Hymenoptera stings in Brazil: a neglected health threat in Amazonas State

Costa, Allyson Guimarães; Chaves, Bárbara Aparecida; Murta, Felipe Leão Gomes; Sachett, Jacqueline Almeida Gonçalves; Sampaio, Vanderson Souza; Silva, Vanessa Costa; Monteiro, Wuelton Marcelo

doi:10.1590/0037-8682-0109-2017

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Revista da Sociedade Brasileira de Medicina Tropical

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Short Communication • Rev. Soc. Bras. Med. Trop. 51 (01) • Jan-Feb 2018 • https://doi.org/10.1590/0037-8682-0109-2017 copy

Hymenoptera stings in Brazil: a neglected health threat in Amazonas State

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

Hymenoptera injuries are commonly caused by stinging insects. In Amazonas state, Brazil, there is no information regarding distribution, profile, and systemic manifestations associated with Hymenoptera injuries.

METHODS:

This study aimed to identify risk factors for systemic manifestation using the Brazilian Notifiable Diseases Surveillance System (2007 to 2015).

RESULTS:

Half of Hymenoptera injuries were caused by bee stings. Hymenoptera injuries were concentrated in Manaus, and 13.36% of cases displayed systemic signs. Delayed medical assistance (4 to 12 hours) presented four times more risk for systemic manifestations.

CONCLUSIONS:

Simple clinical observations and history of injury are critical information for prognostic improvement.

Keywords:
Hymenoptera sting; Bee sting; Wasp sting; Ant sting; Systemic manifestation

Characteristics (Completeness)	Number	%
Hymenoptera (n=423; 100%)
Bees	212	50.12
Wasps	81	19.15
Ants	130	30.73
Sex (n=423; 100%)
Male	263	62.17
Female	160	37.83
Age group in years (n=423; 100%)
<=10	133	31.44
10-20	64	15.13
20-30	69	16.31
30-40	51	12.06
40-50	43	10.17
50-60	33	7.80
>60	30	7.09
Schooling in years (n=213; 50.35%)
Illiterate	33	7.80
1-4	72	17.02
5-8	62	14.66
>8	46	10.87
Ignored	210	49.65
Area of occurrence (n=413; 97.64%)
Urban	239	56.50
Rural	174	41.14
Ignored	10	2.36
Work related accident (N=404; 95.51%)
No	323	76.36
Yes	81	19.15
Ignored	19	4.49
Anatomical region of the injury (n=396; 93.62%)
Lower limbs	104	24.59
Upper limbs	134	31.68
Body	31	7.33
Head	127	30.02
Ignored	27	6.38
Time elapsed from sting to medical assistance in hours (n=392; 92.67%)
0-3	319	75.41
4-6	28	6.62
7-12	9	2.13
13-24	18	4.26
>24	18	4.26
Ignored	31	7.33

Variables	Systemic manifestations		Crude OR (CI 95%)	p-value	Adjusted OR (CI 95%)	p-value
Variables	Yes (%)	No (%)
Hymenoptera
Wasp	6 (10.34)	75 (20.55)	1	1	-	-
Bee	36 (62.07)	176 (48.22)	2.556 (1.033-6.323)	0.042	3.170 (1.134-8.856)	0.028
Ant	16 (27.59)	114 (31.23)	1.754 (0.656-4.686)	0.262	4.085 (1.219-13.687)	0.022
Sex
Male	36 (62.07)	227 (62.19)	1	1	-	-
Female	22 (37.93)	138 (37.81)	1.005 (0.567-1.779)	0.986	-	-
Age group in years
<=10	17 (29.31)	116 (31.78)	1	1	-	-
10-20	7 (12.07)	57 (15.62)	0.837 (0.328-2.135)	0.711	1.208 (0.414-3.529)	0.728
20-30	7 (12.07)	62 (16.99)	0.770 (0.303-1.957)	0.584	0.506 (0.168-1.524)	0.226
30-40	5 (8.62)	46 (12.60)	0.741 (0.258-2.127)	0.578	1.086 (0.335-3.519)	0.889
40-50	7 (12.07)	36 (9.86)	1.326 (0.509-3.452)	0.562	1.127 (0.341-3.717)	0.844
50-60	7 (12.07)	26 (7.12)	1.837 (0.691-4.882)	0.223	1.531 (0.473-4.950)	0.477
>60	8 (13.79)	22 (6.03)	2.481 (0.953-6.454)	0.062	1.462 (0.477-4.485)	0.506
Schooling in years
Illiterate	4 (6.90)	29 (7.95)	1	1	-	-
1-4	11 (18.97	61 (16.71)	1.307 (0.383-4.458)	0.669	-	-
5-8	10 (17.24)	52 (14.25)	1.394 (0.401-4.843)	0.601	-	-
>8	5 (8.62)	41 (11.23)	0.884 (0.218-3.578)	0.863	-	-
Area of occurrence
Urban	26 (44.83)	213 (58.36)	1	1	-	-
Rural	31 (53.45)	143 (39.18)	1.031 (0.832-1.278)	0.777	-	-
Work related injury
No	42 (72.41)	281 (76.99)	1	1	-	-
Yes	15 (25.86)	66 (18.08)	1.520 (0.795-2.905)	0.205	1.403 (0.688-2.861)	0.352
Anatomical region of the injury
Lower limbs	9 (15.52)	95 (26.03)	1	1	-	-
Upper limbs	19 (32.76)	115 (31.51)	1.743 (0.754-4.033)	0.194	2.496 (0.982-6.339)	0.054
Body	6 (10.34)	25 (6.85)	2.533 (0.824-7.787)	0.105	3.402 (0.816-14.171)	0.093
Head	23 (39.66)	104 (28.49)	2.334 (1.028-5.296)	0.043	3.236 (1.067-9.809)	0.038
Time elapsed from sting to medical assistance in hours
0-3	36 (62.07)	283 (77.53)	1	1	-	-
4-6	9 (15.52)	19 (5.21)	3.723 (1.566-8.849)	0.003	4.026 (1.618-10.016)	0.003
7-12	4 (6.90)	5 (1.37)	6.288 (1.614-24.496)	0.008	7.885 (1.716-36.229)	0.008
13-24	2 (3.45)	16 (4.38)	0.982 (0.217-4.449)	0.982	1.156 (0.245-5.459)	0.854
>24	4 (6.90)	14 (3.84)	2.246 (0.701-7.193)	0.173	1.824 (0.464-7.164)	0.389

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[1] Corresponding author: Wuelton Marcelo Monteiro. e-mail:wueltonmm@gmail.com