Massive Envenomations by Africanized Honey Bees (Apis mellifera scutellata) in French Guiana : A Ten-Year Retrospective Study (2014–2023)

ABSTRACT

Background: Massive Africanized honey bee (Apis mellifera scutellata) stings can cause multiorgan failure and life-threatening complications. In French Guiana, data on such envenomations are scarce. This study aimed to describe the epidemiology, clinical characteristics, and predictors of severity in patients presenting to the emergency department.

Methods: We retrospectively reviewed medical records of all patients admitted for bee stings over the period 2014-2023 at Cayenne Hospital. A composite variable of organ failure was created (neurological, respiratory, hemodynamic and digestive). We analyzed associations between clinical and demographic characteristics, number of stings, and the presence of organ failure. Receiver operating characteristic (ROC) analysis was used to identify sting count thresholds predictive of organ dysfunction.

Results: Among 143 patients included, 42% presented at least one organ failure. The number of stings was higher in the organ failure group (203 ± 225 vs 56 ± 72; OR 1.01 [1.01–1.02]). Widespread stings, hives, and digestive symptoms were significantly associated with organ failure (ORs 18.26 [3.40–456.44], 2.09 [1.04–4.27], and 5.86 [2.74–13.10], respectively). ROC analysis indicated that organ failure risk increased substantially above 72–100 stings. Overall mortality was low (0.7%, n=1/143).

Conclusions: This study provides the first detailed epidemiological and clinical description of massive bee envenomations in French Guiana. Organ failure was strongly associated with higher sting counts. These findings can guide risk stratification and support the development of standardized management protocols. Prospective multicenter studies are warranted to validate these results and evaluate antivenom needs.

摘要

背景：大规模非洲化蜜蜂（Africanized honey bee，Apis mellifera scutellata）螫伤可引发多器官衰竭及致命性并发症。法属圭亚那地区针对此类蜂毒中毒的相关数据较为匮乏。本研究旨在描述急诊科就诊患者的流行病学特征、临床特点及病情严重程度预测因素。

方法：本研究回顾性分析了2014-2023年于卡宴医院因蜂螫伤入院的所有患者的病历资料。构建了涵盖神经、呼吸、血流动力学及消化系统的器官衰竭复合变量，分析了患者临床及人口学特征、螫伤次数与器官衰竭发生之间的关联。采用受试者工作特征（Receiver operating characteristic，ROC）曲线分析确定可预测器官功能障碍的螫伤次数阈值。

结果：共纳入143例患者，其中42%出现至少1种器官衰竭。器官衰竭组患者的螫伤次数显著高于非衰竭组（203±225 vs 56±72；比值比[OR]=1.01，95%置信区间[1.01~1.02]）。全身多处螫伤、荨麻疹及消化系统症状与器官衰竭的发生显著相关（OR分别为18.26[3.40~456.44]、2.09[1.04~4.27]及5.86[2.74~13.10]）。ROC曲线分析显示，当螫伤次数超过72~100次时，器官衰竭风险显著升高。总体病死率较低（0.7%，143例中仅1例死亡）。

结论：本研究为法属圭亚那地区大规模蜂螫伤中毒提供了首份详细的流行病学及临床特征描述。器官衰竭与更高的螫伤次数密切相关。本研究结果可指导临床风险分层，并助力标准化救治方案的制定。未来需开展多中心前瞻性研究以验证本研究结果，并评估抗蜂毒血清的使用需求。