis: Summary Report – Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. J Allergy ClinImmunol. 2006;117:391–7. [PubMed]
- Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of anaphylaxis: An updated practice parameter. J Allergy ClinImmunol. 2005;115:S483–S523. [PubMed]
- Ring J ;Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 1977; 1 (8009): 466-69.
- Díaz-Sánchez CL, Lifshitz-Guinzberg A, Ignacio-Ibarra G, Halabe-Cherem J, Quinones-Galvan A. Survival after massive (>2000) Africanized honeybee stings. Arch Intern Med. 1998 Apr 27;158(8):925-7. PMID: 9570180.
- Gabriel DP, Rodrigues AG Jr, Barsante RC, dos Santos Silva V, Caramori JT, Martim LC, Barretti P, Balbi AL. Severe acute renal failure after massive attack of Africanized bees. Nephrol Dial Transplant. 2004 Oct;19(10):2680.
- Incorvaia C, Mauro M, Pastorello EA. - Hymenoptera stings in conscripts. - Allergy 1997; 52 : 680-1.
- Charpin D, Birnbaum J, Lanteaume A, Vervloet D. - Prevalence of allergy to Hymenoptera stings in different samples of general population. - J Allergy ClinImmunol1992 ; 90 : 331-7.
- Herman D, Guinnepain MT, Smiejan JM, Laurent J. - Manifestations cutanéo-muqueuses de l’allergie aux venins d’hyménoptères. Modalités de l’immunothérapie spécifique. - Rev Fr Allergol 1997; 37 : 579-84.
- Müller U, Mosbech H. - Immunotherapy with Hymenoptera venoms. Allergy 1993; 48 (Suppl) : 37-46.
- M. Abi Khalil, H. Damak, D. Décosterd. Anaphylaxie et état de choc anaphylactique. Rev Med Suisse 2014 ; 10 : 1511-5.
- Simons FR, Ardusso LR, Bilò MB, et al. World Allergy Organization Guidelines for the assessment and management of anaphylaxis. World Allergy Organ J 2011;2:13-36.
References
F. Rancé. Traitement du choc et bon usage de l’adrénaline. Revue française d’allergologie et d’immunologie clinique 44 (2004) 336–341.
Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second Symposium on the Definition and Management of Anaphylaxis: Summary Report – Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. J Allergy ClinImmunol. 2006;117:391–7. [PubMed]
Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. The diagnosis and management of anaphylaxis: An updated practice parameter. J Allergy ClinImmunol. 2005;115:S483–S523. [PubMed]
Ring J ;Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 1977; 1 (8009): 466-69.
Díaz-Sánchez CL, Lifshitz-Guinzberg A, Ignacio-Ibarra G, Halabe-Cherem J, Quinones-Galvan A. Survival after massive (>2000) Africanized honeybee stings. Arch Intern Med. 1998 Apr 27;158(8):925-7. PMID: 9570180.
Gabriel DP, Rodrigues AG Jr, Barsante RC, dos Santos Silva V, Caramori JT, Martim LC, Barretti P, Balbi AL. Severe acute renal failure after massive attack of Africanized bees. Nephrol Dial Transplant. 2004 Oct;19(10):2680.
Incorvaia C, Mauro M, Pastorello EA. - Hymenoptera stings in conscripts. - Allergy 1997; 52 : 680-1.
Charpin D, Birnbaum J, Lanteaume A, Vervloet D. - Prevalence of allergy to Hymenoptera stings in different samples of general population. - J Allergy ClinImmunol1992 ; 90 : 331-7.
Herman D, Guinnepain MT, Smiejan JM, Laurent J. - Manifestations cutanéo-muqueuses de l’allergie aux venins d’hyménoptères. Modalités de l’immunothérapie spécifique. - Rev Fr Allergol 1997; 37 : 579-84.
Müller U, Mosbech H. - Immunotherapy with Hymenoptera venoms. Allergy 1993; 48 (Suppl) : 37-46.
M. Abi Khalil, H. Damak, D. Décosterd. Anaphylaxie et état de choc anaphylactique. Rev Med Suisse 2014 ; 10 : 1511-5.
Simons FR, Ardusso LR, Bilò MB, et al. World Allergy Organization Guidelines for the assessment and management of anaphylaxis. World Allergy Organ J 2011;2:13-36.