Correspondence

Not a “Bee-Zoar,” but a Wasp

N Engl J Med 1997; 337:575-576August 21, 1997

Article

To the Editor:

We enjoyed the cautionary tale by Lynch and Rothstein (June 12 issue)1 about a woman who accidentally ingested an insect while drinking a can of soda and was apparently stung in the throat. However, the endoscopic photograph of the bug in her stomach, described as a “bee-zoar,” shows not a bee but a wasp. The culprit appears to be the German yellow jacket, Vespula germanica, an unwelcome but now firmly established migrant from Europe.2 A bee's stinger is barbed and would have remained in the oropharyngeal mucosa with its poison sac and have been easily visualized. A wasp's stinger is easily withdrawn. The allergens in bee venom differ from those in wasp venom, and generally the two are not cross-reactive3 — an important consideration in choosing effective immunotherapy for type I hypersensitivity to insect stings. Clearly, in the case reported, correct speciation was not required for therapy.

Yellow jackets commonly frequent picnics; they are particularly attracted to soft-drink cans and hide in them as they drink. Honeybees tend instead to seek nectar, which provides a more concentrated solution of sugar than do soft drinks. True bee ingestion can occur when Africanized honeybees make lethal attacks on dogs 4 and presumably on humans.

Richard E. Sobonya, M.D.
Arizona Health Sciences Center, Tucson, AZ 85724

Justin O. Schmidt, Ph.D.
Carl Hayden Bee Research Center, Tucson, AZ 85719

4 References

1
Lynch JP, Rothstein RD. A gastric “bee-zoar.“ N Engl J Med 1997;336:1763-1764
Full Text | Web of Science | Medline

2
Akre RD, Greene A, MacDonald JF, Landolt PJ, Davis HG. The yellowjackets of America north of Mexico. Washington, D.C.: Government Printing Office, 1981. (USDA-SEA Agriculture handbook no. 552.)

3
Hoffman DR, Miller JS, Sutton JL. Hymenoptera venom allergy: a geographic study. Ann Allergy 1980;45:276-279
Medline

4
Schmidt JO, Boyer Hassen LV. When Africanized bees attack: what you and your clients should know. Veterinary Medicine. October 1996:923-8.

To the Editor:

Identifying the specific insect involved in a stinging incident has implications for treating the sting and may be critically important for patients with insect-sting allergies. Laypersons and physicians alike tend to call any stinging insect a bee. However, the behavior Lynch and Rothstein describe is characteristic not of a bee (Apis mellifera, or an insect belonging to the superfamily Apoidea), but rather of a wasp (family Vespidae). The abdominal markings on the accompanying photograph show clearly that the insect described was not a bee, but a wasp — the common yellow jacket. Stings by yellow jackets generally cause more intense immediate pain than bee stings, but less subsequent itching and swelling. With honeybee stings, in which the stinger and the poison sac remain in place, it is important to remove the stinger by scraping it in a direction opposite from that of entry, rather than by grasping the stinger itself, to avoid the inadvertent injection of additional venom.

Laura P. Hale, M.D., Ph.D.
Duke University Medical Center, Durham, NC 27710

To the Editor:

The ingested insect is not a bee; it appears instead to be a member of the family Vespidae, almost certainly the common wasp or yellow jacket. The poor honeybee has been maligned before. The bright abdominal bands of the insect ingested in Italy and described in the publication cited by Lynch and Rothstein1 are also much more typical of this same family.

Ian J. Wilson, M.D.
805 Eastwind Dr., Westerville, OH 43081

1 References

1
Girardi A. The bee: an unusual gastric foreign body. Endoscopy 1990;22:240-240
CrossRef | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: Ouch! We have been stung by the comments of our entomologically enlightened colleagues. The insect ingested by our patient was not recovered, nor was the stinger noted in the mucosa at the time of endoscopy. Therefore, the exact identity of the insect could not be determined. We appreciate our readers' comments but will continue, now with tongue in cheek, to refer to this kind of ingestion as a “bee-zoar.”

John P. Lynch, M.D., Ph.D.
Robin D. Rothstein, M.D.
University of Pennsylvania Medical Center, Philadelphia, PA 19104

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