Block of locust muscle glutamate receptors by delta-philanthotoxin occurs after receptor activations

One component (delta-philanthotoxin (delta-PTX) of the venom from the wasp Philanthus triangulum blocks transmission postsynaptically at excitatory synapses on locust muscle. delta-PTX depresses both the iontophoretic glutamate potential and the excitatory junctional current (e.j.c.) in a glutamate receptor activation-dependent manner. The rate of recovery from the effects of the toxin is reduced following either prolonged application of L-glutamate or repetitive iontophoretic application of this amino acid or high frequency neural stimulation of the muscle in the presence of delta-PTX. The decay phase of the e.j.c. is shortened by delta-PTX. The effects of delta-PTX on the e.j.c. are not voltage dependent. The open-close kinetics of glutamate channels in extrajunctional muscle membrane are modified by delta-PTX as shown by patch clamp analysis. The mean life time of the glutamate channel is reduced, whilst the mean interval between single opening events is increased with the events often occurring in bursts. These data are consistent with glutamate channel blocking by this toxin. It is proposed that the toxin blocks open channels gated by both junctional and extrajunctional glutamate receptors on locust muscle. It is further proposed that delta-PTX enters a compartment of the muscle through the glutamate open channels and that it can also block the open channels from this site.     

Genital trauma due to animal bites

PURPOSE: Animal bites to the external genitalia are rare. We retrospectively evaluated our experience with treating genital trauma caused by animal attacks. MATERIALS AND METHODS: We studied the medical records of 10 patients treated in the surgical emergency department at our hospital who presented with genital injury caused by an animal bite from 1983 to 1999. Special attention was given to the severity of injury, surgical treatment, antibiotic prophylaxis and outcome. RESULTS: Of the 2 men and 8 boys 8 were attacked by dogs, 1 by a horse and 1 by a donkey, respectively. In all cases initial local treatment involved débridement and copious wound irrigation with saline and povidone-iodine solution. Five patients who presented with minimal or no skin loss underwent primary skin closure, including 2 in whom urethral lacerations were surgically repaired. There was moderate to extensive tissue loss in 5 patients, including degloving penile injury in 2, traumatic spermatic cord amputation in 1, complete penile and scrotal avulsion in a 5-month-old infant, and partial penectomy in 1. Reconstructive procedures provided satisfactory cosmetic and functional results in 8 cases. Antibiotic prophylaxis was administered in all patients and no infectious complications developed. CONCLUSIONS: Animal bite is a rare but potentially severe cause of genital trauma and children are the most common victims. Morbidity is directly associated with the severity of the initial wound. Because patients tend to seek medical care promptly, infectious complications are unusual. Management involves irrigation, débridement, antibiotic prophylaxis, and tetanus and rabies immunization as appropriate as well as primary wound closure or surgical reconstruction. Good functional and cosmetic results are possible in the majority of cases.     

Multiple cerebral infarctions with severe multi-organ dysfunction following multiple wasp stings

Wasp and bee sting are commonly encountered worldwide. Local reactions are more common, generally are self-limiting and settle within a few hours. Multiple stings can lead to various clinical manifestations like vomiting, diarrhea, dyspnea, generalized edema, hypotension, syncope, acute renal failure, and even death. Rarely, they can cause vasculitis, serum sickness, neuritis, and encephalitis. We are reporting a case of 40-year-old male who presented with stroke, right hemiparesis with severe multi-organ dysfunction due to multiple wasp stings.     

Acute bullous hemorrhagic prurigo: a diagnostic challenge

Insect bites and bite wounds are quite common and most often have mild repercussions in humans. Statistics on the incidence of accidents caused by insects are not available, and the skin reactions after the bites are not always known. The authors present two cases of patients with hemorrhagic blisters on their hands after tabanidae bites and discuss the factors that cause the problem and the importance of the differential diagnosis of blisters with hemorrhagic content on human skin.     

The burden of bites and stings management: Experience of an academic hospital in the Kingdom of Saudi Arabia

PurposeThe main aim of this study is to estimate the economic burden and prevalence of bites and stings injuries in Saudi Arabia.MethodsA retrospective, cross-sectional study was conducted at King Saud University Medical City (KSUMC) for all bites and stings cases presented to the Emergency Department (ED) between the period June 2015 and May 2019.ResultsA total of 1328 bites and stings cases were treated in the ED at KSUMC. There were 886 insect bites and stings cases, 376 animal bites, 22 human bites, 34 scorpion stings, and ten snakebites. Most cases were reported in April - June. Females account for 62% of the reported cases, and the mean age was 24 years old. The total management cost of bite and sting cases during the study period was 3.4 million Saudi Riyal (SR). The spending cost of the management of animal bites was the highest as it cost 1,681,920.76 SR, followed by insect's management costing 1,228,623.68 SR.ConclusionBites and stings have a considerable health care burden on our society. Although the vast majority of the cases were not associated with a severe life-threatening condition, many were visit ED and associated with high medical costs. Increased awareness of the hazards of animal-related injuries, especially during spring and summer, where most cases take place may lower its incidence and decrease EDs visits.     

An unexpected surprise in a common boil

Cutaneous myiasis (myia: Greek word for fly) is an infestation of fly maggots in the skin. A case of human botfly (Dermatobia hominis) myiasis presenting to a Canadian emergency department is described. Typically, it presents as an apparent persistently infected skin abscess or insect bite. As the botfly is indigenous only to Central and South America, the condition is unfamiliar to most North American physicians. However, the rapidity of international air travel permits this exotic tropical infestation to present in any region. Obtaining a history of recent travel to an endemic area is the key to making the diagnosis and instituting appropriate treatment.     

沙蜇刺胞皮炎的调查研究

1986～1987年夏季,北戴河约有3000人被水母蛰伤,发生刺胞皮炎,其中5人死亡。皮疹多是鞭伤样。经证实,沙蜇是主要的蜇人水母,从其丝状附属器等处查到了4种刺胞。电子显微镜观察发现,刺胞释放刺丝刺入皮肤,引起皮炎。针对以上情况,作者提出了防治措施。     

Death Caused by Wasp and Bee Stings in Denmark 1960–1980

During a 21-year period in Denmark a total of 26 deaths were caused by wasp or bee stings (according to the National Health Service). The deaths might be classified, with some overlapping, as caused by either anaphylactic/anaphylactoid shocks (between 65% and 80%), suffocation after stings in the airways (about 15%) or preexisting diseases, especially arteriosclerotic heart disease (approx. 20%). Characteristically, in most persons with shock reactions unconsciousness and death occurred very shortly after the sting (within 45 min), while the interval between sting and death was longer (30 min to a couple of hours) when death was caused by suffocation. In more than 21 of the 26 cases it seemed reasonable to assume that insect allergy might have contributed to the fatal outcome. Six of these cases had a previous history of abnormal reactions to insect venom, thus only a small group would have benefited from the prophylactic effect of hyposensitisation. There was no known previous history of reactions to insect stings in the other cases, but it is likely that more than six persons had had severe reactions to insect stings on other occasions. Presumably many deaths where insect stings have been involved--through not verified as causal--are classified as inexplicable or accidental, thus the real number of deaths caused by wasp or bee stings could be substantially greater. Consequently hyposensitisation after severe insect sting reactions of verified allergic genesis can still be advised.     

大剂量甲泼尼龙联合血浆置换抢救蜂螫伤急性重度溶血性贫血临床观察

目的观察大剂量甲泼尼龙联合血浆置换（PE）抢救蜂螫伤致急性重度溶血性贫血的疗效。方法对13例蜂螫伤致急性重度溶血性贫血患者,随机分为常规量甲泼尼龙联合血液灌流组（HP组）和大剂量甲泼尼龙联合血浆置换组（PE组）,观察其疗效。结果大剂量甲泼尼龙联合血浆置换组比血液灌流联合常规量甲泼尼龙组疗效好,溶血控制迅速,并发症减少,死亡率下降。结论大剂量甲泼尼龙阻断蜂毒素对红细胞的破坏,抑制体内的炎症反应;血浆置换（PE）能有效清除蜂毒素及红细胞溶解产物,二者联合运用能从不同环节阻碍溶血过程的进行,从而发挥了很好的协同治疗效果,保护脏器功能,是抢救蜂螫伤危重者的有效方法。