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Almeida JS, Gomez Ravetti C, de Melo Andrade MV, de Andrade Filho A, Silva E Castro R, Pires Costa Pimenta P, Frizera Vassallo P, Nobre V. Use of point-of-care ultrasound to assess the severity of scorpion stings in hospitalized patients. Clin Toxicol (Phila) 2024; 62:145-151. [PMID: 38563526 DOI: 10.1080/15563650.2024.2328346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Scorpionism is a public health problem, especially in tropical regions. In Brazil, the prevalence of envenomation by scorpions is high, and the average national lethality is around 0.16 percent. The Tityus serrulatus scorpion is the primary species of medical importance. However, objective tools to predict and define the severity of these envenomations are lacking. MATERIALS AND METHODS This was an observational study conducted among patients aged 0-19 years with scorpionism. Patients were admitted to a reference hospital between December 2020 and May 2022. Point-of-care ultrasound was performed within 24 hours of the scorpion sting. RESULTS Forty-nine patients were included, with a median age of 3.6 (interquartile range 2.3-5.3) years and a predominance of females (51 percent). Fifteen patients (30.6 percent) presented major life-threatening signs, 32 (65.3 percent) minor systemic manifestations, and two (4.1 percent) only local manifestations. Left ventricular dysfunction was identified in 13 patients (26.5 percent). Ten patients (20.4 percent) presented pattern B (visualization of three or more B lines in the evaluated quadrant) in at least one lung window. The sensitivity and specificity of cardiac and pulmonary ultrasound to identify the most severely ill patients were 86 percent and 94 percent, respectively. DISCUSSION The changes found on point-of-care ultrasound were associated with life-threatening signs. All patients with class III envenomation were referred to the intensive care unit, showing the importance of early identification of this subgroup. The main limitations were the small sample size and the fact that admission to intensive care was not based on systematic criteria. CONCLUSIONS Point-of-care ultrasound is able to identify early signs of pulmonary congestion and heart failure in scorpionism. It can be useful for the objective selection of patients who are at a higher risk of complications and death and who require intensive support; it may also be valuable for periodic reassessments. Point-of-care ultrasound is a valuable tool for identifying and monitoring severe cases of scorpionism.
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Affiliation(s)
- Juliana Sartorelo Almeida
- Departamento de Toxicologia do Hospital João XXIII, Centro de Informação e Assistência Toxicológica de Minas Gerais (CIAToxMG), Belo Horizonte, Brazil
- Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI), Belo Horizonte, Brazil
| | - Cecilia Gomez Ravetti
- Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marcus Vinícius de Melo Andrade
- Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Adebal de Andrade Filho
- Departamento de Toxicologia do Hospital João XXIII, Centro de Informação e Assistência Toxicológica de Minas Gerais (CIAToxMG), Belo Horizonte, Brazil
| | - Rafael Silva E Castro
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Pedro Pires Costa Pimenta
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Paula Frizera Vassallo
- Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Vandack Nobre
- Núcleo Interdisciplinar de Investigação em Medicina Intensiva (NIIMI), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Wiezel GA, Oliveira IS, Reis MB, Ferreira IG, Cordeiro KR, Bordon KCF, Arantes EC. The complex repertoire of Tityus spp. venoms: Advances on their composition and pharmacological potential of their toxins. Biochimie 2024; 220:144-166. [PMID: 38176606 DOI: 10.1016/j.biochi.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/30/2023] [Accepted: 12/30/2023] [Indexed: 01/06/2024]
Abstract
Animal venoms are a rich and complex source of components, including peptides (such as neurotoxins, anionic peptides and hypotensins), lipids, proteins (such as proteases, hyaluronidases and phospholipases) and inorganic compounds, which affect all biological systems of the envenoming victim. Their action may result in a wide range of clinical manifestations, including tachy/bradycardia, hyper/hypotension, disorders in blood coagulation, pain, edema, inflammation, fever, muscle paralysis, coma and even death. Scorpions are one of the most studied venomous animals in the world and interesting bioactive molecules have been isolated and identified from their venoms over the years. Tityus spp. are among the scorpions with high number of accidents reported in the Americas, especially in Brazil. Their venoms have demonstrated interesting results in the search for novel agents with antimicrobial, anti-viral, anti-parasitic, hypotensive, immunomodulation, anti-insect, antitumor and/or antinociceptive activities. Furthermore, other recent activities still under investigation include drug delivery action, design of anti-epileptic drugs, investigation of sodium channel function, treatment of erectile disfunction and priapism, improvement of scorpion antivenom and chelating molecules activity. In this scenario, this paper focuses on reviewing advances on Tityus venom components mainly through the modern omics technologies as well as addressing potential therapeutic agents from their venoms and highlighting this abundant source of pharmacologically active molecules with biotechnological application.
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Affiliation(s)
- Gisele A Wiezel
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida Do Café s/n, Ribeirão Preto, SP, Brazil.
| | - Isadora S Oliveira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida Do Café s/n, Ribeirão Preto, SP, Brazil; Department of Biotechnology and Biomedicine, Technical University of Denmark, Søtolfts Plads, Building 239 Room 006, Kongens Lyngby, 2800, Denmark.
| | - Mouzarllem B Reis
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida Do Café s/n, Ribeirão Preto, SP, Brazil.
| | - Isabela G Ferreira
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida Do Café s/n, Ribeirão Preto, SP, Brazil.
| | - Kalynka R Cordeiro
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida Do Café s/n, Ribeirão Preto, SP, Brazil.
| | - Karla C F Bordon
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida Do Café s/n, Ribeirão Preto, SP, Brazil.
| | - Eliane C Arantes
- Department of BioMolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida Do Café s/n, Ribeirão Preto, SP, Brazil.
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Çelik E, Çağlar A, Çelik SF. Clinical Effects and Predictive Factors Affecting the Clinical Severity of Scorpion Envenomations in Western Turkey. J Trop Pediatr 2021; 67:6313145. [PMID: 34213542 DOI: 10.1093/tropej/fmab053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Scorpion envenomation is a common medical emergency in many countries, including Turkey. Severe systemic symptoms occur more easily in children and mortality rates are higher. The aim of this study is to describe the clinical effects and predictive factors affecting the clinical severity of scorpion envenomations in Western Turkey. METHODS Two hundred one children (138 mild cases, 34 moderate, and 29 severe) with scorpion envenomation aged between 1 month and -17 years were included in the study. The patients' demographic and laboratory characteristics were compared among clinical severity subgroups. RESULTS The patients' median age was 7 (4-11) years. The median age of the severe group was significantly lower than that of the mild and moderate groups (p < 0.001). Seventeen patients (8.5%) developed myocarditis, while no pulmonary edema was observed in any case. Leukocyte, neutrophil and platelet (PLT) counts, and plateletcrit (PCT) and glucose levels increased significantly with the severity of envenomation (p < 0.001). PLT counts and PCT levels exhibited positive correlation with leukocyte and neutrophil counts (p < 0.001, r = 0.781, r = 0.638, r = 0.772, and r = 0.629, respectively). Supraventricular tachycardia developed in 1 (5.9%) patient, and dilated cardiomyopathy in another (5.9%). No mortality occurred in any case. CONCLUSION Increased PLT counts and PCT levels may be helpful in evaluating clinical severity in patients with scorpion sting envenomation. The possibility of myocarditis development in children should be remembered and cardiac enzymes should be checked, even if patients are asymptomatic and cardiac enzymes are normal on admission.
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Affiliation(s)
- Elif Çelik
- Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydın 09010, Turkey
| | - Aykut Çağlar
- Department of Pediatric Emergency Care, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Serkan Fazlı Çelik
- Department of Pediatric Cardiology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
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Baseer KA, Naser MAA. Predictors for Mortality in Children with Scorpion Envenomation Admitted to Pediatric Intensive Care Unit, Qena Governorate, Egypt. Am J Trop Med Hyg 2020; 101:941-945. [PMID: 31407657 DOI: 10.4269/ajtmh.19-0319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This study aimed to identify the clinical and laboratory manifestations that affect outcome of scorpion envenomation in children. It included 154 children admitted with scorpion sting envenomation over a period of 2 years. The epidemiological, clinical, and laboratory findings of patients were recorded, and grading of severity was performed based on local and systemic involvement. Organ failure was determined according to diagnostic criterion of multiple organ dysfunction syndrome, and severity of illness was assessed by the Pediatric Risk of Mortality (PRISM III) score. Of studied children, 58.4% were males and 41.6% were females. Children aged > 5 years suffered more scorpion stings (79.9%) than others did. The place of residence was rural more than urban, outdoor stings more than indoors, nocturnal more than diurnal, and most stings were on the exposed areas of the limbs. Based on clinical evaluation, 37.7% of patients were classified as class I severity followed by class II (48.7%) and class III (13.6%). Among studied cases, 21 deaths (13.6%) were registered; all of them belonged to class III severity. Mortality was significantly higher in children with agitation, coma, convulsions, arrhythmia, heart failure, pulmonary edema, and priapism. There were significantly higher values of leukocytes, platelets, creatinine, liver enzymes, glucose, and creatine phosphokinase in non-survivors than in survivors. The presence of organ failure was associated with mortality. In addition, the need for mechanical ventilation and inotropic support were at increased risk of mortality. Moreover, a significant association was found between PRISM score and the number of failed organs with fatal outcome.
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Affiliation(s)
- Khaled A Baseer
- Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mohamed A A Naser
- Department of Anaesthesia and ICU, Faculty of Medicine, Assiut University, Assiut, Egypt
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Prasad R, Kumar A, Mishra OP, Singh TB, Singh A. Efficacy of Scorpion Antivenom in Grade III and IV Scorpion Envenomation. Indian J Pediatr 2018; 85:576. [PMID: 29704171 DOI: 10.1007/s12098-018-2688-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 04/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Rajniti Prasad
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Abhishek Kumar
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Om Prakash Mishra
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tej Bali Singh
- Division of Biostatistics, Department of Preventative and Social Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ankur Singh
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
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Role of some vasoactive mediators in scorpion envenomed children: Possible relation to envenoming outcome. Toxicon 2017; 127:77-84. [PMID: 28088475 DOI: 10.1016/j.toxicon.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 11/21/2022]
Abstract
Scorpion envenomation causes an autonomic storm resulting in changes in the vasoactive mediators' levels which lead to myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary edema, multi-system-organ-failure and death. The study aimed to determine the circulating levels of adrenaline, noradrenaline, angiotensin converting enzyme (ACE), Angiotensin II (Ang II), kallikrein enzyme, nitric oxide (NO), aldosterone, and electrolytes Na+, K+ and Ca+2 in scorpion envenomed children and to evaluate the potential relation between these vasoactive mediators, the severity of scorpion envenoming and the clinical outcome of envenomed children. Forty envenomed children (22 mild and 18 severe cases) along with 10 healthy control children were enrolled in the study. The circulating levels of adrenaline, noradrenaline, Ang II, ACE, kallikrein enzyme, and NO were determined by ELISA, and spectrophotometric assays on admission and 24 h later. On admission, serum aldosterone, and electrolytes; Na+, K+ and Ca+2 were determined by RIA, Flame photometer and Flame atomic absorption respectively. All envenomed children showed significant surge of adrenaline, noradrenaline, ACE, Ang II, aldosterone, NO and Na+, that concomitantly faced by significant reduction in kallikrein, K+ and Ca+2 on admission. Twenty four hours later, all envenomed children continued to show significant elevation of ACE, Ang II and NO. The severely envenomed children showed considerable reduction in circulating levels of adrenaline, noradrenaline, ACE and Ang II, while dramatic increase in kallikrein activity was reported in comparison to mildly envenomed children after 24 h of medical care. Also, NO exhibited considerable accumulation in non survivors, on admission, that was persistent for the subsequent 24 h and was accompanied by high kallikrein, low catecholamines and Ang II levels compared to survivors. Finally, the hypertensive cases showed substantial higher levels of catecholamine, ACE and Ang II, 24 h after admission. These findings indicated that, disturbances of the studied vasoactive mediators were common in scorpion envenomed children and may account for several inflammatory manifestations and clinical outcome. ACE inhibitors could be considered as possible therapeutic agent in victims with prominent increase in ACE and Ang II while kallikrein inhibitor and antioxidants may be effective in the treatment of late hypotensive ones.
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Konca C, Tekin M, Turgut M. Doxazosin in the treatment of scorpion envenomation. Indian J Pediatr 2015; 82:499-503. [PMID: 24696312 DOI: 10.1007/s12098-014-1423-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 03/19/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate effectiveness and applicability of Doxazosin in the treatment of scorpion stings in patients who had systemic symptoms. METHODS The medical records of patients were retrospectively reviewed, and the following data were collected: age, sex, clinical symptoms (localized and systemic), vital signs, information on the date and place of the sting occurrence, the anatomical sting site, time between sting and arrival to the hospital, scorpion identification, severity of the symptoms and treatment. RESULTS Of the victims, 48.5 % (n = 16) were males, and 51.5 % (n = 17) were females, with a mean age of 6.8 ± 4.2 y. The most common sting site was lower extremity 72.7 % (n = 24). Systemic toxicity (class II) was seen in 93.9 %, and two patients (6.1 %) manifested evidence of severe envenomation (class III). Both local and systemic effects were seen in the patients. Cold extremities persisted for 4.5 ± 1.5 h after administration of Doxazosin. Mean hospitalization time was 2.5 ± 1.5 d (range: 1.5 to 6 d). Thirty-two patients recovered without any sequel, whereas one patient died due to cardio-pulmonary insufficiency. CONCLUSIONS Doxazosin, especially if Prazosin is not available, can be recommended as an effective drug in the treatment of serious scorpion envenomations with significant sympathetic symptoms.
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Affiliation(s)
- Capan Konca
- School of Medicine, Department of Pediatrics, Pediatric Intensive Care Unit, Adiyaman University, Adiyaman, Turkey,
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Ananda Kumar P, Krishnamurthy S, Srinivasaraghavan R, Mahadevan S, Harichandrakumar K. Predictors of myocardial dysfunction in children with indian red scorpion (Mesobuthus tamulus) sting envenomation. Indian Pediatr 2015; 52:297-301. [DOI: 10.1007/s13312-015-0627-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Suresh SS, Zaki H, Shalamzari JE, Bhatnagar G. Osteomyelitis calcaneum due to a scorpion sting. J Foot Ankle Surg 2014; 53:340-3. [PMID: 24613787 DOI: 10.1053/j.jfas.2014.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Indexed: 02/03/2023]
Abstract
Children are susceptible to various injuries, including insect bites, and scorpion bites are common in the lower extremity of children in Middle East countries. In most cases, the sting will produce just a local reaction; however, serious complications that can result in death have occurred. In this case report, we describe a case of osteomyelitis of the calcaneum after a scorpion sting.
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Affiliation(s)
- Saraswathivilasam S Suresh
- Senior Consultant and Head, Department of Orthopaedics, Ibri Regional Referral Hospital, Ibri, Sultanate of Oman.
| | - Hosam Zaki
- Specialist, Department of Orthopedics, Ibri Regional Referral Hospital, Ibri, Sultanate of Oman
| | | | - Gunmala Bhatnagar
- Senior Consultant, Department of Pathology, Royal Hospital, Muscat, Oman
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Sagarad SV, Thakur BS, Reddy SS, Balasubramanya K, Joshi RM, Kerure SB. Elevated Cardiac Troponin (cTnI) Levels Correlate with the Clinical and Echocardiographic Evidences of Severe Myocarditis in Scorpion Sting Envenomation. J Clin Diagn Res 2012; 6:1369-71. [PMID: 23205349 PMCID: PMC3471504 DOI: 10.7860/jcdr/2012/4760.2361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 07/13/2012] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study was to evaluate the predictive value of the cardiac troponins in scorpion sting myocarditis at a tertiary care hospital in Raichur, (Karnataka state) India. METHODS A total of 84 consecutive patients were prospectively studied. The data included the demographics, the time of presentation to the hospital, the clinical features, the cardiac troponin levels and the echocardiographic findings. RESULTS 12 patients with only local symptoms had troponin levels of less than 0.01μg/L. 12 patients with local and systemic symptoms without an echocardiac evidence of myocarditis had troponin values of 0.01 to 0.11 μg/L. 60 patients with an echocardiographic evidence of myocarditis had troponin levels of above 0.11 μg/L. 6 patients with severe myocarditis who required ventilator support or which led to death had troponin values which were higher than 10 μg/L. CONCLUSIONS High cardiac troponin levels predict myocarditis in scorpion sting envenomation and they can be a useful tool in guiding the therapy early.
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Affiliation(s)
- Suresh V Sagarad
- Assistant Professor, Department of Medicine, NMC&H, Chief of Cardiology, RGSSH & SHRC, Raichur, India
| | | | - S S Reddy
- Associate Professor, NMC&H & Consulting Physician SHRC, Raichur, India
| | | | - R M Joshi
- Consulting Pathologist, RGSSH, Raichur, India
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Priapism in an Infant With Sickle Cell Trait After Cardiac Transplant. Urology 2012; 80:928-30. [DOI: 10.1016/j.urology.2012.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 05/17/2012] [Accepted: 06/05/2012] [Indexed: 01/17/2023]
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Wiwanitkit V. Scorpion sting envenomation. Indian J Pediatr 2011; 78:1021; author reply 1021. [PMID: 21203869 DOI: 10.1007/s12098-010-0320-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 11/26/2010] [Indexed: 11/29/2022]
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