The Hymenoptera (wasps, bees, ants) are common insects whose stings cause significant human morbidity and mortality.
Reactions to stings:
(1) toxic, which can be significant if the victim is small, or elderly or the number of stings is very large
(2) allergic, with anaphylactic the most severe
Group |
Reaction |
Description |
local swelling at the site of the sting |
typical |
<= 10 cm |
|
large |
diameter > 10 cm and lasting > 24 hours |
systemic |
grade I |
generalized urticaria, itching, malaise, anxiety |
|
grade II |
grade I, plus >= 2 of the following • angio-edema (grade II if alone) • constriction of chest • nausea • vomiting • diarrhea • abdominal pain • dizziness |
|
grade III |
any of the above, plus >= 2 of the following • dyspnea (grade III if alone) • wheezing (grade III if alone) • stridor (grade III if alone) • dysphagia • dysarthria • hoarseness • weakness • confusion • feeling of impending doom |
|
grade IV |
any of the above, plus >= 2 of the following • fall in blood pressure • collapse • loss of consciousness • incontinence of urine or stool • cyanosis |
unusual reactions |
serum sickness |
fever, arthritis, lymphadenopathy, exanthema, vasculitic purpura, generalized vasculitis |
|
renal |
glomerulonephritis, nephrotic syndrome, acute renal failure |
|
neurologic |
peripheral neuritis, polyradiculitis, epileptic seizures, reversible CNS damage, irreversible CNS damage |
|
hematologic |
thrombocytopenia, hemolytic anemia, DIC |
|
cardiac |
angina pectoris, myocardial infarction |
Fatal reactions:
(1) tend to occur following stings to the head and neck
(2) may be due to a variety of mechanisms but usually interfere with respiration or cause anaphylaxis
(3) most fatalities occur quickly after the sting
Specialty: Toxicology, Emergency Medicine, Critical Care
ICD-10: ,