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114 Bee and Other Insect Stings

not certain the pathogen can be eliminated • Veterinarians and veterinary technicians SUGGESTED READING
by treatment, and 2) even if the cat is are at a higher risk than the general popu- Breitschwerdt EB: Bartonellosis, one health and all
VetBooks.ir Prevention that have fleas should be treated for AUTHOR: Leah A. Cohn, DVM, PhD, DACVIM
lation for Bartonella spp infection. Animals
bacteremic, zoonosis is not transmitted to
creatures great and small. Vet Dermatol 28:96-e21,
people in the absence of fleas.
2017.
fleas (e.g., nitenpyram) before hospitaliza-
tion.
Strict prevention of ectoparasites (fleas, ticks); • Needlestick transmission of B. henselae and EDITOR: Joseph Taboada, DVM, DACVIM
avoid allowing animals to roam B. vinsonii subsp berkhoffii have been docu-
mented in veterinary workers.
Technician Tips
• People diagnosed with cat-scratch disease Client Education
need not get rid of the cat. Instead, strict Strict flea control is the best way to avoid
flea control is warranted. zoonotic infection with Bartonella spp.

Bee and Other Insect Stings

BASIC INFORMATION often show signs of pruritus, dyspnea, • Blood glucose
salivation, incoordination, and collapse. • Blood urea nitrogen/creatinine
Definition ○ Animals with massive envenomation may
Stings from insects such as bees, wasps, and show signs of acute respiratory distress Advanced or Confirmatory Testing
hornets. Spider envenomation is discussed syndrome (p. 27) or disseminated intra- Rarely required except in cases of anaphylaxis
separately (p. 928). vascular coagulation (p. 1218). (p. 54)
Epidemiology Etiology and Pathophysiology
SPECIES, AGE, SEX • Most systemic signs result from an immu- TREATMENT
More likely to occur in young, inquisitive noglobulin E (IgE)–mediated allergic reaction Treatment Overview
animals. Cats may be more tolerant than dogs (p. 1238). Provide relief of discomfort, address hypersen-
to many insect toxins. • Bee stings result in the loss of the stinger, sitivity reaction
which remains in the victim, and the venom
GENETICS, BREED PREDISPOSITION sac (if attached) will continue to administer Acute General Treatment
Boxers and pit bulls seem especially prone to venom (apitoxin). Facial edema/urticaria:
insect hypersensitivity. ○ Melittin is a major component of apitoxin, • Remove stinger if present. Use fine forceps/
and with phospholipase A 2 , it results in tweezers or a flat object (e.g., dull side of a
GEOGRAPHY AND SEASONALITY altered cell permeability, prostaglandin scalpel blade), taking care not to press on
Bee stings are more common during warm production, and cell death. Other com- the stinger’s sac (if present).
weather when insects are active. ponents include histamine and hyaluroni- • Diphenhydramine 1-2 mg/kg IM
dase, which support inflammation and • Dexamethasone sodium phosphate 0.2 mg/
Clinical Presentation tissue damage. kg IM or slow IV
HISTORY, CHIEF COMPLAINT • Wasps can sting multiple times and inject Anaphylaxis may require diphenhydramine and
For bees, wasps, hornets (order Hymenop- a small amount of venom at each sting. dexamethasone, as well as one or more of the
tera), usually, sting is unwitnessed. Instead, ○ Venom contains histamine, hyaluronidase, following treatments, according to escalating
animals present for clinical signs associated phospholipase, and other small peptides. degree of severity of the reaction:
with allergic reaction (p. 54). Severity of signs The venom also contains acetylcholine, • Intravenous isotonic crystalloid fluids (up to
will depend on the type of venom, location of which contributes to pain. 45-90 mL/kg IV, given incrementally)
the sting, number of stings, and sensitivity of • A small number of dogs and cats may develop • Epinephrine 0.01 mg/kg IV
the animal receiving the sting. anaphylaxis.
Behavior/Exercise
PHYSICAL EXAM FINDINGS DIAGNOSIS Animals should be leash-walked or supervised
• Bees, wasps, hornets when outside to avoid re-exposure.
○ Local reaction associated with an immu- Diagnostic Overview
nologic response is the most common The diagnosis is frequently presumptive and based Recommended Monitoring
finding. This may include a swollen on clinical signs and history of possible exposure. Animals with facial swelling or urticaria should
head/face or diffuse urticaria. Cases Stings are seldom witnessed by pet owners. be monitored for 20-30 minutes to ensure
with severe facial swelling can develop clinical signs are not progressing.
upper airway obstruction and respiratory Differential Diagnosis
distress. • Cellulitis PROGNOSIS & OUTCOME
○ Less commonly, an animal may develop • Peripheral edema
anaphylaxis, usually within 15 minutes • Other causes of allergy or anaphylaxis Most animals with insect bites and stings
of sting (p. 54). Anaphylaxis in dogs have an excellent prognosis. Animals with
manifests as vomiting, defecation, Initial Database severe systemic signs have a more guarded
urination, muscular weakness, collapse, • Packed cell volume short-term prognosis as dictated by the severity
respiratory depression, or seizures. Cats • Serum total protein of signs.

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