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Vaucel JA, Larréché S, Paradis C, Courtois A, Pujo JM, Elenga N, Résière D, Caré W, de Haro L, Gallart JC, Torrents R, Schmitt C, Chevalier J, Labadie M, Kallel H. French Scorpionism (Mainland and Oversea Territories): Narrative Review of Scorpion Species, Scorpion Venom, and Envenoming Management. Toxins (Basel) 2022; 14:toxins14100719. [PMID: 36287987 PMCID: PMC9611377 DOI: 10.3390/toxins14100719] [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: 09/17/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022] Open
Abstract
Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French Guiana. The number of stings is also heterogenous, with up to 90 stings per 100,000 inhabitants occurring annually. Scorpion species can frequently be determined through simple visual factors, including species of medical importance (i.e., Buthus, Centruroides and Tityus). Scorpion venom is composed of local enzymes and peptides with a cysteine-stabilized α/β motif (NaTxs, Ktxs, Calcines), which allow for venom diffusion and the prey's incapacitation, respectively. Harmful scorpion species are limited to Centruroides pococki in the French West Indies, which can induce severe envenoming, and the Tityus obscurus and Tityus silvestris in French Guiana, which can cause fatalities in children and can induce severe envenoming, respectively. Envenomation by one of these scorpions requires hospital monitoring as long as systemic symptoms persist. Typical management includes the use of a lidocaine patch, pain killers, and local antiseptic. In the case of heart failure, the use of dobutamine can improve survival, and pregnant women must consult an obstetrician because of the elevated risk of preterm birth or stillbirth. France does not have scorpion antivenom, as scorpion stings are generally not fatal.
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Affiliation(s)
- Jules-Antoine Vaucel
- Bordeaux Poison Control Centre, Centre Hospitalier et Universitaire Bordeaux Pellegrin, 33000 Bordeaux, France
- Correspondence: ; Tel.: +33-05-5679-8776
| | - Sébastien Larréché
- Medical Biology Department, Hôpital d’Instruction Des Armées Bégin, 94160 Saint-Mandé, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1144, Université de Paris, 75000 Paris, France
| | - Camille Paradis
- Bordeaux Poison Control Centre, Centre Hospitalier et Universitaire Bordeaux Pellegrin, 33000 Bordeaux, France
| | - Arnaud Courtois
- Bordeaux Poison Control Centre, Centre Hospitalier et Universitaire Bordeaux Pellegrin, 33000 Bordeaux, France
| | - Jean-Marc Pujo
- Emergency Department, Centre Hospitalier de Cayenne, 97300 Cayenne, France
| | - Narcisse Elenga
- Pediatric Unit, Centre Hospitalier de Cayenne, 97300 Cayenne, France
| | - Dabor Résière
- Intensive Care Unit, Centre Hospitalier et Universitaire Martinique, 97200 Fort de France, France
| | - Weniko Caré
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR-S 1144, Université de Paris, 75000 Paris, France
- Paris Poison Control Center, Fédération de Toxicologie (FeTox), Hôpital Fernand Widal, AP-HP, 75000 Paris, France
- Internal Medicine Department, Hôpital d’Instruction des Armées Bégin, 94160 Val-de-Marne, France
| | - Luc de Haro
- Marseille Poison Control Centre, Assistance Public des Hôpitaux de Marseille, 13000 Marseille, France
| | - Jean-Christophe Gallart
- Toulouse Poison Control Centre, Centre Hospitalier et Universitaire de Toulouse, 31000 Toulouse, France
| | - Romain Torrents
- Marseille Poison Control Centre, Assistance Public des Hôpitaux de Marseille, 13000 Marseille, France
| | - Corinne Schmitt
- Marseille Poison Control Centre, Assistance Public des Hôpitaux de Marseille, 13000 Marseille, France
| | | | - Magali Labadie
- Bordeaux Poison Control Centre, Centre Hospitalier et Universitaire Bordeaux Pellegrin, 33000 Bordeaux, France
| | - Hatem Kallel
- Intensive Care Unit, Centre Hospitalier de Cayenne, 97300 Cayenne, France
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Les envenimations scorpioniques en France métropolitaine et d’Outremer : mise au point. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Romero-Imbachi MR, Cupitra N, Ángel K, González B, Estrada O, Calderón JC, Guerrero-Vargas J, Beltrán J, Narvaez-Sanchez R. Centruroides margaritatus scorpion complete venom exerts cardiovascular effects through alpha-1 adrenergic receptors. Comp Biochem Physiol C Toxicol Pharmacol 2021; 240:108939. [PMID: 33166680 DOI: 10.1016/j.cbpc.2020.108939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023]
Abstract
Centruroides margaritatus scorpion stings are common in Colombia. However, the cardiovascular toxicity of the venom has not been clarified. AIM To study the effect and mechanisms of action of the complete venom of C. margaritatus (CmV) on the murine cardiovascular system. METHODS We evaluated the in vivo effect of CmV LD50 on the mean arterial pressure (MABP), heart rate, and surface electrocardiogram in male adult normotensive Wistar rats. Ex vivo, we evaluated the vascular reactivity of rat aortic rings to increasing concentrations (1 to 60 μg/mL) of CmV using the blockers L-NAME, indomethacin, seratrodast, and prazosin. RESULTS In the first hour of poisoning, CmV increased the MABP. In the second hour after poisoning, the heart rate decreased as the normalized PR interval and QT corrected increased. After that, cardiovascular shock was demonstrated by a drastic fall in the MABP and signs of cardiac conduction system block. In aortic rings, CmV caused a direct vasoconstrictor effect mediated by alpha-1 adrenergic receptors and counteracted by nitric oxide. CONCLUSION The direct vascular and probably the cardiac alpha-1 effects likely explain the transient hypertension and the maintenance of cardiac function, while interval lengthening may be due to K+ channel blockage. Afterwards, the effects of both the alpha-1 pathway and the K+ channel pathway converged, resulting in fatal cardiovascular shock. This knowledge could aid in understanding the dynamics of the effects of the venom and in designing treatments to address its cardiovascular effects.
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Affiliation(s)
- Margarita Rosa Romero-Imbachi
- Physiology and Biochemistry Research Group-PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia; Herpetological and Toxinological Research Group, Faculty of Natural, Exact and Educational Sciences, University of Cauca, Popayán, Colombia
| | - Nelson Cupitra
- Physiology and Biochemistry Research Group-PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia
| | - Karen Ángel
- Herpetological and Toxinological Research Group, Faculty of Natural, Exact and Educational Sciences, University of Cauca, Popayán, Colombia
| | - Beatriz González
- Laboratory of Cellular Physiology, Center for Biophysics and Biochemistry, Venezuelan Institute for Scientific Research, Venezuela
| | - Omar Estrada
- Laboratory of Cellular Physiology, Center for Biophysics and Biochemistry, Venezuelan Institute for Scientific Research, Venezuela
| | - Juan C Calderón
- Physiology and Biochemistry Research Group-PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia
| | - Jimmy Guerrero-Vargas
- Herpetological and Toxinological Research Group, Faculty of Natural, Exact and Educational Sciences, University of Cauca, Popayán, Colombia
| | - José Beltrán
- Herpetological and Toxinological Research Group, Faculty of Natural, Exact and Educational Sciences, University of Cauca, Popayán, Colombia
| | - Raul Narvaez-Sanchez
- Physiology and Biochemistry Research Group-PHYSIS, Faculty of Medicine, University of Antioquia, Medellin, Colombia.
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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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Dias-Lopes C, Paiva AL, Guerra-Duarte C, Molina F, Felicori L. Venomous Arachnid Diagnostic Assays, Lessons from Past Attempts. Toxins (Basel) 2018; 10:toxins10090365. [PMID: 30201918 PMCID: PMC6162545 DOI: 10.3390/toxins10090365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 12/12/2022] Open
Abstract
Diagnostic tests for arachnid accidents remain unavailable for patients and clinicians. Together with snakes, these accidents are still a global medical concern, and are recognized as neglected tropical issues. Due to arachnid toxins’ fast mechanism of action, quick detection and quantification of venom is required to accelerate treatment decisions, rationalize therapy, and reduce costs and patient risks. This review aims to understand the current limitations for arachnid venom identification and quantification in biological samples. We benchmarked the already existing initiatives regarding test requirements (sample or biomarkers of choice), performances (time, detection limit, sensitivity and specificity) and their validation (on animal models or on samples from envenomed humans). Our analysis outlines unmet needs for improving diagnosis and consequently treatment of arachnid accidents. Hence, based on lessons from past attempts, we propose a road map for raising best practice guidelines, leading to recommendations for future progress in the development of arachnid diagnostic assays.
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Affiliation(s)
- Camila Dias-Lopes
- Departamento de Bioquímica e Imunologia, UFMG, Belo Horizonte 31270901, Brazil.
- Colégio Técnico (COLTEC), UFMG, Belo Horizonte 31270901, Brazil.
| | - Ana Luiza Paiva
- Fundação Ezequiel Dias (FUNED), Belo Horizonte 30510010, Brazil.
| | | | - Franck Molina
- Sys2Diag UMR 9005 CNRS Alcediag, 34000 Montpellier, France.
| | - Liza Felicori
- Departamento de Bioquímica e Imunologia, UFMG, Belo Horizonte 31270901, Brazil.
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Román JP, García F, Medina D, Vásquez M, García J, Graham MR, Romero-Alvarez D, Pardal PPDO, Ishikawa EAY, Borges A. Scorpion envenoming in Morona Santiago, Amazonian Ecuador: Molecular phylogenetics confirms involvement of the Tityus obscurus group. Acta Trop 2018; 178:1-9. [PMID: 29079184 DOI: 10.1016/j.actatropica.2017.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/15/2017] [Accepted: 10/16/2017] [Indexed: 01/10/2023]
Abstract
Scorpion envenoming by species in the genus Tityus is hereby reported from rural locations in the Amazonian province of Morona Santiago, southeastern Ecuador. Twenty envenoming cases (18 patients under 15 years of age) including one death (a 4-year-old male) were recorded at the Macas General Hospital, Morona Santiago, between January 2015 and December 2016 from the counties of Taisha (n=17), Huamboyo (n=1), Palora (n=1), and Logroño (n=1). An additional fatality from 2014 (a 3-year-old female from Nayantza, Taisha county) is also reported. Leukocytosis and low serum potassium levels were detected in most patients. We observed a significant negative correlation between leukocytosis and hypokalemia. Scorpions involved in three accidents from Macuma, Taisha County, were identified as genetically related to Tityus obscurus from the Brazilian Amazonian region based on comparison of mitochondrial DNA sequences encoding cytochrome oxidase subunit I. These cases, along with previously reported envenoming from northern Manabí, reinforce the notion that scorpionism is a health hazard for children in Ecuador and emphasizes the need to supply effective antivenoms against local species, which are not currently available. The genetic affinity of the Ecuadorian specimens with T. obscurus may underlay toxinological, clinical, and venom antigenic relationships among Amazonian scorpions that deserves further exploration for designing therapeutic strategies to treat scorpionism in the region.
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Affiliation(s)
- Juan P Román
- Hospital General de Macas, Macas, Morona Santiago, Ecuador
| | | | - Doris Medina
- Hospital General de Macas, Macas, Morona Santiago, Ecuador
| | - Manolo Vásquez
- Hospital General de Macas, Macas, Morona Santiago, Ecuador
| | - José García
- Hospital General de Macas, Macas, Morona Santiago, Ecuador
| | - Matthew R Graham
- Department of Biology, Eastern Connecticut State University, 83 Windham St., Willimantic, CT 06226, USA
| | - Daniel Romero-Alvarez
- Biodiversity Institute and Department of Ecology and Evolutionary Biology, University of Kansas, Lawrence, KS 66045, USA
| | - Pedro P de Oliveira Pardal
- Laboratory of Medical Entomology and Venomous Animals, Center of Tropical Medicine, Pará Federal University, Av. Generalíssimo Deodoro 92, Umarizal, 66055-240 Belém, Pará State, Brazil
| | - Edna A Y Ishikawa
- Laboratory of Medical Entomology and Venomous Animals, Center of Tropical Medicine, Pará Federal University, Av. Generalíssimo Deodoro 92, Umarizal, 66055-240 Belém, Pará State, Brazil
| | - Adolfo Borges
- Carrera de Biotecnología, Facultad de Ingenierías y Ciencias Agropecuarias, Universidad de Las Américas, Quito, Ecuador; Laboratorio de Biología Molecular de Toxinas y Receptores, Instituto de Medicina Experimental, Facultad de Medicina, Universidad Central de Venezuela, Caracas 1051, Venezuela.
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