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.