Abstract Presentations at the 2005 Wilderness Medical Society Meeting, Snowmass,
Colorado, July 23 to 27, 2005
Oral Presentation
Africanized Bee Attacks on Children
Jeffrey T. Allgaier, MD, Frank F. LoVecchio, DO, MPH.
Maricopa Medical Center, Department of Emergency Medicine and Banner Good
Samaritan Regional Medical Center, Phoenix, Arizona
Introduction: Massive bee envenomation in adults is associated with a greater than 15%
mortality. Melittin, phospholipase A
2
, and hyaluronidase in bee venom produces
vomiting, diarrhea, shock, hemoglobinuria, rhabdomyolysis, multi-organ failure and
death. Experience with adults and animals suggest that clinical manifestations largely
depend on the number of stings/kg body weight. Animal data suggest death is inevitable
when >20 stings/kg are present. Data on children are extremely limited. We describe our
experience with multiple bee stings in eleven children (< 10 years old).
Methods: The eleven children had a median age of 3.6 years [range 2-9 years old]. All
bee stingers were counted. The admitting medical toxicologist recorded all signs and
symptoms. Electrolytes, CPK, CBC, PT/PTT, fibrinogen, and renal function were
measured serially in all patients. Laboratory data were measured at baseline, 8, and 16
hours following presentation. A standard form was retrospectively completed. Telephone
follow-up at 4 days post-envenomation was performed.
Results: The median total stingers were 48 per patient [range 25-50] or 2.64 stingers per
kg [range 1-4.5]. No child had any signs of anaphylaxis. Nine of eleven children had
vomiting that resolved within 90 minutes of envenomation, with eight patients receiving
one dose of an antiemetic (droperidol, hydroxyzine, etc.). Seven of eleven children had at
least one episode of non-bloody diarrhea within two hours of envenomation. Mild
elevations in CK were present in all children (median 181 IU/L; range 141-191 IU/L),
while all other laboratory data remained normal. All patients were discharged the
following day with complete resolution of the symptoms and normal laboratory data.
Telephone follow-up at 4 days post-envenomation was unremarkable.
Conclusions: Bee envenomation resulted in mild systemic illness and mild elevation of
CK in our series of children receiving 1-4.5 stings/kg. Among these systemic symptoms
were nausea, vomiting, and diarrhea. Given prior animal research, adult case studies and
our study in children, two conclusions can reasonably be drawn. First, systemic illness
does result from Africanized bee attacks, the severity of which depends on the number of
stings/kg. Second, the presence of systemic symptoms does not necessarily portend a
poor prognosis.
