SEVERE AND FATAL MASS ATTACKS BY KILLER BEES (AFRICANIZED HONEY-BEES APIS-MELLIFERA-SCUTELLATA) IN BRAZIL - CLINICOPATHOLOGICAL STUDIES WITH MEASUREMENT OF SERUM VENOM CONCENTRATIONS

in Sao Paulo State, Brazil, five males, aged between 8 and 64 years, w ere attacked by 'Africanized' honey bees (Apis mellifera scutellata). The estimated number of stings received by each patient ranged from >2 00 to >1000. All five were transferred to intensive care units in Sao Paulo City. Clinical features included intravascular haemolysis, respi ratory distress with ARDS, hepatic dysfunction, rhabdomyolysis (with m yoglobinaemia and myoglobinuria), hypertension and myocardial damage ( perhaps explained by release of endogenous catecholamines by venom pho spholipase A(2) and mellitin), shock, coma, acute renal failure and bl eeding. Laboratory findings included gross neutrophil leucocytosis, el evated serum enzymes [AST, ALT, LDH, CPK(predominantly CPK-MM)] and cr eatinine. Clotting times were slightly prolonged. Despite treatment wi th antihistamines, corticosteroids, bronchodilators, vasodilators, bic arbonate, mannitol and mechanical ventilation, three of the patients d ied between 22 and 71 h after the attacks, with histopathological feat ures of ARDS, hepatocellular necrosis, acute tubular necrosis, focal s ubendocardial necrosis and disseminated intravascular coagulation. Who le bee venom and phospholipase A(2) (PLA(2)) antigen concentrations we re measured in serum and urine for the first time, using enzyme immuno assay. High venom and PLA, concentrations were detected in serum and u rine for more than 50 h after the stings in two fatal cases, in one of which the total circulating unbound whole venom was estimated at 27 m g, one hour after the attack. An antivenom should be developed to trea t the increasing numbers of victims of mass attacks by Africanized 'ki ller' bees in USA, Middle and South America.