Syed Abd Hamid, Syed Abdul Khaliq
(2015)
Hornet stings: factors associated with systemic reactions in children admitted in HUSM.
Masters thesis, Universiti Sains Malaysia.
Abstract
INTRODUCTION:
Hornets, bees, wasps, and ants are stinging insect with venoms which all belongs under the order Hymenoptera. The stings of these insects is a health concern globally. The stings may result from a mild local reaction to a fatal severe systemic reaction. The venom itself can cause direct toxic envenomation, and may also cause systemic allergic responses. The commonest hymenoptera species that causes problems in Malaysia one of the vespids, the hornet. This study looks to the features of hornet sting among children, the prevalence of systemic reactions and the factors associated with systemic reaction.
OBJECTIVE:
The main objectives of this study is to look at the profiles of children admitted in Hospital Universiti Sains Malaysia (HUSM) due to hornet stings. This study also looks at the prevalence of systemic reactions as well as to determine the factors associated with the development of systemic reactions among children stung by hornet.
METHODOLOGY:
This study was a retrospective record review, of all children admitted in HUSM from 2006 till 2011. The sampling frame was the records obtained from the Medical Record Office and all patients fulfilling the the inclusion and exclusion criteria were recruited into the study.
RESULT:
A total of 141 cases were recruited in this study. Majority were boys (61.7%), and almost all were Malay (98.6%). The youngest patient in our study population was a 6- month old child and the oldest 17 years old. Sixteen cases (11.3%) had history of allergy, 26 cases (18.4%) had history of atopy, 12 cases (8.5%) had history of asthma and 17 cases (17.5%) had a history of previous exposure to hornet stings. Majority of cases were direct visits to HUSM (75.9%). The others were referred from Klinik Kesihatan (19.9%), from district hospital (3.5%) and was admitted following ambulance call (0.7%). The number of cases of children admitted in HUSM for hornet stings is lowest during the rainy months, and peaked in the dry months of April to August. Eighty percent of the cases occurred during daytime (0701H till 1900H), The peak time for stings to occur is at 1509H ± 6.08. Fifty-one percent of the sting events occurred outdoor. Majority of the cases had been stung at their head, face and neck (45.4%). The others were stung at their upper limbs (excluding hand) (22%), at their hand (42.6%), at their anterior trunk (10.6%), at their posterior trunk (17.7%), at their buttocks and genitals (4.3%), at their lower limbs (excluding foot) (12.8%) and at their foot (17.7%). A total of 140 cases (99.3%) had local reaction and only 1 case had no reaction at all. The local reactions were either swelling, pain, itchiness, redness or local infection at the stung site. Fourty-two cases (29.8%) were recorded to present with systemic reactions. Among those with systemic reactions, 37 had severe complications. Anaphylaxis was the commonest reaction observed among the severe complications with 32 cases (22.7%) followed by coagulopathy (7%), renal injuries (0.04%), sepsis (1.4%), cardiovascular, liver impairment and and rhabdomyolisis with 1 case each (0.7% each), and there were 3 deaths noted (2.12%). Children with hornet sting at their anterior trunks has 7.8 times the odds of having systemic reaction (95%CI 2.16, 28.14, p = 0.02). Children with a history of atopy were 4.3 times at odds of having systemic reaction following hornet sting (95% CI 1.63, 11.24, p = 0.03) .
CONCLUSION:
Understanding the features of hornet stings and the behaviour of the insect may help in reducing its incidence. Systemic reactions occurs in 29.8% of the cases with hornet stings. children with a history of atopy and those stung at their anterior necks are the ones with the highest risks of developing systemic reactions. Recognising the features of severe reactions and the factors that may result in a more severe reaction is important to ensure early appropriate treatment is initiated.
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