Swarming hornet attacks: shock and acute kidney injury--a large case series from Vietnam.
BACKGROUND
Social hornets attack victims in swarms in Asia, Africa and the Middle East. The venom consists of multiple proteins with myotoxin, haemotoxin, vasodilatory and anticoagulant effects.


METHODS
We reviewed the records of 65 patients at Cho Ray Hospital (Ho Chi Minh City, Vietnam) attacked by swarms of the lesser banded hornet, Vespa affinis. Patients were divided into four groups. Groups A and B presented within 3 days of attack and C and D after 3 days with </=50 or >50 stings, respectively.


RESULTS
Varying degrees of acute kidney injury (AKI) were seen in 38 (58.5%) patients in all groups. Twenty nine required renal replacement therapy. AKI was likely to be myoglobin and toxin induced with a clinical course consistent with acute tubular injury. The prognosis for renal recovery is excellent in those who survive. Seven patients (one from Group A and six from Group B) developed non-anaphylactic shock which led to four deaths. The predominant finding in Groups C and D who sought delayed tertiary care is renal failure.


CONCLUSIONS
This cases which illustrate the varied effects of hornet venom and the need to be vigilant for shock within the first 2 days and persistent AKI beyond 3 days of attack.
Xuan
Bich Huyen Nguyen
BH
Nephrology Section, Cho Ray Hospital, Ho Chi Minh City, Vietnam.
Mai
Hoa Le
HL
Thi
Tan Xuan Nguyen
TX
Thi
Minh Trinh Huynh
MT
Nguyen
Huu Nhan
HN
Rabenou
Rahmin A
RA
D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D000328:Adult; D000368:Aged; D000818:Animals; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use; D006801:Humans; D007299:Insect Bites and Stings / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012769:Shock / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D013256:Steroids / Q000627:therapeutic use; D015996:Survival Rate; D016896:Treatment Outcome; D014744:Vietnam; D014862:Wasp Venoms / Q000009:adverse effects; D014863:Wasps; D055815:Young Adult
D006633:Histamine Antagonists; D013256:Steroids; D014862:Wasp Venoms