Massive envenomations by bees in French Guiana: A ten-year retrospective study (2014-2023)

Massive bee stings can cause systemic manifestations and life-threatening complications. In French Guiana, data on such envenomations are scarce. This study aimed to describe the epidemiology, clinical characteristics, and management of patients presenting to the emergency department.

We retrospectively reviewed medical records of all patients admitted for bee stings over the period 2014-2023 at Cayenne Hospital. A composite variable of systemic involvement was created (neurological, respiratory, hemodynamic and digestive). All analyses were descriptive. An exploratory two-graph receiver operating characteristic (TG-ROC) analysis was used to describe the sensitivity and specificity of sting-count cut-offs for four binary indicators of systemic involvement.

Among 143 patients included, 40% (n = 57) presented at least one systemic manifestation. The median number of stings was 50 [20-150]. In the exploratory TG-ROC analysis, the cut-offs maximizing the Youden index were approximately 72 stings for digestive and hemodynamic manifestations and 99 stings for neurological and respiratory manifestations, with modest sensitivity (0.50-0.76) and specificity (0.68-0.76). Overall mortality was low (0.7%, n = 1/143).

This study provides the first detailed epidemiological and clinical description of massive bee envenomations in French Guiana. Exploratory analyses suggested that systemic manifestations may occur at sting counts below the conventional 200-sting threshold. These findings should not be interpreted as a validated clinical cutoff and require confirmation in prospective multicenter studies.