title: Deaths from bee stings: a report of three cases from Pretoria, South Africa.
abstract: In South Africa bee stings are most commonly caused by either Apis mellifera capensis or A. mellifera scutellata, indigenous species which are notoriously aggressive when compared to European honey bees. According to Statistics South Africa, 109 deaths were documented for the period 2001-2011 as having been caused by hornets, wasps, and bees (ICD10-X26). This appears to be a small number but, as was reported in Australia, these statistics might be inaccurate due to either over- or underreporting of cases. We report 3 cases of fatalities due to bee stings, including one with postmortem features of diffuse intravascular coagulopathy. A brief overview of the venom of the honey bee, reactions following a bee sting and possible mechanisms of death are presented. Confirming the diagnosis in these cases may be very problematic for the forensic pathologist, as in many cases minimal history is available and both external and internal examination could fail to reveal any specific signs of bee sting or other obvious morphologic abnormalities. Thus, there is a need for reliable confirmatory or supportive diagnostic tests.
authors.affiliation: Department of Forensic Medicine, University of Pretoria, Private Bag X323, Arcadia, 0007, South Africa. lorraine.dutoit@up.ac.za.
authors.forename: Lorraine
authors.initials: L
authors.lastname: du Toit-Prinsloo
authors.affiliation: Department of Forensic Medicine, University of Pretoria, Private Bag X323, Arcadia, 0007, South Africa.
authors.forename: Neil Kennith
authors.initials: NK
authors.lastname: Morris
authors.affiliation: Department of Immunology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia, 0007, South Africa.|Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa.
authors.forename: Pieter
authors.initials: P
authors.lastname: Meyer
authors.affiliation: Department of Forensic Medicine, University of Pretoria, Private Bag X323, Arcadia, 0007, South Africa.
authors.forename: Gert
authors.initials: G
authors.lastname: Saayman
mesh_terms: D000328:Adult; D000707:Anaphylaxis / Q000209:etiology*; D000818:Animals; D000906:Antibodies / Q000097:blood; D001514:Bee Venoms / Q000276:immunology; D001516:Bees; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007299:Insect Bites and Stings / Q000097:blood / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D013019:South Africa; D053802:Tryptases / Q000097:blood
chemical_list: D000906:Antibodies; D001514:Bee Venoms; D007073:Immunoglobulin E; D053802:Tryptases
keywords: Anaphylaxis; Beestings; Envenomation; Medico-legal postmortem examination; Tryptase