The dog was presented to the referring veterinarian within 30 min of envenomation. The dog had no other physical abnormalities or clinical signs of illness leading up to the current incident. An additional important historical finding for this dog was diagnosis of a congenital spinal malformation resulting in hind limb paralysis and urinary incontinence along with significant muscle atrophy and a resulting body condition score (BCS) of 3/9. No further testing was done at that time so, while a mild chronic kidney disease (CKD) (IRIS Stage 1) at the time of the envenomation is conceivable, it cannot be confirmed. Ten months before this incident, routine blood test results from the dog showed a mild increase in blood urea nitrogen (BUN) with a normal creatinine and mild anemia (hematocrit, HCT, 0.34, RR: 0.38 to 0.56) without appreciable dehydration or clinical signs of kidney disease. Honeybees used for crop pollination had been released within the previous hour near the truck which was parked under a tree with the windows down. This paper describes a dog envenomated by honeybees resulting in acute kidney injury.Ī 9-year-old intact female mixed breed dog weighing 10.8 kg was presented to the referring veterinarian after being found unresponsive in the owner’s truck with at least 10 bees, some of which were dead. Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) as defined by acute onset of bilateral pulmonary infiltrates without evidence of left atrial hypertension and subsequent hypoxemia has been reported in dogs and substantiated using advanced imaging and pulmonary function tests ( 16). The combined effects of severe envenomation and anaphylaxis include intravascular hemolysis, rhabdomyolysis, hepatopathy, cardiac damage, AKI, immune-mediated hemolytic anemia (IMHA), immune-mediated thrombocytopenia (IMTP), and DIC ( 1, 10, 11, 13– 15). Both anaphylactic and anaphylactoid reactions are similar in their appearance and treatment, and consequently the terms are often used interchangeably ( 12). Anaphylactoid reactions resemble anaphylaxis but are independent of IgE and, although compounds have been identified that act directly on cell membranes of mast cells, the exact mechanism for these reactions remains unclear ( 12). Anaphylaxis, a Type I (immediate) hypersensitivity mediated by IgE, is the most serious complication in dogs. Reactions to insect envenomation fall into 5 main categories: local pain and swelling, larger regional reaction, anaphylactic reaction, serum sickness (delayed-type hypersensitivity) occurring 3 d to 2 wk after envenomation, and a rare delayed toxic reaction in humans seen within 24 h after severe envenomation characterized by hemolysis, coagulopathy, hepatopathy, thrombocytopenia, and disseminated intravascular coagulation (DIC) ( 1, 11). Hyaluronidase causes breakdown of connective tissue and promotes further uptake and spread of venom ( 6). Peptide 401 causes mast cells to release histamine and vasoactive amines causing vasodilation ( 1). Melittin has also been associated with acute myocardial ischemia, producing arrhythmias ( 6, 10). This in turn releases myoglobin and hemoglobin, which have been linked to acute tubular necrosis and acute kidney injury (AKI) in humans and other species, including dogs ( 7– 9). Melittin, acting synergistically with phospholipase A 2, disrupts cell membranes of certain mammals and causes lysis of erythrocytes, leukocytes, platelets, myocytes, and vascular endothelium ( 6). The main components of bee venom are: melittin, peptide 401 (mast cell degranulating peptide), phospholipase A 2, hyaluronidase, histamine, dopamine, acid phosphatase, apamine, and norepinephrine ( 5), with melittin being the main component of venom both by amount and lethality. The venom sac continues to contract outside the bee’s body and 100% of the venom is delivered within 60 s ( 4). Honeybees are only able to sting once, as their barbed stinger catches in the victim’s skin, pulling the stinging apparatus from the bee’s body causing the bee to die. The venom in the sting can cause pathology ranging from local benign lesions to severe life-threatening systemic reactions. Although honeybees are comparably more docile than most of these venomous hymenopterans, they are very protective of their hives and they will attack humans or animals that pose a threat to their habitat. The 3 groups of Hymenoptera most frequently responsible for physical symptoms relating to allergic reactions seen in veterinary hospitals are: Apidae (bees), Vespidae (hornets, wasps, and yellow jackets), and Formicidae (fire ants) ( 3). Severe systemic allergic reactions in dogs living in North America most commonly occur because of an insect bite or sting, and the most clinically important encounters originate from insects belonging to the order Hymenoptera ( 1, 2).
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