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Benazzouz SM, Benlouahmia N, Bouhadida K, Benlamara M, Arezki N, Sadeddine OEK, Issad M, Attal N, Mansouri K, Derrar F, Djidjik R. Evaluation of the immunoprotective power of a multiple antigenic peptide against Aah II toxin of Androctonus australis hector scorpion. Vaccine X 2024; 19:100503. [PMID: 38868522 PMCID: PMC11167365 DOI: 10.1016/j.jvacx.2024.100503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/14/2024] Open
Abstract
Scorpion envenoming (SE) is a public health problem in developing countries. In Algeria, the population exposed to the risk of SE was estimated at 86.45% in 2019. Thus, the development of a vaccine to protect the exposed population against scorpion toxins would be a major advance in the fight against this disease. This work aimed to evaluate the immunoprotective effect of a Multiple Antigenic Peptide against the Aah II toxin of Androctonus australis hector scorpion, the most dangerous scorpion species in Algeria. The immunogen MAP1Aah2 was designed and tested accordingly. This molecule contains a B epitope, derived from Aah II toxin, linked by a spacer to a universal T epitope, derived from the tetanus toxin. The results showed that MAP1Aah2 was non-toxic despite the fact that its sequence was derived from Aah II toxin. The immunoenzymatic assay revealed that the 3 immunization regimens tested generated specific anti-MAP1Aah2 antibodies and cross-reacted with the toxin. Mice immunized with this immunogen were partially protected against mortality caused by challenge doses of 2 and 3 LD50 of the toxin. The survival rate and developed symptoms varied depending on the adjuvant and the challenge dose used. In the in vitro neutralization test, the immune sera of mice having received the immunogen with incomplete Freund's adjuvant neutralized a challenge dose of 2 LD50. Hence, the concept of using peptide dendrimers, based on linear epitopes of scorpion toxins, as immunogens against the parent toxin was established. However, the protective properties of the tested immunogen require further optimizations.
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Affiliation(s)
- Safouane M. Benazzouz
- Laboratoire de Pharmacologie, Faculté de Pharmacie d’Alger, Université d’Alger 1. 8 Rue du Lieutenant Mohamed Benarfa, El Biar, Alger 16000, Algeria
- Laboratoire des Sérums Thérapeutiques, Département des Produits Biologiques Humains, Direction de la Production, Institut Pasteur d’Algérie. Rue du Petit Staoueli, Dely Ibrahim, Alger 16320, Algeria
| | - Nesrine Benlouahmia
- Laboratoire des Sérums Thérapeutiques, Département des Produits Biologiques Humains, Direction de la Production, Institut Pasteur d’Algérie. Rue du Petit Staoueli, Dely Ibrahim, Alger 16320, Algeria
| | - Karima Bouhadida
- Laboratoire des Sérums Thérapeutiques, Département des Produits Biologiques Humains, Direction de la Production, Institut Pasteur d’Algérie. Rue du Petit Staoueli, Dely Ibrahim, Alger 16320, Algeria
| | - Meriem Benlamara
- Laboratoire des Sérums Thérapeutiques, Département des Produits Biologiques Humains, Direction de la Production, Institut Pasteur d’Algérie. Rue du Petit Staoueli, Dely Ibrahim, Alger 16320, Algeria
| | - Naziha Arezki
- Laboratoire des Sérums Thérapeutiques, Département des Produits Biologiques Humains, Direction de la Production, Institut Pasteur d’Algérie. Rue du Petit Staoueli, Dely Ibrahim, Alger 16320, Algeria
| | - Oum El Kheir Sadeddine
- Laboratoire des Sérums Thérapeutiques, Département des Produits Biologiques Humains, Direction de la Production, Institut Pasteur d’Algérie. Rue du Petit Staoueli, Dely Ibrahim, Alger 16320, Algeria
| | - Mourad Issad
- Laboratoire des Vaccins Viraux Humains, Département des Produits Biologiques Humains, Direction de la Production, Institut Pasteur d’Algérie, Rue du Petit Staoueli, Dely Ibrahim, Alger 16320, Algeria
| | - Nabila Attal
- Laboratoire d’Immunologie, Faculté de Pharmacie d’Alger, Université d’Alger 1. 8 Rue du Lieutenant Mohamed Benarfa, El Biar, Alger 16000, Algeria
- Département d’Immunologie, Direction des Laboratoires, de la Recherche et du Développement, Institut Pasteur d’Algérie, Rue du Petit Staoueli, Dely Ibrahim, Alger 16320, Algeria
| | - Kamel Mansouri
- Laboratoire de Pharmacologie, Faculté de Pharmacie d’Alger, Université d’Alger 1. 8 Rue du Lieutenant Mohamed Benarfa, El Biar, Alger 16000, Algeria
| | - Fawzi Derrar
- Laboratoire de la Grippe et autres Virus Respiratoires, Département de Virologie, Direction des Laboratoires, de la Recherche et du Développement, Institut Pasteur d’Algérie. Rue du Petit Staoueli, Dely Ibrahim, Alger 16320, Algeria
- Laboratoire de Microbiologie, Faculté de Médecine d’Alger, Université d’Alger 1. 8 Rue du Lieutenant Mohamed Benarfa, El Biar, Alger 16000, Algeria
| | - Reda Djidjik
- Laboratoire d’Immunologie, Faculté de Pharmacie d’Alger, Université d’Alger 1. 8 Rue du Lieutenant Mohamed Benarfa, El Biar, Alger 16000, Algeria
- Laboratoire d’Immunologie Médicale, CHU Issaad Hassani, Rue Ibrahim Hadjeras, Beni Messous, Alger 16206, Algeria
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Campbell SID, Chow CY, Neri-Castro E, Alagón A, Gómez A, Soria R, King GF, Fry BG. Taking the sting out of scorpions: Electrophysiological investigation of the relative efficacy of three antivenoms against medically significant Centruroides species. Comp Biochem Physiol C Toxicol Pharmacol 2024; 283:109977. [PMID: 39025425 DOI: 10.1016/j.cbpc.2024.109977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 06/22/2024] [Accepted: 07/14/2024] [Indexed: 07/20/2024]
Abstract
In this study, we report the innovative application of whole-cell patch-clamp electrophysiology in assessing broad-spectrum neutralisation by three different antivenoms, of venoms from the medically significant scorpion genus Centruroides. Envenomations by as many as 21 species from the Centruroides genus result in up to 300,000 envenomations per year in Mexico, which poses significant and potentially life-threatening pathophysiology. We first evaluated the in vitro manifestation of envenomation against two human voltage-gated sodium (hNaV) channel subtypes: hNaV1.4 and hNaV1.5, which are primarily expressed in skeletal muscles and cardiomyocytes, respectively. The neutralisation of venom activity was then characterised for three different antivenoms using a direct competition model against the more potent target, hNaV1.4. While broad-spectrum neutralisation was identified, variation in neutralisation arose for Centruroides elegans, C. limpidus, C. noxius and C. suffusus venoms, despite the presence of a number of these venoms within the immunising mixture. This raises questions regarding the truly "broad" neutralisation capacity of the antivenoms. This study not only extends previous validation of the in vitro investigation of antivenom efficacy utilising the whole-cell patch-clamp technique but also underscores the potential of this animal-free model in exploring cross-reactivity, experimental scalability, and most importantly, informing clinical management practices regarding the administration of antivenom in Mexico.
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Affiliation(s)
- Sam I D Campbell
- Adaptive Biotoxicology lab, School of the Environment, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Chun Yuen Chow
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia; Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Edgar Neri-Castro
- Facultad de Ciencias Biológicas, Universidad Juárez del Estado de Durango, Av. Universidad s/n. Fracc. Filadelfia, C.P. 35010 Gómez Palacio, Durango, Mexico; Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos 62210, Mexico
| | - Alejandro Alagón
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Morelos 62210, Mexico
| | - Aarón Gómez
- Instituto Clodomiro Picado, Universidad de Costa Rica, San José 11501, Costa Rica
| | - Raúl Soria
- Inosan Biopharma S.A. Arbea Campus Empresarial, Edificio 2. Planta 2, Carretera Fuencarral a Alcobendas, Km. 3.8, 28108 Alcobendas, Madrid, Spain
| | - Glenn F King
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia; Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Bryan G Fry
- Adaptive Biotoxicology lab, School of the Environment, The University of Queensland, Brisbane, QLD 4072, Australia
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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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Ornelas RC, Silva LD, de Macedo LR, de Matos IM. Scorpion Stings in Minas Gerais (Brazil): A Monocentric Retrospective Study Evaluating All Envenoming Cases of Local Scorpionism. Wilderness Environ Med 2023; 34:442-450. [PMID: 37558612 DOI: 10.1016/j.wem.2023.06.005] [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: 09/08/2022] [Revised: 06/08/2023] [Accepted: 06/15/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION We aim to provide better insights into the demographic, epidemiological, and seasonal characteristics of scorpion envenomation reported in the Rio Doce Valley, Brazil. METHODS We conducted this monocentric retrospective descriptive study with data on Investigation Forms of Accidents by Venomous Animals, only envenoming cases of scorpion stings, between January 1, 2017 and December 31, 2020, belonging to the compulsory notification system of the Municipal Hospital of Governador Valadares. RESULTS There were 3032 accidents, and the male-to-female ratio was 1.17:1 (male, 54%; females, 46%). Accidents occurred every month, but there was an increase in June, July, and October to January. In most cases, the time between the scorpion sting and medical care was between 1 and 3 h (n=1304; 43%). The most frequent clinical and systemic manifestations were pain at the bite site (94%) and vagal symptoms (7%). Cases were mild (n=2750, 91%), moderate (n=221, 7%), and severe (n=56, 2%). Children younger than 10 y constituted the most cases, 522 (17%). There was a significant difference between clinical severity and age (P<0.01). Ten patients developed acute pulmonary edema. Two 4-y-old children died. All severely envenomated patients as well as 74% and 2% of mild and moderately envenomated patients, respectively, received specific scorpion antivenoms. CONCLUSIONS Scorpion envenomation is of greater severity in children aged <10 y. The clinical presentation includes mainly local pain associated with vagal symptoms. Accidents occur every month, but there was an increase in June, July, and October to January.
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Affiliation(s)
- Rachel C Ornelas
- Federal University of Juiz de Fora, Campus Governador Valadares, Brazil
| | - Letícia D Silva
- Federal University of Juiz de Fora, Campus Governador Valadares, Brazil
| | - Leandro R de Macedo
- Department of Economics, Federal University of Juiz de Fora, Campus Governador Valadares, Brazil
| | - Ione M de Matos
- Department of Basic Life Sciences, Federal University of Juiz de Fora, Campus Governador Valadares, Brazil.
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Takehara CA, Lamas JLT, Gasparino RC, Fusco SDFB. Moderate or severe scorpion sting: identification of risk factors. Rev Esc Enferm USP 2023; 57:e20230022. [PMID: 37902581 PMCID: PMC10615126 DOI: 10.1590/1980-220x-reeusp-2023-0022en] [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: 03/02/2023] [Accepted: 07/20/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE To characterize scorpion accidents at the Information and Toxicological Assistance Center (CIATox) in Campinas, to analyze risk factors related to the moderate and severe classification, and to determine the age group at greatest risk for this classification. METHOD Cross-sectional and retrospective study, with patients assisted in person at CIATox, who had a scorpion accident, from January 2015 to December 2019. Descriptive and inferential analysis was conducted. For the age variable, a ROC curve was constructed to determine cutoff points in relation to the severity classification. Poisson regression models were adjusted considering severity classification as the dependent variable. RESULTS A total of 754 cases with a mean age of 36.05 years, mostly female and non-occupational accidents that occurred in the urban area, was analyzed. The most frequent scorpion was the Tityus serrulatus. The risk factors found for greater severity were age group up to 22 years and previous care in other health services. CONCLUSION The age range up to 22 years old should be used as a predictive factor of severity in the clinical evaluation of patients stung by scorpions to carry out adequate management of cases.
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Agnew J, Gorzelski A, Zhu J, Romero A. Coconut fatty acids exhibit strong repellency and week-long efficacy against several urban pest arthropods of the southwestern United States. PEST MANAGEMENT SCIENCE 2023; 79:3511-3519. [PMID: 37144346 DOI: 10.1002/ps.7531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/06/2023] [Accepted: 05/02/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The southwestern United States is home to a variety of arthropods including Turkestan cockroaches, Blatta lateralis (Walker); hematophagous kissing bugs, Tritoma rubida (Uhler); and Arizona bark scorpions, Centruroides sculpturatus Ewing. These arthropods cause medical concern when they become established around homes and/or invade indoors. Traditionally, the management of these pests has relied primarily on the use of chemical insecticides; however, they offer poor prospects for control owing to their lack of efficacy as well as the effects of insecticides on humans and the environment. Botanical repellents are an option that has not been fully investigated for the management of these pests. Here, we investigated the behavioral responses of common urban pests of the southwestern USA to recently discovered coconut fatty acids (CFAs), to establish the potential use of these compounds as repellents. RESULTS Fresh residues of CFA mixture (CFAm) and their constituents caprylic acid, capric acid, capric acid methyl ester, lauric acid, and lauric acid methyl ester, tested at a concentration of 1 mg cm-2 , strongly repelled all arthropods. The repellent activity of CFAm lasted for at least 7 days, and the addition of lavender oil, used as an odor-masking agent, did not decrease this effect. Concentrations of CFAm ten times lower (0.1 mg cm-2 ) still repelled Turkestan cockroaches, and concentrations 100 times lower (0.01 mg cm-2 ) repelled T. rubida and scorpions. CONCLUSIONS CFAm and some of their constituents are efficacious, economical, and logistically feasible for inclusion in integrated pest management programs for these important urban pests of the southwestern USA. © 2023 Society of Chemical Industry.
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Affiliation(s)
- John Agnew
- Department of Entomology, Plant Pathology and Weed Science, New Mexico State University, Las Cruces, NM, USA
| | - Ashton Gorzelski
- Department of Biology, New Mexico State University, Las Cruces, NM, USA
| | - Junwei Zhu
- United States Department of Agriculture, Agricultural Research Service, Agroecosystem Management Research Unit, University of Nebraska, Lincoln, NE, USA
| | - Alvaro Romero
- Department of Entomology, Plant Pathology and Weed Science, New Mexico State University, Las Cruces, NM, USA
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Martins JG, de Castro Figueiredo Bordon K, Moreno-González JA, Almeida B, Pardal P, Lira A, Candido D, Arantes EC, Procópio R. On the noxious black Amazonian scorpion, Tityus obscurus (Scorpiones, Buthidae): Taxonomic notes, biology, medical importance and envenoming treatment. Toxicon 2023; 228:107125. [PMID: 37054995 DOI: 10.1016/j.toxicon.2023.107125] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
Tityus obscurus has caused mild, moderate and severe accidents of medical relevance in the eastern Brazilian Amazon and French Guiana. Tityus obscurus has sexual dimorphism although males and females have uniform black coloration. In the Amazon, one of the habitats of this scorpion is seasonally flooded forests (igapós and várzeas). However, most stings occur in terra firme forest areas (non-flooded region), where most rural communities are located. Adults and children stung by T. obscurus may experience an "electric shock" sensation for more than 30 h after the sting. Our data shows that people inhabiting remote forest areas, including rubber tappers, fishermen and indigenous people, with no access to anti-scorpion serum, use parts of native plants, such as seeds and leaves, against pain and vomiting caused by scorpion stings. Although there is a technical effort to produce and distribute antivenoms in the Amazon, many cases of scorpion stings are geographically unpredictable in this region, due to the lack of detailed knowledge of the natural distribution of these animals. In this manuscript, we compile information on the natural history of T. obscurus and the impact of its envenoming on human health. We identify the natural sites that host this scorpion in the Amazon, in order to warn about the risk of human envenoming. The use of specific antivenom serum is the recommended treatment for accidents involving venomous animals. However, atypical symptoms not neutralized by the available commercial antivenom are reported in the Amazon region. Facing this scenario, we present some challenges to the study of venomous animals in the Amazon rainforest and possible experimental bottlenecks and perspectives for establishing a method aimed at producing an efficient antivenom.
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Affiliation(s)
- Jonas Gama Martins
- Pós-Graduação em Genética, Conservação e Biologia Evolutiva, Instituto Nacional de Pesquisas da Amazônia (INPA), Manaus, AM, Brazil.
| | - Karla de Castro Figueiredo Bordon
- Departamento de Ciências BioMoleculares, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Jairo A Moreno-González
- Division of Invertebrate Zoology, American Museum of Natural History New York, Central Park West at 79th Street, 10024-5192, New York City, NY, USA
| | - Bruno Almeida
- Instituto Federal de Educação, Ciência e Tecnologia do Pará, Campus Itaituba, PA, Brazil
| | - Pedro Pardal
- Laboratório de Entomologia Médica e Animais Peçonhentos, Núcleo de Medicina Tropical, Universidade Federal do Pará (UFPA), Belém, PA, Brazil
| | - André Lira
- Universidade Federal de Campina Grande, Centro de Educação e Saúde, Cuité, PB, Brazil
| | - Denise Candido
- Laboratório de Artrópodes, Instituto Butantan, São Paulo, Brazil
| | - Eliane Candiani Arantes
- Departamento de Ciências BioMoleculares, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Rudi Procópio
- Pós-Graduação em Biotecnologia e Recursos Naturais da Amazônia, Universidade do Estado do Amazonas (UEA), Manaus, AM, Brazil
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Elmourid A, Boussaa S, El Hidan MA, Amahmid O, Touloun O. Epidemiological, toxicological and physiopathological characteristics of scorpion stings and their management in Morocco: A literature review. Acta Trop 2023; 239:106812. [PMID: 36596437 DOI: 10.1016/j.actatropica.2022.106812] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
All around the world, scorpion envenomation represents a public health issue. In Morocco, it represents the first cause of poisoning. The aim of this review is to highlight the epidemiological, toxicological and physiopathological characteristics of scorpion stings and envenomation in Morocco as well as their management. According to the bibliography, the most areas affected by scorpion stings and envenomation are those in the center and south of Morocco. Lethality rate is more important in children than adult. Age, admission class, season, serum venom concentration, and the time elapsed between the scorpion sting and medical intervention are risk factors for a poor prognosis. Until now, we have only known the LD50 of 14 scorpion species from three genera: Androctonus, Buthus and Hottentota, and only 6 species, out of 61 moroccan scorpions, have been assessed for their venom toxicity on mice organs. The venom of harmful moroccan scorpions induces several histopathological changes in the myocardium, brain, liver, pulmonary alveoli, and kidneys in rats, as well as severe consequences in the lungs with intra-alveolar hemorrhage. There was also a significant increase in serum enzyme levels of aspartate transaminase (AST), alanine transaminase (ALT), creatine phosphokinase (CPK), and lactate dehydrogenase (LDH), as well as high levels of plasma albumin, creatine and glucose. In the absence of a specific treatment, the management of scorpion envenomation is based only on symptomatic therapy. We noted a widely use of traditional remedies. Despite the magnitude of the scorpion problem in Morocco, it remains understudied and continues to claim lives, particularly given the lack of an efficient etiological cure.
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Affiliation(s)
- Abdessamad Elmourid
- Polyvalent Team in Research and Development (EPVRD), Department of Biology & Geology, Polydisciplinary Faculty, University, Sultan My Slimane, Beni Mellal, 23030, Morocco.
| | - Samia Boussaa
- ISPITS-Higher Institute of Nursing Professions and Health Techniques, Ministry of Health and Social Protection, Rabat, Morocco
| | - Moulay Abdelmounaim El Hidan
- Laboratory of Biotechnology and Valorization of Natural Resources, Faculty of Applied Sciences, Ibn Zohr University, Agadir, Morocco
| | - Omar Amahmid
- Department of Life and Earth Sciences, (Biology /Geology Research Units), Regional Centre for Careers of Education and Training Crmef Marrakech-Safi, Marrakesh Morocco
| | - Oulaid Touloun
- Polyvalent Team in Research and Development (EPVRD), Department of Biology & Geology, Polydisciplinary Faculty, University, Sultan My Slimane, Beni Mellal, 23030, Morocco
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Antimicrobial Activity Developed by Scorpion Venoms and Its Peptide Component. Toxins (Basel) 2022; 14:toxins14110740. [PMID: 36355990 PMCID: PMC9693228 DOI: 10.3390/toxins14110740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/28/2022] [Accepted: 10/23/2022] [Indexed: 01/26/2023] Open
Abstract
Microbial infections represent a problem of great importance at the public health level, with a high rate of morbidity-mortality worldwide. However, treating the different diseases generated by microorganisms requires a gradual increase in acquired resistance when applying or using them against various antibiotic therapies. Resistance is caused by various molecular mechanisms of microorganisms, thus reducing their effectiveness. Consequently, there is a need to search for new opportunities through natural sources with antimicrobial activity. One alternative is using peptides present in different scorpion venoms, specifically from the Buthidae family. Different peptides with biological activity in microorganisms have been characterized as preventing their growth or inhibiting their replication. Therefore, they represent an alternative to be used in the design and development of new-generation antimicrobial drugs in different types of microorganisms, such as bacteria, fungi, viruses, and parasites. Essential aspects for its disclosure, as shown in this review, are the studies carried out on different types of peptides in scorpion venoms with activity against pathogenic microorganisms, highlighting their high therapeutic potential.
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10
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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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11
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Özlüer YE, Karaman K, Kayaöz D, Avcil M. Low peripheral perfusion index values may indicate the need for antivenom in the early phase of scorpion envenomation. Am J Emerg Med 2022; 56:104-106. [DOI: 10.1016/j.ajem.2022.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022] Open
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12
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Kerdoun MA. Epidemiological aspects of scorpion stings in Algeria: A monocentric retrospective study. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2022. [DOI: 10.1016/j.toxac.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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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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14
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Darkaoui B, Lafnoune A, Chgoury F, Daoudi K, Chakir S, Mounaji K, Karkouri M, Cadi R, Naoual O. Induced pathophysiological alterations by the venoms of the most dangerous Moroccan scorpions Androctonus mauretanicus and Buthus occitanus: A comparative pathophysiological and toxic-symptoms study. Hum Exp Toxicol 2022; 41:9603271211072872. [PMID: 35130762 DOI: 10.1177/09603271211072872] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scorpion envenomation is a serious public health issue. Androctonus mauretanicus (Am) and Buthus occitanus (Bo) are the most dangerous scorpions in Morocco. Despite their medical relevance, no study has yet related their kinetics of symptom apparition and the consequent tissue disorders at the same interval post-injection. This work achieved the first comparative pathophysiological and toxic-symptoms study between the Am and Bo venoms from a biochemical, toxicological and physiopathological standpoint. The activity of venoms and their subletal dose were determined by administration of increasing concentrations of the venoms. 30, 60 and 120 min following the experimental envenomation in mice, the profile of clinical symptoms was underlined and the main organs: brain, heart, lungs, liver and kidneys were removed for histological examination. The Am venom is a rich source of proteins and three-times more toxic than the Bo. The most observed clinical symptoms are neurological and cardiopulmonary. The Am venom caused histopathological alterations at 30, 60, and 120 min which were more important than the Bo. This study highlighted that both venoms exhibited a strong toxicity with variable intensities. Moreover, we showed the presence of correlation between the level of histopathological disorders observed and the intensity of signs appeared at the same time following venom inoculation.
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Affiliation(s)
- Bouchra Darkaoui
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, Casablanca, Morocco.,Laboratory of Molecular Genetics, Physiopathology and Biotechnology, Faculty of Sciences Ain Chock, Hassan II University of Casablanca, Casablanca, Morocco
| | - Ayoub Lafnoune
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, Casablanca, Morocco.,Laboratory of Molecular Genetics, Physiopathology and Biotechnology, Faculty of Sciences Ain Chock, Hassan II University of Casablanca, Casablanca, Morocco
| | - Fatima Chgoury
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, Casablanca, Morocco
| | - Khadija Daoudi
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, Casablanca, Morocco.,Laboratory of Molecular Genetics, Physiopathology and Biotechnology, Faculty of Sciences Ain Chock, Hassan II University of Casablanca, Casablanca, Morocco
| | - Salma Chakir
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, Casablanca, Morocco
| | - Khadija Mounaji
- Laboratory of Molecular Genetics, Physiopathology and Biotechnology, Faculty of Sciences Ain Chock, Hassan II University of Casablanca, Casablanca, Morocco
| | - Mehdi Karkouri
- Department of Anatomical Pathology, 107900University Hospital of Ibn Rochd, Casablanca, Morocco
| | - Rachida Cadi
- Laboratory of Molecular Genetics, Physiopathology and Biotechnology, Faculty of Sciences Ain Chock, Hassan II University of Casablanca, Casablanca, Morocco
| | - Oukkache Naoual
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, Casablanca, Morocco
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15
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Rebahi H, Ba-M'hamed S, Still ME, Mouaffak Y, Younous S, Bennis M. Clinical features and prognosis of severe scorpion envenomation in children. Pediatr Int 2022; 64:e14687. [PMID: 33682212 DOI: 10.1111/ped.14687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/28/2021] [Accepted: 03/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scorpionism is endemic and represents a real public health problem in Morocco. The most dangerous arthropod in the central area is Androctonus mauretanicus (Am) scorpion. Its venom can be lethal, especially for children. This study aimed to determine a clinico-epidemiological profile of severe scorpion envenomation among children and identify risk factors for mortality. METHODS This retrospective cohort study included 606 children admitted for severe scorpion envenomation (SSE) from January 2010 to July 2015 in the Pediatric Intensive Care Unit (PICU) of Mohammed VI Teaching Hospital. RESULTS The mean age of envenomed children was 6.3 ± 4.2 years. Seventy-four percent of them came from rural settings. Envenomation occurred mostly during the summer months and 78.4% of stings were nocturnal. The time between the sting and evaluation was greater than 2 h in 83% of cases. Bivariate analysis indicated that from 1 to 24 months of age (P = 0.001), hyperthermia (P = 0.022), episodes of diarrhea (P < 0.001), tachycardia (P < 0.001), abdominal distention (P < 0.001), skin marbling (P < 0.001), signs of respiratory distress (P < 0.001), irritability (P < 0.001), generalized seizures (P = 0.053), and Glasgow Coma Score (GCS) of 3 to 9 (P < 0.001) were significantly correlated with mortality. On multivariate analysis, diarrhea (P = 0.007), skin marbling (P = 0.006), and respiratory distress (P = 0.002), and GCS 3-9 (P = 0.007) were found to be independent risk factors for mortality in our patient population. CONCLUSIONS Children are at high risk of developing serious complications, even death, from severe scorpion envenomation. Here we identified multiple factors that appear to increase the mortality risk in children after scorpion envenomation, including previously described central nervous system alterations.
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Affiliation(s)
- Houssam Rebahi
- Department of Anesthesia & Intensive Care Medicine, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Childhood, Health & Development, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Pharmacology, Neurobiology and Behavior (URAC-37), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | - Saadia Ba-M'hamed
- Laboratory of Pharmacology, Neurobiology and Behavior (URAC-37), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
| | | | - Youssef Mouaffak
- Department of Anesthesia & Intensive Care Medicine, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Childhood, Health & Development, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Said Younous
- Department of Anesthesia & Intensive Care Medicine, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco.,Laboratory of Childhood, Health & Development, Faculty of Medicine & Pharmacy of Marrakech, Cadi Ayyad University, Marrakech, Morocco
| | - Mohamed Bennis
- Laboratory of Pharmacology, Neurobiology and Behavior (URAC-37), Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakech, Morocco
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16
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Borges A, Graham MR, Cândido DM, Pardal PPO. Amazonian scorpions and scorpionism: integrating toxinological, clinical, and phylogenetic data to combat a human health crisis in the world's most diverse rainfores. J Venom Anim Toxins Incl Trop Dis 2021; 27:e20210028. [PMID: 34887908 PMCID: PMC8629433 DOI: 10.1590/1678-9199-jvatitd-2021-0028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022] Open
Abstract
Venom from Amazonian scorpions of the genus Tityus contains components capable of eliciting a distinct clinical, mostly neurological, syndrome. This contrasts with the mainly autonomic manifestations produced after envenomation by congeneric southern and northern South American species. Herein, we summarize Pan-Amazonian scorpionism by synthesizing available toxinological, clinical, and molecular data gathered from all affected areas in Amazonia, including Brazil, Ecuador, Colombia, Peru, Venezuela, and French Guiana. We searched multiple databases, as well as our own records, for reports of scorpion envenomations in Amazonia by confirmed Tityus spp., and compared the clinical manifestations. To help uncover clinical and venom relationships among problematic species, we explored phylogenetic relationships with a rate-calibrated analysis of mitochondrial COI data from available species. The possible existence of diversity gradients for venom toxic and immunogenic components despite the predicted strong phylogenetic association among species is underscored by discussed clinical and toxinological findings. A multicentric effort, involving all nations affected by this neglected disease, is urgently needed to offer alternatives for treating and understanding this pathology, including the preparation of neutralizing antibodies with a broad range of efficacy.
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Affiliation(s)
- Adolfo Borges
- Center for the Development of Scientific Research (CEDIC), Asunción,
Paraguay
- Laboratory of Molecular Biology of Toxins and Receptors, Institute
of Experimental Medicine, School of Medicine, Central University of Venezuela,
Caracas, Venezuela
| | - Matthew R. Graham
- Department of Biology, Eastern Connecticut State University,
Willimantic, CT, United States
| | | | - Pedro P. O. Pardal
- Laboratory of Medical Entomology and Venomous Animals, Center of
Tropical Medicine, Federal University of Pará (UFPA), Belém, PA, Brazil
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17
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Vaucel JA, Larréché S, Paradis C, Labadie M, Courtois A, Grenet G, Langrand J, Tournoud C, Nisse P, Gallart JC, Schmitt C, Torrents R, Le Roux G, Gil-Jardine C, Kallel H. Relationship Between Scorpion Stings Events and Environmental Conditions in Mainland France. JOURNAL OF MEDICAL ENTOMOLOGY 2021; 58:2146-2153. [PMID: 34224562 DOI: 10.1093/jme/tjab109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Indexed: 06/13/2023]
Abstract
In the world, the impact of environmental conditions on the number of scorpion events was evaluated in North Africa,Middle East, and the Amazonian region but not in Europe. In mainland France, scorpion species described are Buthus occitanus (Amoreux, 1789), Belisarius xambeui (Simon, 1879) and 4 Euscorpiidae: Euscorpius concinnus (Koch, 1837), Euscorpius italicus (Herbst, 1800), Euscorpius tergestinus (Koch, 1837), and Tetratrichobothrius flavicaudis (De Geer, 1778). We aimed to describe the impact of environmental conduction on the number of scorpion events. For this, a retrospective multi-center study was conducted with data from the French poison control centers files about scorpion events between 1 January 2011 and 31 December 2020. During the study period, 975 incoming calls for scorpion events were recorded and 574 were related to scorpions native to mainland France and Corsica: B. occitanus (n = 86), Euscorpiidae species (n = 222), B. xambeui (n = 1), and undetermined species (n = 265). Cases were mostly reported along the Mediterranean coast, along rivers, and in cities with a trading port. The number of scorpion events was linked to the rivers' water level, rivers' flow, temperature, sunshine, and pluviometry (P < 0.05 for all variables). B. occitanus need warmest and driest environment than Euscorpiidae spp. A link between the severity of the envenoming and climatic condition or seasonality was not demonstrated.
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Affiliation(s)
- Jules-Antoine Vaucel
- Centre Antipoison Nouvelle Aquitaine [Poison Control Center of Nouvelle-Aquitaine], Centre hospitalier et universitaire Pellegrin, CHU de Bordeaux, 1 Place Amélie Rabat Léon, Bordeaux 33076, Nouvelle Aquitaine, France
- Service des urgences adulte [Emergency Department], Centre hospitalier et universitaire Pellegrin, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Sébastien Larréché
- Département de Biologie Médicale [Medical Biology Department], Hôpital d'Instruction Des Armées Bégin, Saint-Mandé 94160, Ile de France, France
| | - Camille Paradis
- Centre Antipoison Nouvelle Aquitaine [Poison Control Center of Nouvelle-Aquitaine], Centre hospitalier et universitaire Pellegrin, CHU de Bordeaux, 1 Place Amélie Rabat Léon, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Magali Labadie
- Centre Antipoison Nouvelle Aquitaine [Poison Control Center of Nouvelle-Aquitaine], Centre hospitalier et universitaire Pellegrin, CHU de Bordeaux, 1 Place Amélie Rabat Léon, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Arnaud Courtois
- Centre Antipoison Nouvelle Aquitaine [Poison Control Center of Nouvelle-Aquitaine], Centre hospitalier et universitaire Pellegrin, CHU de Bordeaux, 1 Place Amélie Rabat Léon, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Guillaume Grenet
- Centre Hospitalier Universitaire de Lyon, Centre Antipoison [Lyon Poison Control Center], Lyon 69000, Auvergne-Rhône-Alpes, France
| | - Jérome Langrand
- Centre Antipoison de Paris [Poison Control Center of Paris], hôpital Fernand-Widal, Paris 75000, Ile de France, France
| | - Christine Tournoud
- Centre Hospitalier Universitaire de Nancy, Centre Antipoison [East Poison Control Center], Nancy 54000, Grand Est, France
| | - Patrick Nisse
- Centre hospitalier Universitaire de Lille, Centre Antipoison [Lille Poison Control Center], Lille 59000, Haut de France, France
| | - Jean-Christophe Gallart
- Centre Hospitalier Universitaire de Toulouse, Centre Antipoison-SAMU 31 [Toulouse Poison Control Center], Toulouse 31000, Occitanie, France
| | - Corinne Schmitt
- Centre Hospitalier Universitaire de Marseille, Centre Antipoison [Marseille Poison Control Center], Marseille 13000, Provence-Alpes-Côte-D'azur, France
| | - Romain Torrents
- Centre Hospitalier Universitaire de Marseille, Centre Antipoison [Marseille Poison Control Center], Marseille 13000, Provence-Alpes-Côte-D'azur, France
| | - Gaël Le Roux
- Centre Hospitalier Universitaire d'Angers, Centre Antipoison [Angers Poison Control Center], Angers 49000, Pays de la Loire, France
| | - Cédric Gil-Jardine
- Service des urgences adulte [Emergency Department], Centre hospitalier et universitaire Pellegrin, Bordeaux 33076, Nouvelle Aquitaine, France
- Bordeaux Population Health Research Center, IETO Team, Université de Bordeaux, Bordeaux 33076, Nouvelle Aquitaine, France
| | - Hatem Kallel
- Service de Réanimation [Intensive Care Unit], Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
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18
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Mendoza-Tobar LL, Meza-Cabrera IA, Sepúlveda-Arias JC, Guerrero-Vargas JA. Comparison of the Scorpionism Caused by Centruroidesmargaritatus, Tityuspachyurus and Tityus n. sp. aff. metuendus Scorpion Venoms in Colombia. Toxins (Basel) 2021; 13:toxins13110757. [PMID: 34822541 PMCID: PMC8625436 DOI: 10.3390/toxins13110757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 01/04/2023] Open
Abstract
Among other scorpion species, Colombia has two genera of the Buthidae family Centruroides and Tityus, considered to be dangerous to humans. This research shares scientific knowledge aiming to a better understanding about the pathophysiological effects of such venoms. The venom of the three species: Centruroides margaritarus, Tityus pachyurus, and T. n. sp. aff. metuendus with biomedical interest were studied. An initial pre-glycemic sample was taken from ICR mice. They were later intraperitoneally inoculated with doses of 35% and 70% of LD50 of total venom. Poisoning signs were observed during a 6-h period to determine the level of scorpionism. After observation, a second glycemic sample was taken, and a histopathological evaluation of different organs was performed. This work revealed that all three venoms showed considerably notorious histopathological alterations in main organs such as heart and lungs; and inducing multiple organ failure, in relation to the glycemia values, only C. margaritatus and T. n. sp. aff. metuendus showed significant changes through manifestation of hyperglycemia. According to the Colombian scorpionism level; signs were mild to severe affecting the autonomous nervous system.
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Affiliation(s)
- Leydy Lorena Mendoza-Tobar
- Programa de Doctorado en Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira 660003, Colombia; (L.L.M.-T.); (J.C.S.-A.)
- Grupo de Investigaciones Herpetológicas y Toxinológicas, Centro de Investigaciones Biomédicas-Bioterio, Departamento de Biología, Facultad de Ciencias Naturales, Exactas y de la Educación, Universidad del Cauca, Popayán 190002, Colombia
| | | | - Juan C. Sepúlveda-Arias
- Programa de Doctorado en Ciencias Biomédicas, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira 660003, Colombia; (L.L.M.-T.); (J.C.S.-A.)
| | - Jimmy Alexander Guerrero-Vargas
- Grupo de Investigaciones Herpetológicas y Toxinológicas, Centro de Investigaciones Biomédicas-Bioterio, Departamento de Biología, Facultad de Ciencias Naturales, Exactas y de la Educación, Universidad del Cauca, Popayán 190002, Colombia
- Correspondence:
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19
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Colombian Scorpion Centruroides margaritatus: Purification and Characterization of a Gamma Potassium Toxin with Full-Block Activity on the hERG1 Channel. Toxins (Basel) 2021; 13:toxins13060407. [PMID: 34201318 PMCID: PMC8273696 DOI: 10.3390/toxins13060407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 01/06/2023] Open
Abstract
The Colombian scorpion Centruroides margaritatus produces a venom considered of low toxicity. Nevertheless, there are known cases of envenomation resulting in cardiovascular disorders, probably due to venom components that target ion channels. Among them, the humanether-à-go-go-Related gene (hERG1) potassium channels are critical for cardiac action potential repolarization and alteration in its functionality are associated with cardiac disorders. This work describes the purification and electrophysiological characterization of a Centruroides margaritatus venom component acting on hERG1 channels, the CmERG1 toxin. This novel peptide is composed of 42 amino acids with a MW of 4792.88 Da, folded by four disulfide bonds and it is classified as member number 10 of the γ-KTx1 toxin family. CmERG1 inhibits hERG1 currents with an IC50 of 3.4 ± 0.2 nM. Despite its 90.5% identity with toxin ɣ-KTx1.1, isolated from Centruroides noxius, CmERG1 completely blocks hERG1 current, suggesting a more stable plug of the hERG channel, compared to that formed by other ɣ-KTx.
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20
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Vaucel JA, Gil-Jardine C, Labadie M, Larréché S, Paradis C, Nardon A, Courtois A, Langrand J, Kallel H. Epidemiology of scorpionism in France: nationwide scorpion exposure. Clin Toxicol (Phila) 2021; 59:888-895. [DOI: 10.1080/15563650.2021.1884692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jules-Antoine Vaucel
- Centre Antipoison Nouvelle Aquitaine [Poison Control Centre of Nouvelle Aquitaine], Centre Hospitalier et Universitaire Bordeaux Pellegrin, Bordeaux, France
- Service des Urgences Adulte [Emergency Department], Centre Hospitalier et Universitaire Bordeaux Pellegrin, Bordeaux, France
| | - Cédric Gil-Jardine
- Service des Urgences Adulte [Emergency Department], Centre Hospitalier et Universitaire Bordeaux Pellegrin, Bordeaux, France
| | - Magali Labadie
- Centre Antipoison Nouvelle Aquitaine [Poison Control Centre of Nouvelle Aquitaine], Centre Hospitalier et Universitaire Bordeaux Pellegrin, Bordeaux, France
| | - Sébastien Larréché
- Département de Biologie Médicale [Medical Biology Department], Hôpital d'Instruction Des Armées Bégin, Saint-Mandé, France
| | - Camille Paradis
- Centre Antipoison Nouvelle Aquitaine [Poison Control Centre of Nouvelle Aquitaine], Centre Hospitalier et Universitaire Bordeaux Pellegrin, Bordeaux, France
| | - Audrey Nardon
- Centre Antipoison Nouvelle Aquitaine [Poison Control Centre of Nouvelle Aquitaine], Centre Hospitalier et Universitaire Bordeaux Pellegrin, Bordeaux, France
| | - Arnaud Courtois
- Centre Antipoison Nouvelle Aquitaine [Poison Control Centre of Nouvelle Aquitaine], Centre Hospitalier et Universitaire Bordeaux Pellegrin, Bordeaux, France
| | - Jérôme Langrand
- Centre Antipoison de Paris [Poison Control Centre of Paris], Hôpital Fernand-Widal, Paris, France
| | - Hatem Kallel
- Service de Réanimation [Intensive Care Unit], Centre Hospitalier de Cayenne, Cayenne, France
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21
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Amr ZS, Abu Baker MA, Al-Saraireh M, Warrell DA. Scorpions and scorpion sting envenoming (scorpionism) in the Arab Countries of the Middle East. Toxicon 2020; 191:83-103. [PMID: 33387549 DOI: 10.1016/j.toxicon.2020.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/16/2020] [Accepted: 12/27/2020] [Indexed: 01/27/2023]
Abstract
The twelve Arab countries of the Middle East are inhabited by 117 species of scorpions of varying medical importance within six families. Scorpion stings are a very common occurrence throughout the region. Twenty-two scorpion species are considered to be dangerously venomous, causing potentially life threatening stings. Accessible literature in English and Arabic on scorpions, scorpion stings and available antivenoms was reviewed to document the scorpion fauna and scorpion stings in each country. Saudi Arabia, Iraq and Jordan report the highest numbers of stings and envenomings. Clinically, the most important toxins in Old World scorpion venoms are α-toxins that target voltage-gated sodium (Nav) channels at neurotoxin binding site 3, causing sympathetic excitation and the endogenous release of catecholamines that is responsible for transient, but life-threatening myocardial damage. Most victims of scorpion stings suffer severe local pain, but a few, especially children, develop systemic envenoming which, in the case of most Middle Eastern buthid species, such as Androctonus and Leiurus species, is dominated by the cardiovascular and respiratory consequences of hypercatecholinaemic myocarditis. Other syndromes include paralysis (Parabuthus leiosoma), coagulopathy (Nebo hierichonticus and Hemiscorpius species), and local tissue damage, haemolysis and acute kidney injury (H. lepturus). Early antivenom treatment is recommended but its value remains controversial. However, intensive care, with the ancillary use of vasoactive drugs such as prazosin and dobutamine, has proved effective.
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Affiliation(s)
- Zuhair S Amr
- Biology Department, Jordan University for Science and Technology, Irbid, Jordan.
| | | | | | - David A Warrell
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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Hauke TJ, Herzig V. Love bites - Do venomous arachnids make safe pets? Toxicon 2020; 190:65-72. [PMID: 33307110 DOI: 10.1016/j.toxicon.2020.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/30/2020] [Accepted: 12/06/2020] [Indexed: 12/21/2022]
Abstract
With a global estimate of tens of thousands of arachnid enthusiasts, spiders and scorpions are gaining increasing popularity as pets in industrialised countries in Europe, Northern America and Asia. As most spiders and all scorpions are venomous and due to their mostly negative image in the public media, several governments are already considering introducing legislation to regulate the domestic care of potentially dangerous captive animals. We aimed to investigate the circumstances and effects of exposure to arachnids kept in captivity. Thus, we collected and analysed data from 354 self-reported bites and stings attributed to pet arachnids. Our data revealed that on average there were less than 20 recorded envenomations per year with ~90% preventable by due care. We also categorized the severity of the resulting symptoms and found that the vast majority of symptoms were either local (60.7%) or minor (32.8%), 5.4% were asymptomatic, only 1.1% were severe and no fatalities were recorded. Based on our database of bite and sting reports, we performed a risk assessment for arachnid pet ownership and concluded that, with the proper care, arachnids can be safely kept as pets and pose a lower risk than many other recreational activities.
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Affiliation(s)
| | - Volker Herzig
- GeneCology Research Centre, School of Science, Technology and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, 4556, Australia.
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Gomes JV, Fé NF, Santos HLR, Jung B, Bisneto PF, Sachett A, de Moura VM, Mendonça da Silva I, Cardoso de Melo G, Pereira de Oliveira Pardal P, Lacerda M, Sampaio V, Wen FH, de Almeida Gonçalves Sachett J, Monteiro WM. Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon. Toxicon 2020; 187:245-254. [PMID: 32991937 DOI: 10.1016/j.toxicon.2020.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/16/2020] [Accepted: 09/25/2020] [Indexed: 11/19/2022]
Abstract
Scorpion envenomations are a major public health problem in Brazil, and most medically important cases are attributable to the Tityus genus. The objective of this study is to describe the clinical and epidemiological aspects of a series of 151 cases of confirmed scorpion stings, which were treated at the hospitals of two cities in the Western Brazilian Amazon, between June 2014 and December 2019. This study shows that the genus Tityus was the most prevalent. Tityus (Atreus) metuendus (Pocock, 1897) was responsible for the greatest number of cases (68.2%), followed by Tityus (Archaeotityus) silvestris (Pocock, 1897) (14.6%). Most of the envenomations involved males (53.6%), and analysis showed a slight predominance in the group from 40 to 49 years (22.5%). The most affected body regions were feet (49.0%) and hands (31.8%). The time elapsed between the accident and medical care was ≤6 h in 92.1% of cases. Regarding clinical severity, classes I (80.8%) and II (15.9%) predominated. However, there were five (3.3%) class III cases; four for T. metuendus and one for T. silvestris. The most frequent local and systemic manifestations were, respectively, pain (84.1%), paresthesia (34.4%) and mild edema (25.8%), and nausea (9.3%) and myoclonia (8.6%). The clinical manifestations were similar among the patients stung by the different species of scorpions. There were no differences between the manifestations of envenomation caused by T. metuendus, T. silvestris and T. raquelae. For victims of T. apiacas, a higher frequency of piloerection and myoclonia was observed, and was described by the affected patients as a 'sensation of receiving an electric shock' throughout the body. No deaths were registered. The species of greatest epidemiological importance in Manaus is T. metuendus, a species that leads to clinical pictures that do not differ substantially from those observed in other Brazilian regions. T. apiacas causes neurological manifestations that differed from other Tityus species. Our findings suggest that the available antivenoms have little effectiveness when used in the treatment of envenomations by some Amazonian scorpions.
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Affiliation(s)
- Jacimara Vasques Gomes
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Nelson Ferreira Fé
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Hildegard Loren Rebouças Santos
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Bruna Jung
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Pedro Ferreira Bisneto
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Programa de Pós-Graduação em Zoologia, Universidade Federal do Amazonas, Manaus, Brazil
| | - André Sachett
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Valéria Mourão de Moura
- Programa de Pós-graduação em Recursos Naturais da Amazônia, Universidade Federal do Oeste do Pará, Santarém, Pará, Brazil
| | - Iran Mendonça da Silva
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Gisely Cardoso de Melo
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Marcus Lacerda
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Instituto Leônidas & Maria Deane, Manaus, Brazil
| | - Vanderson Sampaio
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Jacqueline de Almeida Gonçalves Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil; Diretoria de Ensino e Pesquisa, Fundação Alfredo da Matta, Manaus, Brazil
| | - Wuelton M Monteiro
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil.
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Vaucel J, Mutricy R, Hoarau M, Pujo JM, Elenga N, Labadie M, Kallel H. Pediatric scorpionism in northern Amazonia: a 16-year study on epidemiological, environmental and clinical aspects. J Venom Anim Toxins Incl Trop Dis 2020; 26:e202000038. [PMID: 32973890 PMCID: PMC7485965 DOI: 10.1590/1678-9199-jvatitd-2020-0038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The Amazon basin is one of the seven major geographical areas where
scorpionism is recorded. In French Guiana, 90 stings per 100,000 inhabitants
are registered per year. As the severity of cases is higher in children,
descriptive studies are needed to have a better understanding of this
pathology. The aim of the present study is to describe pediatric scorpionism
in French Guiana. Methods: We conducted a monocentric descriptive retrospective study on scorpion
stings in all pediatric patients admitted to Cayenne General Hospital from
January 1, 2002 to December 31, 2018. Results: In this survey, 132 patients were included. Of them, 63% were male. Patients
with general signs of envenomation were younger and lighter (p = 0.04). The
picture was “one sting” (95.3%) by a “big” (47.6%), “black” (60%) and “small
pincer” (58%) scorpion on the extremity of the body (84%). Stings occurred
mainly during the day, while patients changed clothes. There was no
envenomation during night. The monthly evaluation highlights that the number
of stings and percentage of general signs of envenomation were closely
connected to a composite variable including the variation of the level of
rivers (p = 0.005). Cardiac symptoms were recorded in 82% of cases with
general signs of envenomation. The presence of pulmonary; ear, nose, and
throat (ENT); or gastrointestinal symptoms are related to major envenomation
(p = 0.001, p = 0.01, and p = 0.02 respectively). Leukocytosis and glycemia
increased according to the envenomation grade whereas serum potassium and
alkaline reserve decreased. Forty-six patients needed hospitalization and
seven of them required intensive care. No patient died nor presented
sequelae at discharge from the hospital. Conclusion: Pediatric scorpionism in French Guiana is closely associated with child
activities and climatic conditions. Severe envenomation presented most of
the time with cardiac, pulmonary, and gastrointestinal symptoms.
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Affiliation(s)
- Jules Vaucel
- Poison Control Center (Centre Antipoison) Nouvelle Aquitaine, Centre Hospitalier et Universitaire Pellegrin, Bordeaux 33076, Aquitaine, France.,Emergency Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Remi Mutricy
- Emergency Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Maëlle Hoarau
- Emergency Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Jean-Marc Pujo
- Emergency Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Narcisse Elenga
- Emergency Pediatric Department, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
| | - Magali Labadie
- Poison Control Center (Centre Antipoison) Nouvelle Aquitaine, Centre Hospitalier et Universitaire Pellegrin, Bordeaux 33076, Aquitaine, France
| | - Hatem Kallel
- Intensive Care Unit, Centre Hospitalier de Cayenne, Cayenne 97300, French Guiana, France
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Feola A, Perrone MA, Piscopo A, Casella F, Della Pietra B, Di Mizio G. Autopsy Findings in Case of Fatal Scorpion Sting: A Systematic Review of the Literature. Healthcare (Basel) 2020; 8:healthcare8030325. [PMID: 32899951 PMCID: PMC7551928 DOI: 10.3390/healthcare8030325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/18/2023] Open
Abstract
Scorpion sting is a public health issue in several countries, particularly in America, the Middle East, India and Africa. The estimated annual global incidence of scorpion envenomings is about 1.5 million, resulting in 2600 deaths. Scorpions are Arthropoda characterized by a tail ending in a terminal bulbous (telson) containing paired venom glands and the stinger. There are 19 known families of scorpions and more than 2200 species, of which about 50 from the families of Buthidae, Hemiscorpiidae and Scorpionidae are harmful to humans. Scorpion venom is a complex structure composed of neurotoxic proteins, salts, acidic proteins and organic compounds, thereby having neurologic, cardiovascular, hematologic and renal side effects, in addition to local effects such as redness, pain, burning and swelling. When the sting is fatal, the mechanism of death is often related to cardiotoxicity with terminal pulmonary edema. However, the cholinergic excess or the neuromuscular excitation can provoke respiratory failure. Sometimes, death is due to an anaphylactic reaction to the envenoming. The purpose of this literature review is to evaluate the autopsy findings in scorpion sting-related deaths in order to better understand the pathophysiological mechanisms underlying them, thus helping pathologists in defining the correct diagnosis.
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Affiliation(s)
- Alessandro Feola
- Department Experimental Medicine, University of Campania, 80138 Naples, Italy;
- Correspondence: ; Tel.: +39-081-5666-018
| | | | - Amalia Piscopo
- Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy; (A.P.); (G.D.M.)
| | - Filomena Casella
- Unit of Legal Medicine, AORN “Sant’Anna e San Sebastiano”, 81100 Caserta, Italy;
| | - Bruno Della Pietra
- Department Experimental Medicine, University of Campania, 80138 Naples, Italy;
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy; (A.P.); (G.D.M.)
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Nait Mohamed FA, Laraba-Djebari F. Scorpion envenomation: a deadly illness requiring an effective therapy. TOXIN REV 2020. [DOI: 10.1080/15569543.2020.1800746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
| | - Fatima Laraba-Djebari
- USTHB, Faculty of Biological Sciences, Laboratory of Cellular and Molecular Biology, Algiers, Algeria
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Dobutamine in the treatment of severe scorpion envenoming. Toxicon 2020; 182:54-58. [DOI: 10.1016/j.toxicon.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/27/2020] [Accepted: 05/15/2020] [Indexed: 01/27/2023]
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Silva de Oliveira SM, Bertani R, Quispe Torrez PP, Lopes de Sousa PR, Martinez Quiroga MM, Bertolozzi MR, Oscar de Siqueira Franca F. Electric shock sensation in the first reports of envenomations by Tityus strandi in the Brazilian Amazon. Toxicon 2020; 178:8-12. [PMID: 32094100 DOI: 10.1016/j.toxicon.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Rogerio Bertani
- Special Laboratory of Ecology and Evolution, Instituto Butantan, São Paulo, SP, Brazil
| | - Pasesa Pascuala Quispe Torrez
- Advanced Tropical Medicine Center, Santarém, PA/Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | | | - Mariana Margarita Martinez Quiroga
- Advanced Tropical Medicine Center, Santarém, PA/Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Maria Rita Bertolozzi
- Department of Nursing in Public Health, School of Nursing, University of São Paulo, São Paulo, SP, Brazil
| | - Francisco Oscar de Siqueira Franca
- Advanced Tropical Medicine Center, Santarém, PA/Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil; Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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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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Abstract
Scorpion envenomation is common in the tropical and subtropical regions. It poses a major public health problem with some patients having serious clinical manifestations and severe complications including death. Old World and New World scorpions are usually contrasted because of differences in venom composition, clinical presentation and severity, and, accordingly, different therapeutic approaches. The majority of scorpion stings are either dry or result in low amounts of injected venom, thus explaining why up to 95% of scorpion stings ensue only in local signs. For a clinical envenomation to occur, it has been suggested that the interaction between the quantity of venom introduced in the body of the prey and the distribution volume should ensue in a critical threshold of scorpion toxin plasma concentration. In this case, there is a massive release of neurohormonal mediators (mainly catecholamine), with systemic vasoconstrictor effects eliciting a sharp increase in systemic arterial pressure and LV-filling pressure and decreased cardiac output. This early phase of cardiac dysfunction, also called "vascular phase", is followed by a severe cardiomyopathy, a form of Takotsubo cardiomyopathy, involving both ventricles and reversible in days to weeks. The more comprehensive understanding of the disease pathophysiology has allowed for a well-codified symptomatic treatment, thus contributing to a substantial reduction in the death toll of scorpion envenomation over the past few decades. The standard intensive-care treatment (when available) overcomes envenomation's consequences such as acute pulmonary edema and cardiogenic shock. Even though it continues to inspire many evaluative studies, immunotherapy seems less attractive because of the major role held by mediators in the pathogenesis of envenomation, and unfavorable pharmacokinetic properties to existing sera compared to venom. Meta-analyses of controlled trials of immunotherapy in severe scorpion envenomation reached similar conclusions: there is an acceptable level of evidence in favor of the use of scorpion antivenom (Fab'2) against Centruroides sp. in USA/Mexico, while there is still a need for a higher level of evidence for immunotherapy in the Old World envenomation.
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Vaucel J, Le Blond du Plouy N, Courtois A, Bragança C, Labadie M. Euscorpius flavicaudis sting is not lethal but not harmless either: First record of neurological symptoms in child after sting. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2020. [DOI: 10.1016/j.toxac.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Monteiro WM, Gomes J, Fé N, Mendonça da Silva I, Lacerda M, Alencar A, Seabra de Farias A, Val F, de Souza Sampaio V, Cardoso de Melo G, Pardal P, Mota da Silva A, Bernarde PS, Carlos de Lima Ferreira L, Gutierrez JM, de Almeida Gonçalves Sachett J, Fan HW. Perspectives and recommendations towards evidence-based health care for scorpion sting envenoming in the Brazilian Amazon: A comprehensive review. Toxicon 2019; 169:68-80. [DOI: 10.1016/j.toxicon.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/26/2019] [Accepted: 09/01/2019] [Indexed: 01/01/2023]
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Iserson KV, Jagit Ramcharran SD. Black Scorpion (Tityus obscurus) Fatalities in Guyana and a Literature Review. J Emerg Med 2019; 57:554-559. [DOI: 10.1016/j.jemermed.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/04/2019] [Accepted: 07/18/2019] [Indexed: 10/25/2022]
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Reis MB, Zoccal KF, Gardinassi LG, Faccioli LH. Scorpion envenomation and inflammation: Beyond neurotoxic effects. Toxicon 2019; 167:174-179. [DOI: 10.1016/j.toxicon.2019.06.219] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/13/2019] [Accepted: 06/18/2019] [Indexed: 12/16/2022]
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Evaluation of Scorpion Envenomation by Tityus trivittatus in Adults: An Analysis of Variables Related to Severity of Clinical Presentation. Wilderness Environ Med 2019; 30:274-280. [PMID: 31351826 DOI: 10.1016/j.wem.2019.05.007] [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: 11/10/2018] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION In Argentina, the scorpion species Tityus trivittatus has been the species most commonly associated with serious injury and death. METHODS We performed a retrospective study of cases of T trivittatus envenomation that presented to the emergency department at an infectious disease hospital in Cordoba, Argentina, between December 2014 and February 2015. All cases were taxonomically confirmed using criteria established in the Argentine Ministry of Health national guidelines. The primary outcome was classification of clinical presentation (mild/moderate/severe). Classification of clinical presentation was performed in a post hoc fashion using the national guidelines and compared to the classification of clinical presentation given to patients at the time of diagnosis in the emergency department. RESULTS We included 450 individuals with T trivittatus envenomation. The median age of was 36 y (interquartile range 25-52), and 57% were female. In the emergency department, only 5 patients (<1%) were diagnosed as moderate cases and received antivenom; all other cases were diagnosed as mild. Conversely, in our post hoc classification of clinical presentations, 280 patients had mild presentations, 170 had moderate presentations, and no patients had severe presentations. In our cohort, there were no deaths, no inpatient hospital admissions, and no requirements for continuous cardiac monitoring. We found that age >50 y, (odds ratio [OR] 2.5, P<0.001), time from sting to presentation >120 min (OR 2.6, P=0.02), and pre-existing hypertension (OR=3.9, P<0.001) were all independently associated with worse post hoc classification severity. CONCLUSIONS Our study exposed factors associated with moderate presentations of scorpion envenomation and proposes the option of conservative treatment for affected adults.
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Pediatric scorpionism in French Guiana: Epidemiological and clinical study – Preliminary result. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2019. [DOI: 10.1016/j.toxac.2019.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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de Roodt AR, Lanari LC, Laskowicz RD, Costa de Oliveira V, Litwin S, Calderon L, Damin CF, Dokmetjian JC, Dolab JA, Lago NR, Lértora E. Study on the obtaining of Tityus trivittatus venom in Argentina. Toxicon 2019; 159:5-13. [DOI: 10.1016/j.toxicon.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/16/2018] [Accepted: 12/21/2018] [Indexed: 11/29/2022]
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Carmo ÉA, Nery AA, Pereira R, Rios MA, Casotti CA. FACTORS ASSOCIATED WITH THE SEVERITY OF SCORPIO POISONING. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2017-0561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to analyze the factors associated with the severity of scorpionism, according to sociodemographic, clinical and epidemiological aspects. Method: a cross-sectional study was carried out, in 2017, with data extracted directly from the Epidemiological Investigation Records of the Information System for Notifiable Diseases, for the period from 2007 to 2015. These records were provided by the reference hospital in attendance to the cases of scorpionism, located in the municipality of Jequié (Brazil). Logistic regression was used to verify the factors associated with the severity of scorpionism. Results: in the period investigated, 3,565 cases of scorpionism were identified, of which 15.9% were classified as of greater severity. The adjusted analysis showed that the severity of the scorpionism is associated with the ages ranging from 0 to 9 years (OR=6.87; CI 5.23-9.03), from 10 to 19 years old (OR=1.39; CI 1.03-1.87) and 60 or more (OR=4.04, CI 3.12-5.23), and the time elapsed between the moment of the bite and the hospital care of more than 3 hours (OR = 1.38; CI 1.02-1.85). Conclusion: it was found that the age range and the time elapsed between the moment of the bite and the hospital care are associated with the severity of the scorpionism, which signals the emergency characteristics of these accidents, especially when children and elderly people are affected.
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Affiliation(s)
| | | | | | - Marcela Andrade Rios
- Universidade Estadual do Sudoeste da Bahia, Brasil; Universidade do Estado da Bahia, Brazil
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Aslan N, Yildizdas D, Horoz OO, Arslan D, Varan C, Erdem S, Yılmaz HL. Severe Troponin I Elevation and Myocardial Dysfunction in a Child with Scorpion Sting. J Pediatr Intensive Care 2018; 7:219-224. [PMID: 31073500 DOI: 10.1055/s-0038-1673624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/03/2018] [Indexed: 01/20/2023] Open
Abstract
Background Scorpion sting is a common medical problem and major cause of mortality and morbidity in many countries. The symptoms of envenomation are more severe in the pediatric population. The clinical manifestations of scorpion envenomation appear by activation of sympathetic and parasympathetic nervous system. Envenomation can cause multiorgan dysfunction and death. Case Presentation and Findings In this case report, we present a pediatric patient from Adana, Southeast Anatolia, with severe scorpion envenomation with Leiurus abdullahbayrami which is an especially dangerous species for children. Severe systolic dysfunction was detected by echocardiography. Troponin I levels elevated significantly and rapidly responded to three doses of antivenom therapy. Conclusion Early echocardiographic examination is an important procedure for patients with scorpion envenomation. Troponin I is a significant parameter to monitor the degree of cardiac injury. Antivenom therapy is the only recommended specific therapy for children with severe scorpion envenomation due to Leiurus abdullahbayrami . Abnormal echocardiography findings may require repeated doses of scorpion antivenom.
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Affiliation(s)
- Nagehan Aslan
- Division of Pediatric Intensive Care, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dincer Yildizdas
- Division of Pediatric Intensive Care, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ozden Ozgur Horoz
- Division of Pediatric Intensive Care, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Didar Arslan
- Division of Pediatric Intensive Care, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Celal Varan
- Division of Pediatric Cardiology, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Sevcan Erdem
- Division of Pediatric Cardiology, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Hayri Levent Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Cukurova University, Faculty of Medicine, Adana, Turkey
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Ward MJ, Ellsworth SA, Nystrom GS. A global accounting of medically significant scorpions: Epidemiology, major toxins, and comparative resources in harmless counterparts. Toxicon 2018; 151:137-155. [DOI: 10.1016/j.toxicon.2018.07.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 01/18/2023]
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Albuquerque PLMM, Magalhaes KDN, Sales TDC, Paiva JHHGL, Daher EDF, da Silva GB. Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review. Rev Inst Med Trop Sao Paulo 2018; 60:e30. [PMID: 29972468 PMCID: PMC6029862 DOI: 10.1590/s1678-9946201860030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/08/2018] [Indexed: 12/12/2022] Open
Abstract
Despite the high number of accidents due to scorpion stings in Brazil, severe cases in adults are seldomly reported. In the Northeast region of Brazil, Tityus stigmurus is the most prevalent species. A 69 year-old woman who was stung by a scorpion attended the emergency room 5 hours after envenomation. She got worse due to abdominal pain. Clinical findings were concordant with class III scorpion envenomation (major systemic manifestations), complicated by acute kidney injury and acute pancreatitis. Intensive supportive therapy was adopted. In the follow-up, 3 months later, she was completely recovered. This report is being brought to recommend the thorough management of victims of scorpion accidents, enabling early diagnosis of severe complications, which could lead to death if aggressive supportive measures are not early and adequately taken.
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Affiliation(s)
- Polianna Lemos Moura Moreira Albuquerque
- Universidade Federal do Ceará, Programa de Pós-Graduação em Ciências Médicas, Fortaleza, Ceará, Brazil
- Instituto Dr. José Frota, Centro de Informação e Assistência Toxicológica, Fortaleza, Ceará, Brazil
| | | | - Tamiris de Castro Sales
- Instituto Dr. José Frota, Centro de Informação e Assistência Toxicológica, Fortaleza, Ceará, Brazil
| | | | | | - Geraldo Bezerra da Silva
- Universidade de Fortaleza, Curso de Medicina, Programas de Pós-Graduação em Saúde Coletiva e Ciências Médicas, Fortaleza, Ceará, 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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Successful Use of Extracorporeal Membrane Oxygenation for the Treatment of Cardiogenic Shock due to Scorpion Envenomation. Case Rep Crit Care 2017; 2017:8073989. [PMID: 28536661 PMCID: PMC5425842 DOI: 10.1155/2017/8073989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/10/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction. The occurrence of a cardiogenic shock is a rare presentation after scorpion envenomation. The treatment includes classically the use of inotropes and specific vasodilators. Case Presentation. We report a case of an 11-year-old boy presenting with cardiogenic shock and pulmonary edema after a scorpion sting. Despite adequate management at the emergency department and intensive care unit, the patient's hemodynamic status worsened rapidly, justifying his transfer to our department for ventricular mechanical assistance by venoarterial extracorporeal membrane oxygenation. The following outcomes were favorable and the boy was discharged home on day 29 without aftereffects. Conclusion. This is the first report of successful use of extracorporeal membrane oxygenation for the treatment of cardiogenic shock after scorpion envenomation.
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Dokur M, Dogan M, Yagmur EA. Scorpion-related cardiomyopathy and acute pulmonary edema in a child who is stung by Leiurus abdullahbayrami. Turk J Emerg Med 2017; 17:104-108. [PMID: 28971158 PMCID: PMC5608594 DOI: 10.1016/j.tjem.2016.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 11/17/2022] Open
Abstract
Venom of Leiurus abdullahbayrami (Scorpiones: Buthidae) is an extremely toxic one and it stimulates voltage-gated sodium and potassium channels. In case of a stung by this scorpion; excessive catecholamine release occur and it impairs left ventricle contractility and consequently a heart failure occurs (scorpion sting-related cardiomyopathy). In addition to this cardiac-induced acute pulmonary, edema may occur in severe cases too. An 11-year-old male child who was stung by a scorpion (species: Leiurus abdullahbayrami) consulted to the Emergency Room. Even after 7 h of scorpion envenomation he was confused and having hallucinations. Besides he was dyspneic, tachycardic, hypotensive and got worse in overall situation due to cardiogenic pulmonary edema. These clinical findings are concordant with the Level III scorpion envenomation (major systemic manifestations). Positive inotropic agents, diuretics and antiagregant agents used on supportive therapy in his treatment. After 2 weeks he get recovered and discharged from the pediatric intensive care unit. This research is conducted by thinking emergency physicians should learn that Leiurus abdullahbayrami envenomation can cause scorpion-related cardiomyopathy and acute pulmonary edema especially in children.
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Affiliation(s)
- Mehmet Dokur
- Necip Fazil City Hospital, Department of Emergency Medicine, 46050, Dulkadiroglu, Kahramanmaras, Turkey
| | - Mustafa Dogan
- Pamukkale University School of Medicine, Department of Pediatrics, Kinikli Campus, 20070, Denizli, Turkey
| | - Ersen Aydin Yagmur
- Manisa Celal Bayar University Alasehir Vocational High School, 45600, Alaşehir, Manisa, Turkey
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Scorpionism by Tityus silvestris in eastern Brazilian Amazon. J Venom Anim Toxins Incl Trop Dis 2016; 22:24. [PMID: 27570532 PMCID: PMC5000479 DOI: 10.1186/s40409-016-0079-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scorpionism is a serious public health problem in Brazil. Although cases of envenomation by scorpions are frequent in Brazil, Tityus silvestris - found throughout the Amazon region - is considered of minor medical significance and with only a few descriptions in the literature. This article aims to describe for the first time the epidemiological characteristics and clinical manifestations of scorpion stings by T. silvestris that occurred in eastern Brazilian Amazon. METHODS A prospective and observational study was carried out on 13 confirmed cases of T. silvestris envenomation registered from 2007 to 2011 in the cities of Belém and Ananindeua, Pará state, Brazil. RESULTS The stings occurred mainly during daytime, at domiciliary environment, and the scorpions were found in clothing, fruits or vegetables. Envenomation was more frequent in the age group between 21 and 30 years old, upper limbs were more affected and medical aid was usually provided within two hours. Men and women were equally affected. Regarding severity, ten patients were classified as Class I and three patients as Class II according to the Scorpion Consensus Expert Group. Local manifestations were present in all patients, being pain the most common symptom. Mild systemic manifestations including nausea, vomiting, somnolence, malaise and prostration were observed in three victims. Symptomatic treatment of pain was offered to all patients, and only one received specific antivenom. All victims had a favorable outcome. CONCLUSIONS To the best of our knowledge, this study is the first to report the systemic symptomatology of envenomation by T. silvestris in the Brazilian Amazon, highlighting the medical relevance of the species in this region. Further research on the venom and clinical manifestations of envenomation by T. silvestris should be conducted in order to verify the relevance of this species to public health.
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Akella A, Deshpande SB. Vagal efferent stimulation protects against Mesobuthus tamulus venom-induced acute respiratory distress syndrome in rats. Toxicon 2015; 108:189-201. [PMID: 26525658 DOI: 10.1016/j.toxicon.2015.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/18/2015] [Accepted: 10/20/2015] [Indexed: 11/19/2022]
Abstract
Mesobuthus tamulus (MBT) venom and oleic acid (OA) have been shown to produce acute respiratory distress syndrome (ARDS) involving different mechanisms. The role of vagally mediated anti-inflammatory pathway in ARDS is poorly understood. Therefore, the effects of vagal efferent stimulation on these two models of ARDS were examined. Experiments were performed on anesthetized adult rats. Parameters like ventilatory changes (respiratory frequency and minute ventilation), hypoxemic status (PaO2/FiO2 ratio; P/F ratio), survival time, pulmonary water content and histopathological evidences of lung injury were determined to assess the severity of ARDS. In addition, heart rate (HR) and mean arterial pressure (MAP) were monitored. Injection of OA/MBT venom produced respiratory alterations, hypoxemia, pulmonary edema and histopathological changes demonstrating the development of ARDS. In both the groups, animals died around 60 min. Tachypnea and hyperventilation were seen after OA while bradypnea and hypoventilation were seen after MBT venom. Pulmonary edema was absent in vagotomised animals in MBT venom group but not in OA group. Further, electrical stimulation of the cut peripheral ends of vagii prolonged the survival time and attenuated all the parameters of MBT venom-induced ARDS significantly. In case of OA, there was improvement in histopathological changes but the survival time of animals was not prolonged. Stimulation of α7-nicotinic receptors (by pretreatment with GTS-21) exacerbated OA as well as MBT venom-induced ARDS. The present results indicate that vagal efferent stimulation protects against MBT venom-induced ARDS.
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Affiliation(s)
- Aparna Akella
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India
| | - Shripad B Deshpande
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India.
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Borges A, Morales M, Loor W, Delgado M. Scorpionism in Ecuador: First report of severe and fatal envenoming cases from northern Manabí by Tityus asthenes Pocock. Toxicon 2015; 105:56-61. [DOI: 10.1016/j.toxicon.2015.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/13/2015] [Accepted: 08/26/2015] [Indexed: 02/08/2023]
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Elatrous S, Ouanes-Besbes L, Ben Sik-Ali H, Hamouda Z, BenAbdallah S, Tilouche N, Jalloul F, Fkih-Hassen M, Dachraoui F, Ouanes I, Abroug F. Study of severe scorpion envenoming following subcutaneous venom injection into dogs: Hemodynamic and concentration/effect analysis. Toxicon 2015; 104:1-6. [PMID: 26166304 DOI: 10.1016/j.toxicon.2015.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 06/27/2015] [Accepted: 07/01/2015] [Indexed: 11/30/2022]
Abstract
To evaluate the dose-effects of Androctonus australis hector (Aah) venom injected subcutaneously on hemodynamics and neurohormonal secretions, 10 anesthetized and ventilated mongrel dogs, were split in two groups (n = 5/group). Subcutaneous injection was done with either 0.2 mg/kg or 0.125 mg/kg of the purified G50 scorpion toxic fraction. Hemodynamic parameters using right heart catheter were recorded and plasma concentrations of catecholamine, troponin, and serum toxic fraction were measured sequentially from baseline to 120 min. We identified the dose of toxic fraction evoking characteristic hemodynamic perturbation of severe envenomation, the time-lapse to envenomation, and the associated plasma level. The injection of 0.125 mg/kg toxic fraction was not associated with significant variations in hemodynamic parameters, whereas the 0.2 mg/kg dose caused envenomation characterized by significant increase in plasma catecholamines, increased pulmonary artery occluded pressure, mean arterial pressure, and systemic vascular resistance (p < 0.05), in association with sustained decline in cardiac output (p < 0.001). Envenomation occurred by the 30th minute, and the corresponding concentration of toxic fraction was 1.14 ng/ml. The current experiment allowed the identification of the sub-lethal dose (0.2 mg/kg) of the toxic fraction of Aah administered by the subcutaneous route. Two parameters with potential clinical relevance were also uncovered: the time-lapse to envenomation and the corresponding concentration of toxic fraction.
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Affiliation(s)
- Souheil Elatrous
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Tahar Sfar. Mahdia, University of Monastir, Tunisia.
| | - Lamia Ouanes-Besbes
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Habiba Ben Sik-Ali
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Tahar Sfar. Mahdia, University of Monastir, Tunisia
| | - Zineb Hamouda
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Saoussen BenAbdallah
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Nejla Tilouche
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Tahar Sfar. Mahdia, University of Monastir, Tunisia
| | - Faten Jalloul
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Mohamed Fkih-Hassen
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Tahar Sfar. Mahdia, University of Monastir, Tunisia
| | - Fahmi Dachraoui
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Islem Ouanes
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
| | - Fekri Abroug
- Laboratoire de Recherche LR12-SP15 (Recherche Cardio - pulmonaire en médecine aigue et Toxicologie), Tunisia; ICU CHU Fatouma Bourguiba Monastir, University of Monastir, Tunisia
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Queiroz AM, Sampaio VS, Mendonça I, Fé NF, Sachett J, Ferreira LCL, Feitosa E, Wen FH, Lacerda M, Monteiro W. Severity of Scorpion Stings in the Western Brazilian Amazon: A Case-Control Study. PLoS One 2015; 10:e0128819. [PMID: 26061734 PMCID: PMC4465172 DOI: 10.1371/journal.pone.0128819] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Scorpion stings are a major public health problem in Brazil, with an increasing number of registered cases every year. Affecting mostly vulnerable populations, the phenomenon is not well described and is considered a neglected disease. In Brazil, the use of anti-venom formulations is provided free of charge. The associate scorpion sting case is subject to compulsory reporting. This paper describes the epidemiology and identifies factors associated with severity of scorpions stings in the state of Amazonas, in the Western Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS This study included all cases of scorpion stings in the state of Amazonas reported to the Brazilian Diseases Surveillance System from January 1, 2007 to December 31, 2014. A case-control study was conducted to identify factors associated with scorpions sting severity. A total of 2,120 cases were reported during this period. The mean incidence rate in the Amazonas was 7.6 per 100,000 inhabitants/year. Scorpion stings showed a large spatial distribution in the state and represent a potential occupational health problem for rural populations. There was a positive correlation between the absolute number of cases and the altimetric river levels in the Central (p<0.001; Rs = 0.479 linear) and Southwest (p = 0.032; linear Rs = 0.261) regions of the state. Cases were mostly classified as mild (68.6%), followed by moderate (26.8%), and severe (4.6%). The overall lethality rate was 0.3%. Lethality rate among children ≤10 years was 1.3%. Age <10 years [OR = 2.58 (95%CI = 1.47-4.55; p = 0.001)], stings occurring in the rural area [OR = 1.97 (95%CI = 1.18-3.29; p = 0.033) and in the South region of the state [OR = 1.85 (95%CI = 1.17-2.93; p = 0.008)] were independently associated with the risk of developing severity. CONCLUSIONS/SIGNIFICANCE Scorpion stings show an extensive distribution in the Western Brazilian Amazon threatening especially rural populations, children ≤10 in particular. Thus, the mapping of scorpions fauna in different Amazon localities is essential and must be accompanied by the characterization of the main biological activities of the venoms. Urban and farming planning, in parallel with awareness of workers at risk for scorpion stings on the need for personal protective equipment use should be considered as public policies for preventing scorpionism.
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Affiliation(s)
- Amanda M. Queiroz
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Vanderson S. Sampaio
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Iran Mendonça
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Nelson F. Fé
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Jacqueline Sachett
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Luiz Carlos L. Ferreira
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Esaú Feitosa
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
| | | | - Marcus Lacerda
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Instituto de Pesquisas Leônidas & Maria Deane (FIOCRUZ), Manaus, Brazil
| | - Wuelton Monteiro
- Departamento de Ensino e Pesquisa, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
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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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