{ "abstract": "Background: 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. 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 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. Results: 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). Conclusions: 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. Author summary: Most bee stings cause only local pain and swelling. However, being stung many times can lead to serious illness because of the large amount of venom injected. Few studies have described these multiple-sting attacks in French Guiana. We reviewed the medical records of 143 patients treated at Cayenne Hospital after multiple honey bee stings between 2014 and 2023. Most patients were men, and the median number of stings was 50. Forty percent of patients developed at least one systemic manifestation, such as breathing problems, low blood pressure, severe digestive symptoms, or neurological symptoms. Our results suggest that such symptoms may occur after fewer than the 200 stings traditionally considered to indicate severe envenomation. However, this observation needs to be confirmed, as our study was retrospective and based on patients treated at a single hospital, and the number of stings was estimated from medical records. These findings suggest that people who have been stung many times should be assessed carefully, even when the number of stings is below 200. Further studies are needed to confirm these results.", "abstract_shown": true, "affiliations": [ "Emergency Department, Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana, France", "University Department of General Practice, Université des Antilles-Guyane, Pointe-à-Pitre, Guadeloupe, France", "Emergency Department, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique, France", "Infectious and Tropical Diseases Unit, Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana, France", "Centre d’Investigation Clinique Guyane – INSERM 1424, UMR UA 17 Santé des Populations en Amazonie, Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana, France", "Intensive Care Unit, Centre Hospitalier Universitaire de Guyane, Cayenne, French Guiana, France" ], "article_type": "Research Article", "arxiv": null, "author_total": 8, "authors": [ { "affs": [ 0, 1 ], "name": "Rémy Blaud" }, { "affs": [ 0 ], "name": "Rémi Mutricy" }, { "affs": [ 2 ], "name": "Florian Negrello" }, { "affs": [ 1 ], "name": "Marie Eeckhout" }, { "affs": [ 3, 4 ], "name": "Loïc Epelboin" }, { "affs": [ 4 ], "name": "Maylis Douine" }, { "affs": [ 5 ], "name": "Hatem Kallel" }, { "affs": [ 0, 4 ], "name": "Alexis Fremery", "orcid": "0000-0001-5365-6191" } ], "bibtex": "https://research.draconitic.com/paper/335700a1k3tsr.bib", "cited_by": 0, "doi": "10.1371/journal.pntd.0014824", "fulltext_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014824", "id": "335700a1k3tsr", "issns": [ "1935-2735", "1935-2727" ], "landing_url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014824", "language": "en", "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Allergies" ], [ "heading", "Animals" ], [ "heading", "Arthropoda" ], [ "heading", "Bees" ], [ "heading", "Biology and Life Sciences" ], [ "heading", "Chemical Elements" ], [ "heading", "Chemistry" ], [ "heading", "Clinical Immunology" ], [ "heading", "Clinical Medicine" ], [ "heading", "Critical Care and Emergency Medicine" ], [ "heading", "Entomology" ], [ "heading", "Eukaryota" ], [ "heading", "Hematology" ], [ "heading", "Hemodynamics" ], [ "heading", "Honey Bees" ], [ "heading", "Hymenoptera" ], [ "heading", "Immunology" ], [ "heading", "Insects" ], [ "heading", "Invertebrates" ], [ "heading", "Medicine and Health Sciences" ], [ "heading", "Organisms" ], [ "heading", "Oxygen" ], [ "heading", "Pathology and Laboratory Medicine" ], [ "heading", "Physical Sciences" ], [ "heading", "Research Article" ], [ "heading", "Resuscitation" ], [ "heading", "Toxic Agents" ], [ "heading", "Toxicology" ], [ "heading", "Toxins" ], [ "heading", "Venoms" ], [ "heading", "Zoology" ], [ "openalex", "1311|Venomous Animal Envenomation and Studies" ], [ "plos", "/Biology and life sciences/Immunology/Clinical immunology/Allergies" ], [ "plos", "/Biology and life sciences/Organisms/Eukaryota/Animals/Invertebrates/Arthropoda/Insects/Hymenoptera/Bees" ], [ "plos", "/Biology and life sciences/Organisms/Eukaryota/Animals/Invertebrates/Arthropoda/Insects/Hymenoptera/Bees/Honey bees" ], [ "plos", "/Biology and life sciences/Toxicology/Toxic agents/Toxins/Venoms" ], [ "plos", "/Biology and life sciences/Zoology/Animals/Invertebrates/Arthropoda/Insects/Hymenoptera/Bees" ], [ "plos", "/Biology and life sciences/Zoology/Animals/Invertebrates/Arthropoda/Insects/Hymenoptera/Bees/Honey bees" ], [ "plos", "/Biology and life sciences/Zoology/Entomology/Insects/Hymenoptera/Bees" ], [ "plos", "/Biology and life sciences/Zoology/Entomology/Insects/Hymenoptera/Bees/Honey bees" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Clinical immunology/Allergies" ], [ "plos", "/Medicine and health sciences/Critical care and emergency medicine" ], [ "plos", "/Medicine and health sciences/Critical care and emergency medicine/Resuscitation" ], [ "plos", "/Medicine and health sciences/Hematology/Hemodynamics" ], [ "plos", "/Medicine and health sciences/Immunology/Clinical immunology/Allergies" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Toxicology/Toxic agents/Toxins/Venoms" ], [ "plos", "/Physical sciences/Chemistry/Chemical elements/Oxygen" ] ], "openalex": "W7223391042", "pdf_url": "https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0014824&type=printable", "pmcid": "PMC13719035", "pmid": "42912812", "published": "2026-10-23", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/335700a1k3tsr.ris", "sources": [ { "first_seen": "2026-10-30T12:17:23Z", "native_id": "10.1371/journal.pntd.0014824", "source": "plos", "url": "https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0014824" }, { "first_seen": "2026-11-02T12:22:57Z", "native_id": "PMC13719035", "source": "pmc", "url": "https://doi.org/10.1371/journal.pntd.0014824" } ], "subjects": [ { "field": "biology", "origin": "plos:immunology", "subfield": "immunology" }, { "field": "biology", "origin": "plos:zoology", "subfield": "zoology-behaviour" }, { "field": "chemistry", "origin": "heading:Chemistry", "subfield": "general" }, { "field": "medicine", "origin": "plos:toxicology", "subfield": "pharmacology-toxicology" } ], "title": "Massive envenomations by bees in French Guiana: A ten-year retrospective study (2014–2023)", "title_text": "Massive envenomations by bees in French Guiana: A ten-year retrospective study (2014–2023)", "type": "peer-reviewed", "updated_at": "2026-11-02T12:22:57Z", "url": "https://research.draconitic.com/paper/335700a1k3tsr", "venue": "PLOS Neglected Tropical Diseases", "versions": [] }