Clinical Research Study
Honeybee Stings in the Era of Killer Bees: Anaphylaxis and Toxic Envenomation

https://doi.org/10.1016/j.amjmed.2019.10.028Get rights and content

Abstract

Background

Twenty-six years after the arrival of “killer bees” in Arizona, the entire state with the exception of high elevations in the north is populated with this bee variety and 11 people have died at the scene of massive bee attacks.

Methods

Because of the aggressive behavior of these bees we studied bee stings reported to the Arizona Poison and Drug Information Center. The center received 399 calls regarding 312 victims of bee stings from January 2017 to June 2019. Calls originated from private residences and emergency centers.

Results

Stings occurred at victims’ home residences in 272 (84.7%) of cases and 24 (7.5%) in public areas; 251 people suffered 1 sting; 42 individuals, 2-10 stings, 4 had 11-49 stings, and 13 individuals had >50 stings (so-called massive stinging). Three individuals were admitted to intensive care units (ICU) and one 35-year-old man died of anaphylaxis after 1 sting; moderate clinical effects occurred in 32 individuals including 6 admitted to the hospital but not in the intensive care unit. Anaphylaxis occurred in 30 (9.6%) of individuals, 16 receiving 1 sting. Toxic effects, tachycardia, elevated creatinine, or rhabdomyolysis occurred in 13 (4.2%) individuals.

Conclusions

In the past, individuals stung more than 50 times were beekeepers working with European honeybees, whereas, in the current era, single as well as massive stings are the result of feral “killer bees.” This change in epidemiology requires a new approach to sting victims: those with massive stinging should be evaluated and observed for anaphylaxis and serial laboratory values obtained for days to detect the toxic effects of envenomation.

Introduction

Africanized bees or “killer bees” (Apis mellifera scutellata) were first reported in the United States in Hidalgo, Texas, in 1990, a small community located several miles north of the Rio Grande River. The killer bees quickly made their way from Mexico into Arizona and New Mexico by 1993 and subsequently, California and Nevada.1 Today, all wild honeybees in Arizona are killer bees with the exception of those in the high elevations of the northernmost part of the state where these bees cannot survive the winter months (JO Schmidt, personal observation). Geographic spread of this bee newcomer into the Southwest may have been assisted by the almost coincidental decline in feral and domestic honeybee populations from parasitic infections.2,3 For example, colonies of feral European honeybees existed in Organ Pipe National Monument in southern Arizona in the 1980s, but Varroa mites exterminated them by the 1990s (JO Schmidt, personal observation).

Most residents of Arizona are aware of the presence of killer bees in their state and stinging incidents prompt phone calls to the Arizona Poison and Drug Information Center and visits to urgent care centers and emergency departments. We report a 30-month experience with honeybee stings as well as coroner cases of lethal bee attacks in the state and attempt to determine if the presence of killer bees has changed the epidemiology and medical treatment of bee stings.

Section snippets

Data Collection

The Arizona Poison and Drug Information Center (APDIC) in Tucson (Pima County) receives calls from 14 of the 15 counties in Arizona and surrounding states concerning victims of bee and wasp stings; all data is stored in the ToxSentry database. We accessed ToxSentry for all reports pertaining to bee and wasp stings from January 2017 to June 2019. Calls were received by trained personnel who took a history and either suggested on-site care of the bee sting or referred victims to a health care

When and Where Stings Occurred

During the study period of January 2017 through June 2019, 399 calls were received regarding stings to 321 individuals; the majority, 312 or 97.2%, were stung by honeybees and 9 people by wasps or unknown insects. There were 185 victims in 2017, 96 in 2018, and 40 sting victims in 2019. The majority of victims, 192 (59.8%), were stung in Pima County where Tucson is the county seat or Maricopa County where Phoenix is the county seat (36 or 11.2%); the remainder of sting victims came from 12

Discussion

Treatment of bee sting victims in the United States preceding the arrival of Africanized bees was focused on recognition and treatment of anaphylaxis.12 Prior to the arrival of killer bees in the United States in 1990, beekeepers were the sole victims of 50 or more stings.13 In our study, 13 individuals (4.2%) over a 30-month period received >50 stings, mainly outside their home residence (Table 3) and displayed some features of toxic envenomation. All these victims survived, the only death in

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      In cases of systemic toxic reaction, rhabdomyolysis and arrhythmias are common clinical signs (Rahimian et al., 2019; Schmidt, 2018) that may result in renal and heart failure. When the patient is elderly, preexisting chronic conditions, such as high blood pressure, coronary atherosclerosis, kidney failure and others, can contribute to the worsening of the condition, and may be associated with the high lethality of this age group (Rahimian et al., 2019; Toledo et al., 2006). Moreover, children and elderly persons are more likely to remain indoors, the place with the highest occurrence of bee attacks according to Toledo et al. (2006).

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    Funding: None.

    Conflicts of Interest: None.

    Authorship: All authors had access to the data and a role in writing this manuscript.

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