JOURNAL OF INDIAN ACADEMY OF FORENSIC MEDICINE

1. Case Report
Journal Indian Acad Forensic Medicine 2015 ,Vol 37 No .1
Dr.Nafeeya
Department of Forensic Medicine &
Toxicology

2. • Fatal Asian Giant Hornet‟s Sting: First Case Series
from Kumaon Hills of Uttarakhand, India
• Paramjeet singh , Ashok kumar et all
• Department of Forensic Medicine & Toxicology
• Medicine , Microbiology
• Government Medical College, Haldwani uttarakhand

3. Overview
• Introduction
• In detail about the cases
• Conclusion
• Discussion
• Autopsy finding
• Medicolegal importance

4. Introduction
• Hornet stings are medically important sting
• ARF, Myocarditis , Hepatitis
• Venom – myocardial injury or liver impairment
• Delay-fatal outcome
• 6500 feet

5. Case 1
• A 34 -year-old male
• Complaints -multiple hornet stings on face, back, upper and lower limbs.
• O/E-Generalized swelling of the body
• Multiple rounded erythematous lesions of 2-4 cm size, with skin necrosis.
• Features of cellulites were also present.
• ICU.
• ABG metabolic acidosis.
• ECG was showing sinus tachycardia .
Central skin necrosis
Dead

6. Case 2
• 38 years old male -26 bite marks.
• Severe pain at the site of bites, generalized swelling all over
the body and oliguria.
• He was anemic-intravascular hemolysis.
• The patient was put on intravenous antibiotics,
antihistamines along with corticosteroids.
• ICU - 4 units packed RBCs and 5 units of fresh frozen
plasma
• Two days- He developed anuria, hypertension and
tachypnoea.
• His blood urea- 164 mg% and serum Creatinine to 7.7
mg%.
• Metabolic acidosis-hemodialysed[7 times]
HB-4.4 gm%,
platelet count 4.5 lacs/ cubic
mm.
Urine examination- positive
for RBCs.
CPK- 487 U/L,
SGOT-264 U/L
SGPT of 448 U/L.
Blood Urea of 108 mg%
Serum Creatinine of 2.3 mg%.

7. Case 3
• 34 years female
• 6 bites on face and back .
• Severe pain at bite sites.
• Swelling and erythema around the lesions.
• She was not having any features suggestive of acute renal
failure or hemolysis
• Treatment – conservatively ,iv ,antibiotics,antihistamines &
supportive
• 6 days
Investigation –
raised WBC,
polymorph
count,elevated
liver & muscle
enzymes

8. Umblicated lesion Central skin necrosis

9. Conclusion
•The delay in diagnosis,
unawareness of fatal complication &
• Delay in treatment may also be a contributory factor for fatal
outcome.
•In the remote, backward area of hills, where the emergency medical
facilities are not easily available, lead to increase mortality.

10. V. Sakhuja et al
Intravascular
hemolysis-dialysis
Renal HPE-ATN
Liver biopsy-
centilobular
necrosis
Acute renal failure following hornet sting bite

11. Aman sharma et all
Focal interstitial
infiltration with
eosinophil &
lymphocytes with
hyaline & pigmented
granular cast in the
tubules.ATN
Acute tubulo-intestitial nephritis leading to acute renal failure following multiple hornet
sting

12. Yashad Dongol et all
Acute renal failure following multiple hornet sting bite
Urea
creatinine
&Cpk values –
suggestive of
ARF

13. Harold D.levine
Acute myocardial infarction following wasp/ hornet sting bite
Case 2-Acute infarct and transient
atrial fibrillation
Case 1-Acute Anteroseptal
Myocardial Infarction.

14. Discussion

15. Discussion
• Hymenoptera (Ants,Bees,Wasps)
• Apidae , Vespidae , formicidae
• Characteristics – stingers - females
• Venom -The hornet sting produces 19 mg of
hydroxytryptamine per gram of venom sac.
• Ca+2-dependent cell death pathways-MOA
• Melittin, apamine, phospholipases ,hyaluronidase ,acid
phosphatase ,histamine & kinin.

16. Signs & Symptoms
• Large local reaction -48 hrs – 7 days
• Toxic reaction – 50- 100 stings –IgE- antibodies
• Unusal reaction – vasculitis , neuritis , encephalitis etc
• Anaphylaxis – laryngeal edema,collapse, shock
,hypotension bronchospasm

17. Diagnosis
• Skin allergy test
Skin prick test ,
Skin injection test,
Skin scrath test.
• RAST-Radioallergosorbent test
• NIH guidelines
• Similar diagnostic value in terms of sensitivity and specificity
• Venom-specific IgE and IgG antibodies

18. Stinging Insect First aid
Treatment Kit
Bite pump

19. Autopsy findings
• Skin – sting marks all over the body
• Pulmonary edema
• Laryngeal edema
• Signs of asphyxia

20. • Preservation :
• Sting mark with 5cm margin subcutaneous tissue for analysis
• -70 c
• Blood – tryptase analysis
• Serum IgE antibodies
Skin

21. Medicolegal importance
• Sudden death - choking by anaphylaxis
• Traffic accidents-
• Crime-suicide or homicide
• Occupational accidents - Bee keepers
Bee venom collectors
Confectionery shops
Farming
Honey industry
Preservation of fruits
Refineries

22. THE NEW YORK TIMES
• ‘Murder Hornets’ in the U.S.: The Rush to Stop the Asian
Giant Hornet.
• In Japan, the hornets kill up to 50 people a year. Now, for the
first time, they have arrived in the United States.
• Kills 50-china, Japan-150
• Efforts to stop these insects from establishing colonies in
North America
• Sylo Insecticide & D-fense Dust
• https://youtu.be/-gAVlh-7WZM 13 NOV 2020

23. References
• Principles of Forensic Medicine & Toxicology Rajesh Bardalae.
• Knights Forensic Pathology.
• Anil Aggrawal textbook of forensic medicine and toxicology.
• Robert E.Reshman .The new england journal of medicine
• Haelovd D.levine –acute myocardial infarction following wasp bite.Journal of family medicine and primary care
• Yashad dongaol et all –acute renal failure following multiple hornet sting
• V.shakhuja et all- acute renal failure following multiple hornet sting
• Aman sharma et all-acute tubular interstital nephritis following acute renal failure