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Infect Dis Clin North Am 2019 Mar;33(1):17-38

Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. Electronic address:

This article discusses the epidemiology, prevention, clinical features, and treatment of venomous bites by snakes, lizards, and spiders; stings by fish, jellyfish, echinoderms, insects, and scorpions; and poisoning by ingestion of fish, turtles, and shellfish. Invertebrate stings cause fatalities by anaphylaxis, secondary to acquired hypersensitivity (Hymenoptera, such as bees, wasps, and ants; and jellyfish), and by direct envenoming (scorpions, spiders, jellyfish, and echinoderms). Simple preventive techniques, such as wearing protective clothing, using a flashlight at night, and excluding venomous animals from sleeping quarters, are of paramount importance to reduce the risk of venomous bites and stings. Read More

Biomed Res Int 2018 25;2018:5631372. Epub 2018 Dec 25.

Emergency Department, Taihe Hospital, Shiyan 442000, China.

To analyze the dynamic changes of serum metabolomics in wasp sting victims, we collected serum from 10 healthy volunteers and 10 patients who had been stung 3 hours, 24 hours, and 72 hours before sample collection. We analyzed the metabolomics by high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) techniques and then performed enrichment analysis. A total of 838 metabolites were identified. Read More

J Agromedicine 2019 Jan 9:1-11. Epub 2019 Jan 9.

b Department of Toxicology , North Carolina State University , Raleigh , NC , USA.

Objective: Ants, bees, hornets, wasps, and yellow jackets (insects in Order Hymenoptera) are potentially a serious concern to outdoor workers, as the venom from their stings can cause life-threatening allergic reactions. This study assessed the impacts of Hymenoptera stings and related worker training regimes of forestry workers across the United States (US).

Methods: A survey was distributed to nearly 2,000 outdoor workers in the forestry industry from four US regions (South, West, Northeast, and Midwest). Read More

J Med Case Rep 2018 Oct 14;12(1):294. Epub 2018 Oct 14.

Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.

Background: Wasp stings are commonly encountered worldwide and result in a variety of clinical manifestations including local and systemic reactions. Neurological and vascular complications are rarely reported following a wasp sting.

Case Presentation: A 69-year-old Sri Lankan Tamil man presented to our hospital with focal neurological deficit following multiple wasp stings; the deficit was confirmed to be an acute infarction on magnetic resonance imaging scan. Read More

Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2018 09;30(9):819-823

Department of Emergency, Taihe Hospital, Hubei University of Medicine, Affiliated Hospital of Hubei University of Medicine, Shiyan 442000, Hubei, China. Corresponding author: Xiao Min, Email:

Objective: To improve the diagnosis and treatment of wasp sting, summarize the experience, the experts from Chinese Society of Toxicology Poisoning and Treatment of Specialized Committee, Hubei Emergency Medicine Committee of Chinese Medical Association and Hubei Provincial Poisoning and Occupational Disease Union made the Expert consensus statement on standardized diagnosis and treatment of wasp stings in China on the development of domestic and oversea in this field. The consensus statement emphasized the idea of staged treatment, different treatments at different stages, and strived to achieve bundling and individuation. To achieve the four pairs of different concept as earlier as possible, the "two early" (early assessment and early treatment), the "two anti" (anti-anaphylaxis and anti-shock), namely the "two hormone" (adrenaline and glucocorticoid) and the "two hua" (hydration and alkalization), we could avoid or reduce subsequent organ failures, significantly shorten the course and improve prognosis of wasp sting victims. Read More

Clin Toxicol (Phila) 2018 Oct 11:1-6. Epub 2018 Oct 11.

c Community Medicine , Indira Gandhi Medical College , Shimla , India.

Aim: To study the epidemiology and outcome of acute kidney injury (AKI) caused by venomous animals.

Methods: A retrospective study of patients admitted at Indira Gandhi Medical College Hospital, Shimla, with AKI due to venomous animals over a period of 15 years (January 2003-December 2017). Medical records were evaluated for patient information on demographic factors, clinical characteristics, complications, and outcome. Read More

J Dtsch Dermatol Ges 2018 Oct;16(10):1228-1247

Department of Dermatology and Allergology, Skin Cancer Center Wiesbaden, Helios Dr. Horst Schmidt Clinics, Wiesbaden, Germany.

Hymenoptera venom allergy is the most common cause of anaphylactic reactions in adults. In children, it is the second most common cause after food-related anaphylaxis. Such reactions are primarily due to stings by honeybees (Apis) and certain social wasps (Vespula vulgaris and Vespula germanica in particular). Read More

Pediatr Allergy Immunol 2019 Feb 20;30(1):93-98. Epub 2018 Nov 20.

Paediatrics and Child Health, University College Cork, Cork, Ireland.

Background: Insect venom is the second most common cause of anaphylaxis outside of medical encounters. Stings cause over 20% of all anaphylactic deaths and 7% of anaphylaxis in children. To date, there have been no longitudinal studies of insect sting events or allergy in preschool children. Read More

DNA Cell Biol 2018 Dec 28;37(12):967-972. Epub 2018 Sep 28.

4 Department of Pulmonary and Critical Care Medicine, Institute of Respiratory Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China.

Previous studies have shown that serum levels of interleukin-6 (IL-6), which plays an important role in the development of systemic inflammatory response syndrome (SIRS), is significantly increased in wasp sting patients. However, the association between IL-6 gene variants and the risk of SIRS development in these patients is not clearly understood. In this study, we investigated the association between IL-6 gene polymorphism in the promoter region and the risk of SIRS in wasp sting patients. Read More

J Investig Allergol Clin Immunol 2018 Sep 5. Epub 2018 Sep 5.

Department of Genetics; Wroclaw Medical University, Wroclaw, Poland.

Background And Objective: To perform a genome-wide characterization of changes of microRNA (miRNA) expression in the course of VIT (venom immunotherapy).

Methods: miRNA was isolated form in the whole-blood of 13 allergic patients and 14 controls, who showed no allergic reaction upon stings by honeybees and wasps. We analyzed 2549 different miRNAs from whole blood of these patients prior to VIT and 12 months after the start of the VIT. Read More

Int Arch Allergy Immunol 2018;177(4):365-369. Epub 2018 Sep 3.

Allergy Unit, Department of Internal Medicine, University Hospital of Ancona, Allergy and Clinical Immunology School, Università Politecnica delle Marche, Ancona,

Cross-reactions between Polistes dominula and Vespula species are common in southern Europe. Currently, only CAP-inhibition demonstrates high accuracy in identifying genuine sensitizations, but this method is time-consuming and expensive, so a new approach is required. This study investigates skin tests, molecular diagnostics, total IgE (tIgE), and the Ves v 5/Pol d 5 (or vice versa) ratio. Read More

J Med Entomol 2019 Jan;56(1):254-260

School of Applied Biosciences, College of Agriculture and Life Sciences, Kyungpook National University, Daegu, Republic of Korea.

To better understand the impact of social wasps on the health of people in South Korea, we analyzed requests to emergency services call centers for the removal of social wasp nests and the effect of Hymenoptera stings on human health between 2010 and 2014. There were 483,233 calls requesting removal of wasp nests and Hymenoptera stings caused 78,860 injuries and 49 deaths. The strong relationships between both the number of emergency calls and injuries, and urban density reflect the sensitivity of densely populated areas to potential threats from wasp and the increased awareness of the wasp nest removal service communicated by public education programs. Read More

Ulus Travma Acil Cerrahi Derg 2018 Jul;24(4):343-350

Department of Emergency Medicine, Karadeniz Technical University Faculty of Medicine,Trabzon-Turkey.

Background: To evaluate the distribution of bite and sting cases presenting to a district public hospital and the use of antivenom in scorpion sting and snake bite cases.

Methods: The demographic characteristics of patients with bites/stings reporting to a public hospital in 2014, the agent involved, the season of reporting, severity of clinical findings during presentation, and use of antivenom in scorpion sting and snake bite cases were evaluated retrospectively. χ2 test was used for statistical analysis. Read More

Nature 2018 05;557(7706):471

Int Arch Allergy Immunol 2018 22;176(2):101-105. Epub 2018 May 22.

Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Milan, Italy.

Mosquito bite is usually followed by a local reaction, but severe or systemic reaction may, in rare cases, occur. Allergic reactions to Aedes communis (Ac) may be underestimated due to the lack of reliable diagnostic tools. In this multicenter study, 205 individuals reporting large local reactions to Ac were enrolled and studied for cutaneous or IgE reactivity to Ac, Blattella germanica, Penaeus monodon, and Dermatophagoides pteronyssinus. Read More

Toxicon 2018 Aug 19;150:96-104. Epub 2018 May 19.

Southwestern Biological Institute, 1961 W. Brichta Drive, Tucson, AZ 85745, USA. Electronic address:

Many familiar Hymenoptera are brightly colored and can sting painfully-thus, their threat and clinical importance may be exaggerated. Most stinging insects only sting to defend themselves or their colonies from predators. The clinical nature of Hymenoptera envenomations contrasts that of other venomous animals, including other arthropods, primarily because allergic reaction, not direct intoxication, is the usual main concern. Read More

Int Arch Allergy Immunol 2018 16;176(2):150-156. Epub 2018 May 16.

Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.

Background: Insect venom allergy is common and greatly impairs patients' quality of life. Additionally, low compliance with carrying emergency medication is reported. The aim of our study was to analyze the disease burden, levels of anxiety and depression, and to evaluate attitudes towards the set of emergency medication in affected patients. Read More

PeerJ 2018 2;6:e4743. Epub 2018 May 2.

Department of Biology, Utah State University-Tooele, Tooele, UT, USA.

The stings of bees, wasps, and ants are something that catches the attention of anyone that experiences them. While many recent studies have focused on the pain inflicted by the stings of various stinging wasps, bees, or ants (Hymenoptera: Aculeata), little is known about how the length of the sting itself varies between species. Here, we investigate the sting length of a variety of aculeate wasps, and compare that to reported pain and toxicity values. Read More

Int Arch Allergy Immunol 2018 12;176(1):39-43. Epub 2018 Apr 12.

Allergology Department, Laikon General Hospital, Athens, Greece.

Background: The long-term protection provided by venom immunotherapy (VIT) is related to the dose administered and to its long duration; the latter, however, becomes inconvenient for patients in countries like Greece, with many islanders or inhabitants of distant mountainous areas. Maintenance interval prolongation reduces the number of office visits - saving time and money - and as a consequence contributes to the patients' compliance. The aim of this prospective study was to evaluate the safety and efficacy of VIT on a progressively prolonged maintenance interval (PPMI). Read More

Postgrad Med J 2018 07 6;94(1113):418-420. Epub 2018 Apr 6.

Department of Nephrology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.

Ann Allergy Asthma Immunol 2018 04;120(4):424-428

Division of Pediatrics, Pediatric Allergy and Asthma, Faculty of Medicine, Hacettepe University School of Medicine, Ankara, Turkey. Electronic address:

Background: Venom immunotherapy (VIT) is safe in children, although adverse effects can occur.

Objective: To document adverse effects and to determine re-sting reactions and the efficacy of VIT in childhood.

Methods: We retrospectively analyzed data from children who had taken VIT from 2002 through 2015. Read More

Toxicon 2018 Jun 29;148:74-84. Epub 2018 Mar 29.

Toxicology & Pharmacology, University of Leuven (KU Leuven), O&N 2, PO Box 992, Herestraat 49, 3000 Leuven, Belgium. Electronic address:

Vespa tropica, a social wasp locally found in Thailand is responsible for many out off the record accidental stings due to close encounters with human activities and because of the animal's highly potent venom. Phospholipase (PLA) is one of the major proteins commonly found in insect venom. In this work, V. Read More

Ann Allergy Asthma Immunol 2018 Mar;120(3):338-339

Department of Dermatology and Allergy Center, Odense Research Center for Anaphylaxis, Odense, Denmark; Mastocytosis Center Odense University Hospital, Odense, Denmark.

J Med Entomol 2018 May;55(3):752-756

Department of Entomology, Penn State University, University Park, PA.

Sclerodermus Latreille, 1809 (Hymenoptera: Bethylidae), are parasitoids of wood-boring beetle larvae that can co-infest furniture and homes attacked by such larvae. This can result in the human inhabitants receiving stings from adult female wasps as they wander in search of new hosts. Herein, I report the first infestation of Sclerodermus macrogaster (Ashmead, 1887) of a home in North America and provide a review of Sclerodermus biology and clinical signs relevant to their pestiferous nature. Read More

Ann Allergy Asthma Immunol 2018 04 2;120(4):429-430. Epub 2018 Feb 2.

Cardiac/Pulmonary Rehabilitation, ASST Pini/CTO, Milan, Italy.

Jpn J Ophthalmol 2018 Mar 30;62(2):221-225. Epub 2018 Jan 30.

Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan.

Purpose: To compare the outcomes of ocular injuries of hornets and paper wasps' stings.

Study Design: Retrospective case series.

Methods: Patients diagnosed with ocular injuries sustained by bee stings at Miyata Eye Hospital (Miyazaki, Japan) between August 2000 and July 2016 were enrolled. Read More

Wilderness Environ Med 2018 03 17;29(1):36-44. Epub 2018 Jan 17.

Department of Surgery, Stanford University, Stanford, CA.

Introduction: To review recent (2008-2015) United States mortality data from deaths caused by nonvenomous and venomous animals and compare with historical data.

Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was queried to return all animal-related fatalities between 2008 and 2015. Mortality frequencies for animal-related fatalities were calculated using the estimated 2011 United States population. Read More

Mediators Inflamm 2017 29;2017:6978194. Epub 2017 Oct 29.

Laboratory of Veterinary Physiology and Cell Signaling, College of Veterinary Medicine, Kyungpook National University, Daegu, Republic of Korea.

Pest control in the agricultural fields, a major concern globally, is currently achieved through chemical or biological methods. Chemical methods, which leave toxic residue in the produce, are less preferred than biological methods. Venoms injected by stings of various wasps that kill the pest is considered as the examples of the biological method. Read More

Int Arch Allergy Immunol 2017 9;174(3-4):190-199. Epub 2017 Nov 9.

Allergy Unit, Department of Dermatology, University and University Hospital of Zurich, Zurich, Switzerland.

Background: Skin test reactivity to hymenoptera venom and venom-specific IgE are important for diagnosing venom allergy and deciding on the appropriate allergen for venom immunotherapy (VIT). Longitudinal data on skin test reactivity during VIT and their correlation with venom-specific immunoglobulin (Ig)E and IgG are scarce.

Methods: We retrospectively analyzed shifts in skin test reactivity and serum levels of venom-specific IgE and IgG in patients allergic to hymenoptera venom before the initiation of VIT with ultrarush therapy and after ≥3 years of VIT. Read More

Wounds 2017 Sep;29(9):E70-E72

University of Calgary, Calgary, Alberta, Canada; and Alberta Children's Hospital, Calgary, Alberta, Canada.

While jogging in a local park in Hong Kong, a 55-year-old, previously healthy man was stung on the ventral aspect of his right wrist. The tiny stinger was gently removed with nail cutters and examined under a microscope at 80x magni cation; plucking the stinger is ill- advised as this may inject more venom into the wounded site. Two days after stinging, the microscopic appearance of the stinger con rmed the diagnosis to be from a bee instead of a wasp or other insect. Read More

Acta Derm Venereol 2018 01;98(1):149-150

Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.

BMJ Case Rep 2017 Sep 7;2017. Epub 2017 Sep 7.

Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK.

A 45-year-old previously healthy man with minimal coronary artery disease on imaging presented with an acute MI after sustaining a wasp sting following previous non-eventful exposures throughout his life. This is the first case of Kounis syndrome with optical coherence tomography imaging and proven IgE wasp venom hypersensitivity. The Hymenoptera venom is composed of allergenic proteins and vasoactive amines which are responsible for venom toxicity. Read More

Curr Opin Allergy Clin Immunol 2017 Oct;17(5):344-349

Dipartimento di Biologia, Università degli Studi di Firenze, Italy.

Purpose Of Review: This review aims to update the world status of the main allergenic stinging Hymenoptera.

Recent Findings: In this review, we consider the problems that social Hymenoptera (bees, wasps and ants) could represent in the nearest future for human health in different parts of the world.

Summary: Distribution and consistency of allergenic species including venomous insects are interested by accelerated dynamics caused by climate changes and globalization. Read More

Ann Allergy Asthma Immunol 2017 Sep 20;119(3):287-288. Epub 2017 Jul 20.

Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.

Wilderness Environ Med 2017 Sep 18;28(3):249-252. Epub 2017 Jul 18.

Departments of Nephrology (Dr Vikrant) and Community Medicine (Dr Parashar), Indira Gandhi Medical College, Shimla, India.

Acute kidney injury (AKI) is an unusual complication of wasp stings. Treatment of established AKI is largely supportive but the preventive strategies are not well documented. This is a report of 2 human cases that developed AKI after multiple wasp stings (Vespa magnifica). Read More

Case Rep Nephrol 2017 19;2017:8596981. Epub 2017 Jun 19.

Department of Internal Medicine, Inje University College of Medicine, Goyang, Republic of Korea.

Multiple wasp stings can induce multiple organ dysfunction by toxic reactions. However, acute pancreatitis is a rare manifestation in wasp sting injury. A 74-year-old woman visited the emergency department by anaphylactic shock because of multiple wasp stings. Read More

PLoS One 2017 7;12(7):e0180270. Epub 2017 Jul 7.

Department of Medicine and Surgery, University of Parma, Parma, Italy.

Background: Venom immunotherapy (VIT) is highly effective in preventing allergic reactions to insect stings, but the appropriate venom must be used to achieve clinical protection. In patients with multiple positive results to venoms, molecular allergy diagnostics or CAP-inhibition may identify the causative venom. Concerning allergy to venom from Polistes spp. Read More

Pediatr Emerg Care 2017 Jun 13. Epub 2017 Jun 13.

From the Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Objective: The purpose of this study was to evaluate the clinical characteristics of allergy to stings from the Hymenoptera order of insects in a hospital in Thailand.

Methods: A descriptive retrospective analytical study was carried out in inpatients and outpatients suffering from Hymenoptera stings from 2009 to 2013 in Siriraj Hospital.

Results: Medical records of 386 patients with an allergy to Hymenoptera stings were evaluated. Read More

Hum Vaccin Immunother 2017 10 12;13(10):2467-2481. Epub 2017 Jun 12.

a Center of Allergy and Environment (ZAUM) , Technical University of Munich and Helmholtz Center Munich, Member of the German Center of Lung Research (DZL) , Munich , Germany.

Stings of hymenoptera can induce IgE-mediated hypersensitivity reactions in venom-allergic patients, ranging from local up to severe systemic reactions and even fatal anaphylaxis. Allergic patients' quality of life can be mainly improved by altering their immune response to tolerate the venoms by injecting increasing venom doses over years. This venom-specific immunotherapy is highly effective and well tolerated. Read More

Postepy Dermatol Alergol 2017 Apr 13;34(2):159-167. Epub 2017 Apr 13.

Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland.

Introduction: Venom immunotherapy (VIT) is recommended as the first-line treatment for patients allergic to Hymenoptera venom.

Aim: To analyze the safety and efficacy of VIT in a real life setting.

Material And Methods: One hundred and eighty patients undergoing VIT were studied to evaluate the safety, efficacy, incidence and nature of symptoms after field stings and adverse reactions to VIT. Read More

Curr Allergy Asthma Rep 2017 Jun;17(6):38

Department of Dermatology and Allergy Biederstein, Technische Universität München, Biedersteiner Straße 29, 80802, Munich, Germany.

Purpose Of Review: Hymenoptera anaphylaxis is one of the leading causes of severe allergic reactions and can be fatal. Venom-specific immunotherapy (VIT) can prevent a life-threatening reaction; however, confirmation of an allergy to a Hymenoptera venom is a prerequisite before starting such a treatment. Component resolved diagnostics (CRD) have helped to better identify the responsible allergen. Read More

J Allergy Clin Immunol Pract 2017 Sep - Oct;5(5):1264-1271. Epub 2017 May 10.

Department of Allergology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Background: Patients with indolent systemic mastocytosis (ISM) are at risk for severe anaphylactic reactions to yellow jacket (YJ) stings while demonstration of sensitization can be challenging because specific IgE (sIgE) levels are regularly below 0.35 kU/L. The implication of missing YJ allergy is illustrated by a case of fatal anaphylaxis. Read More

J Dtsch Dermatol Ges 2017 May;15(5):507-515

Department of Dermatology, Jena University Hospital, Jena, Germany.

Background: The measurement of specific IgE (sIgE) antibodies plays a key role in the diagnosis of honeybee and wasp venom allergy. In recent years, component-resolved diagnosis (CRD) has been introduced, which allows for the measurement of sIgE antibodies against Api m 1, Ves v 1, Ves v 5, and Pol d 5, as well as cross-reactive carbohydrate determinants (CCDs). These tests are intended to help determine the clinical relevance of any given sensitization, especially in patients with dual sensitization. Read More

Ann Allergy Asthma Immunol 2017 05;118(5):531-536

Division of Bacterial, Parasitic and Allergenic Products, US Food and Drug Administration, Silver Spring, Maryland. Electronic address:

Objective: To review allergenic extracts used to diagnose or treat insect allergies, including how the extracts are manufactured and their measurements of potency or concentration.

Data Sources: Peer-reviewed articles derived from searching PubMed (National Center for Biotechnology Information) about insect allergies and extract preparation. Encyclopedia of Life (http://www. Read More

J Proteomics 2017 05 19;161:88-103. Epub 2017 Apr 19.

Laboratório de Biologia Molecular de Artrópodes-LBMA-IBRC-UNESP (Univ Estadual Paulista), Av. 24-A, n° 1515, CEP 13506-900, Bela Vista, Rio Claro, SP, Brazil; Centro de Estudos de Venenos e Animais Peçonhentos-CEVAP (Univ Estadual Paulista), Rua José Barbosa de Barros, 1780, Fazenda Experimental Lageado, Botucatu 18610-307, SP, Brazil. Electronic address:

Polybia paulista (Hymenoptera: Vespidae) is a neotropical social wasp from southeast Brazil. As most social Hymenoptera, venom from P. paulista comprises a complex mixture of bioactive toxins ranging from low molecular weight compounds to peptides and proteins. Read More

J Investig Allergol Clin Immunol 2017;27(2):127-129

Department of Neurology, Wroclaw Medical University, Wroclaw, Poland.

Wilderness Environ Med 2017 06 3;28(2):150-152. Epub 2017 Apr 3.

Department of Environmental and Occupational Health Sciences, School of Public Health, New Orleans, LA; Department of Anesthesiology, School of Medicine Louisiana State University Health Sciences Center New Orleans, LA. Electronic address:

Int Arch Allergy Immunol 2017 6;172(3):167-172. Epub 2017 Apr 6.

Division of Pediatric Pneumology and Allergy, University Hospital for Children and Adolescents, Leipzig, Germany.

Background: Data on the long-term outcome of children after specific venom immunotherapy (VIT) are limited. Therefore, we assessed sting recurrence and anaphylaxis relapse rates as well as adherence to anaphylaxis guidelines with regard to the availability of emergency equipment and education status.

Methods: For this long-term survey, data of 311 children with a history of anaphylactic reactions to hymenoptera stings were collected by chart review. Read More

ANZ J Surg 2017 04;87(4):315-316

Department of Infectious Diseases, Tangdu Hospital, the Fourth Military Medical University, Xi'an, China.