Acute Kidney Injury Due to Acute Cortical Necrosis Following a Single Wasp Sting

Acute kidney injury (AKI) can develop after multiple wasp or bee stings. The etiology is the acute tubular necrosis secondary to shock, pigment toxicity, interstitial nephritis, or direct nephrotoxicity of venom. We report a 40-year-old female who presented with oliguric AKI after a single wasp sting on her hand. Her history, examination, and investigations did not support any of the established causes of AKI in such settings. She did not improve with supportive management and dialysis, and kidney biopsy showed acute cortical necrosis (ACN). This is the first report of ACN after a single wasp sting.     

单向白蛋白透析滤过治疗重症蜂蛰伤中毒的临床研究

目的观察单向白蛋白透析滤过（SPADF）治疗重症蜂蛰伤中毒的,瞄床疗效及对预后的影响。方法54例重症蜂蛰伤中毒患者,16例行SPADF,19例行血液灌流（HP）和血液透析滤过（CVVHDF）,19例行血液透析滤过（CVVHDF）治疗。SPADF以4．4％质量浓度白蛋白溶液作透析液。分别于治疗前、后检测肝、肾功能、凝血功能、心肌酶学和炎症因子水平变化,观察临床表现。结果SPADF治疗后,肝功能、凝血功能、心肌酶学明显好转、肿瘤坏死因子（TNF-α）浓度明显下降（P〈0．05）,患者临床症状与体征改善,优于HP＋CVVHDF组和CVVHDF组。结论单向白蛋白透析滤过能清除重症蜂蛰伤中毒患者体内水溶性和蛋白结合性毒素及炎症介质,提高临床症状,改善预后。     

Hymenoptera venom allergens

Hymenoptera venoms each contain a variety of protein allergens. The major components have all been characterized, and most of the amino acid sequences are known. This article concentrates on the use of contemporary techniques including cloning, mass spectrometry and genomics in the characterization of venom allergens, and newer separation techniques for protein isolation. Examples of the use of these techniques with venom proteins are presented.

     

Allergic reactions to insect stings: results from a national survey of 10,000 junior high school children in Israel

BACKGROUND: Insect sting allergy is a medical condition the magnitude of which has not been fully estimated in children. OBJECTIVES: We sought to evaluate the prevalence of insect stings among schoolchildren in Israel, the rate of allergic reactions, and hospital attendance. METHODS: A self-report questionnaire of the International Study of Asthma and Allergies in Childhood was administered to a national sample of schoolchildren aged 13 to 14 years across Israel. Questions regarding insect stings, allergic reactions, and hospital attendance were added. RESULTS: Ten thousand twenty-one questionnaires were available for analysis. Most (56.3%) had been stung at least once in their lifetime. Of these, 20.5% had a large local reaction (LLR), 11.6% had a mild (cutaneous) systemic reaction (MSR), and 4.4% had a moderate-to-severe systemic reaction (SSR); 11.5%, 6.5%, and 2.5% of the study group, respectively. Arabs had significantly more allergic reactions of all 3 types than Jews (P < .0001). On multivariate analysis, LLR was associated with SSR (odds ratio, 6.25; 95% CI, 4.66-8.41) and MSR (odds ratio, 5.15; 95% CI, 4.24-6.25). More than 10% of the children with an LLR only attended a hospital compared with 7.5% of those with an MSR only and 14.5% with an SSR only. CONCLUSIONS: The frequency of reported allergic sting reactions in children might be higher than previously estimated. Arab children reported significantly more allergic reactions than Jews. Hospital attendance does not correlate with the severity of the allergic reaction, and only a minority of children with SSRs are treated in hospital. CLINICAL IMPLICATIONS: The improper care of severe reactions highlights the need for better public and physician education.     

儿童蜱虫叮咬致感染三例诊治分析并文献复习

目的　探讨儿童蜱虫叮咬后的继发危害、处理及预防。方法　结合文献复习,对2018-07-06、2018-07-19南京医科大学附属儿童医院收治的3例蜱虫叮咬致感染患儿的临床资料（性别、年龄、症状、体征、实验室检查、处理等）进行分析。结果　3例患儿中,男1例,女2例;年龄分别为1岁7个月、5岁3个月、15岁6个月;病程中均有发热,体温最高均超过38.5 ℃。患儿1经外科清除蜱虫,同时局部行清创缝合,治疗效果最好,病程最短,费用最少。患儿2和患儿3为姐弟俩,均未找到明确蜱虫叮咬部位,均因“发热”就诊,经疾病预防控制中心血液检验确诊为“新型布尼亚病毒”感染,其中弟弟常规对症治疗后好转,姐姐病情较重,在常规治疗基础上加用利巴韦林和丙种球蛋白2 g/kg后好转。结论　蜱虫叮咬后及时有效清除虫体效果好,对找不到叮咬部位者,如出现发热,白细胞计数和血小板计数降低,应及时向疾病预防控制中心送检血液,尽早明确病因,早期治疗,减少并发症。     

蜂蛰伤导致急性肾损伤的防治

在我国、南亚及东南亚地区,蜂蛰伤事件时常发生,已经成为一个严重威胁广大民众生命和健康的问题。蜂蛰伤导致的急性肾损伤(AKI)是非常常见的严重并发症,病情凶险,危及患者生命。急性肾小管坏死(ATN)是其主要肾脏病理改变。目前认为低血压引起的缺血性肾损伤、血管内溶血、横纹肌溶解和蜂毒直接毒性作用是蜂蛰伤致AKI的主要机制。血液净化治疗是目前救治蜂蛰伤后AKI的有效方法,同时蜂毒的免疫治疗主要针对蜂毒过敏人群。本文就蜂蛰伤导致的AKI防治研究的最新进展作一综述。     

生物防治技术在绿色中药材生产中的应用

药用植物在引种栽培过程中 ,遭受到各种病虫害的危害 ,直接影响其产量和质量。为防治药用植物病虫害 ,目前主要依靠化学农药。由于长期、过量施用化学农药 ,造成中药材中的农药残留问题、害虫的抗药性问题及造成流水、土壤等的环境污染问题 ,因此提出以生物防治为主的综合防治措施 ,为生产绿色中药材提供新技术。现已完成了以下几方面的研究 :①应用管氏肿腿蜂防治蛀茎性害虫 ;②研制木霉制剂 ,用于药用植物病害的防治 ;③应用农抗 1 2 0防治人参根疫病 ;④应用昆虫病原线虫防治枸杞负泥虫的研究等。     

黄蜂蜇伤并发缺血性脑卒中

黄蜂蜇伤并发缺血性脑卒中非常罕见。目前,全世界范围内有20余例公开病例报道。与一般脑梗死相比,与蜂蜇伤相关脑卒中的病理生理学机制和治疗的信息还非常有限。病例 该文报道了1例25岁男性患者,在黄蜂蜇伤后以癫痫样发作为首发表现。经头部CT及MRI检查,诊断为“缺血性脑卒中” 。DSA检查未见右侧颈总动脉及其远端血管显影,血管内介入治疗抽吸出少许红色血栓,复查血管再通。然而,其后发生了“脑梗死后出血转化,并脑疝形成”。虽经去骨瓣减压、颅内血肿清除术及系统康复治疗,但预后不理想,日常生活活动 仍严重依赖他人照料。这是国内蜂蜇伤继发缺血性脑损伤并出血转化的首例报道。蜂蜇后脑血管损伤是一个持续性进展过程,首诊医师需高度警惕蜂毒的迟发性血管损 伤效应,需动态监测 D-二聚体、凝血功能、超敏 C-反应蛋白等血液指标。早期抗组胺或类固醇药物抑制炎症反应有助于延缓病情发展。炎症反应和凝血功能不稳定可能是蜂蜇后缺血性脑损伤的主要机制。与一般缺血性脑卒中患者相比,介入治疗的出血性风险更高。