Wei-Fan Ou1, Wei-Hsuan Huang1, Hsien-Fu Chiu2, Yan-Chiao Mao3, Mei-Chin Wen4, Cheng-Hsu Chen2,5, Sheng-Jou Hung6, Ming-Ju Wu2,7,8,9, Chieh-Liang Wu10,11, Wen-Cheng Chao10,12. 1. Department of Internal Medicine. 2. Division of Nephrology, Department of Internal Medicine. 3. Division of Clinical Toxicology, Department of Emergency Medicine. 4. Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital. 5. Department of Life Science, Tunghai University. 6. Department of Medical Research, Taichung Veterans General Hospital. 7. School of Medicine, Chung Shan Medical University. 8. Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, College of Life Science, National Chung Hsing University. 9. Graduate Institute of Clinical Medical Science, School of Medicine, China Medical University. 10. Department of Critical Care Medicine, Taichung Veterans General Hospital. 11. Department of Industrial Engineering and Enterprise Information. 12. Department of Computer Science, Tunghai University, Taichung, Taiwan.
Abstract
INTRODUCTION: Multiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings. PATIENT CONCERNS: Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps (Vespa basalis). DIAGNOSIS: Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings. INTERVENTIONS: Both 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17. OUTCOMES: Both patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2. CONCLUSION: In conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.
INTRODUCTION: Multiple wasp stings is an emergency result from systemic reactions to the toxin with a wide range of manifestations, and we presented 2 patients with distinct clinical and transcriptomic findings. PATIENT CONCERNS: Two patients without systemic disease presented with nearly 90 painful papules after attacked by a swarm of wasps (Vespa basalis). DIAGNOSIS: Patient 1 was a 44-year-old healthy male whose clinical manifestations mainly comprised hemolysis, hepatic injury, rhabdomyolysis, and acute kidney injury. Patient 2 was a 49-year-old healthy female who presented with severe acute respiratory distress syndrome (ARDS) in addition to certain clinical manifestations that were also found in patient 1. We used ribo- nucleic acid sequencing (RNA-Seq) to characterize the inflammatory responses of 2 patients with distinct clinical manifestations after multiple wasp stings. INTERVENTIONS: Both 2 patients received 5 sessions of plasmapheresis, and patient-1 further received mechanical ventilation for 8 days as well as 8 sessions of hemodialysis until day 17. OUTCOMES: Both patients recovered uneventfully after the aforementioned management. We used RNA-Seq to demonstrate a largely regulated neutrophil-predominated immune response in patient 1. In patient 2, we found a profound neutrophilc response on week 1 and a robust neutrophilic as well as pro-inflammatory responses on week 2. Furthermore, we found increased expression of signals that were associated with renal system process on week 2. CONCLUSION: In conclusion, we report 2 patients who manifested with shared and distinct presentations after an attack by the same swarm of wasps. Both patients had hemolysis, rhabdomyolysis, hepatic injury and acute kidney injury, and 1 patient had ARDS. The whole transcriptomic analyses were consistent with the distinct clinical manifestation, and these results suggest the potential of RNA-Sequencing to disentangle complex inflammatory responses in patients with multiple wasp stings. Plasmapheresis and corticosteroid were administered to both patients and case 2 also underwent 8 sessions of hemodialysis.
Authors: Zheng Liu; Xiang-Dong Li; Bo-Hui Guo; Yi Li; Ming Zhao; Hai-Yan Shen; Ying Zhai; Xue-Li Wang; Tao Liu Journal: Environ Health Prev Med Date: 2016-02-24 Impact factor: 3.674
Authors: Giacomo Bellani; John G Laffey; Tài Pham; Eddy Fan; Laurent Brochard; Andres Esteban; Luciano Gattinoni; Frank van Haren; Anders Larsson; Daniel F McAuley; Marco Ranieri; Gordon Rubenfeld; B Taylor Thompson; Hermann Wrigge; Arthur S Slutsky; Antonio Pesenti Journal: JAMA Date: 2016-02-23 Impact factor: 56.272
Authors: S J Harper; J H Pringle; A C Wicks; J Hattersley; L Layward; A Allen; A Gillies; I Lauder; J Feehally Journal: Kidney Int Date: 1994-03 Impact factor: 10.612
Authors: Jing Liu; Sanjeev Kumar; Egor Dolzhenko; Gregory F Alvarado; Jinjin Guo; Can Lu; Yibu Chen; Meng Li; Mark C Dessing; Riana K Parvez; Pietro E Cippà; A Michaela Krautzberger; Gohar Saribekyan; Andrew D Smith; Andrew P McMahon Journal: JCI Insight Date: 2017-09-21