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Çelik E, Çağlar A, Çelik SF. Clinical Effects and Predictive Factors Affecting the Clinical Severity of Scorpion Envenomations in Western Turkey. J Trop Pediatr 2021; 67:6313145. [PMID: 34213542 DOI: 10.1093/tropej/fmab053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Scorpion envenomation is a common medical emergency in many countries, including Turkey. Severe systemic symptoms occur more easily in children and mortality rates are higher. The aim of this study is to describe the clinical effects and predictive factors affecting the clinical severity of scorpion envenomations in Western Turkey. METHODS Two hundred one children (138 mild cases, 34 moderate, and 29 severe) with scorpion envenomation aged between 1 month and -17 years were included in the study. The patients' demographic and laboratory characteristics were compared among clinical severity subgroups. RESULTS The patients' median age was 7 (4-11) years. The median age of the severe group was significantly lower than that of the mild and moderate groups (p < 0.001). Seventeen patients (8.5%) developed myocarditis, while no pulmonary edema was observed in any case. Leukocyte, neutrophil and platelet (PLT) counts, and plateletcrit (PCT) and glucose levels increased significantly with the severity of envenomation (p < 0.001). PLT counts and PCT levels exhibited positive correlation with leukocyte and neutrophil counts (p < 0.001, r = 0.781, r = 0.638, r = 0.772, and r = 0.629, respectively). Supraventricular tachycardia developed in 1 (5.9%) patient, and dilated cardiomyopathy in another (5.9%). No mortality occurred in any case. CONCLUSION Increased PLT counts and PCT levels may be helpful in evaluating clinical severity in patients with scorpion sting envenomation. The possibility of myocarditis development in children should be remembered and cardiac enzymes should be checked, even if patients are asymptomatic and cardiac enzymes are normal on admission.
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Affiliation(s)
- Elif Çelik
- Department of Pediatrics, Faculty of Medicine, Adnan Menderes University, Aydın 09010, Turkey
| | - Aykut Çağlar
- Department of Pediatric Emergency Care, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Serkan Fazlı Çelik
- Department of Pediatric Cardiology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
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2
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Involvement of the Endothelin Receptor Type A in the Cardiovascular Inflammatory Response Following Scorpion Envenomation. Toxins (Basel) 2020; 12:toxins12060389. [PMID: 32545475 PMCID: PMC7374423 DOI: 10.3390/toxins12060389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
Elevated levels of endothelin-1 (ET-1) were recorded in sera of scorpion sting patients. However, no studies focused on the mechanism of ET-1 involvement in the pathogenesis of scorpion envenomation, particularly in the cardiovascular system which is seriously affected in severe cases of scorpion stings. Inflammation induced by Androctonus australis hector (Aah) scorpion venom in the heart together with the aorta was studied in mice pretreated with a specific endothelin A receptor (ETA-R) inhibitor. ETA-R inhibition resulted in the attenuation of the high amounts of cytokine (tumor necrosis factor alpha (TNF-α) and interleukin-17 (IL-17)) recorded in the sera of envenomed mice. The recovery of the oxidative stress marker balance and matrix metalloproteinase (MMP) expression were also observed, concomitantly with the reduction of tissular neutrophil infiltration. Additionally, the cardiac and the aortic tissue alterations, and the metabolic enzymes (creatine kinase (CK) and muscle–brain isoform creatine kinase (CK-MB)) overspread into sera were significantly attenuated. Obtained results suggest the implication of endothelin throughout its ETA receptors in the inflammatory response observed in the cardiovascular components during scorpion envenomation. Further knowledge is needed to better understand the implication of the endothelin axis and to improve the therapeutic management of severe scorpion sting cases.
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Gökay SS, Kendir ÖT, Güllü UU, Nalbant T, Ekinci F, Matyar S, Ünal İ, Erdem S, Yildizdaş RD, Yilmaz HL. Myocarditis and Early Markers of Cardiac Response Associated with Scorpion Stings in Children. Wilderness Environ Med 2018; 29:471-478. [DOI: 10.1016/j.wem.2018.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/02/2018] [Accepted: 06/22/2018] [Indexed: 01/10/2023]
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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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5
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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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6
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Chakroun-Walha O, Karray R, Jerbi M, Ben Rebeh A, Jammeli C, Bahloul M, Ammar R, Chabchoub I, Bouaziz M, Nasri A, Rekik N. Value of troponin levels in the diagnosis of cardiac dysfunction in moderate scorpion envenomation. Hum Exp Toxicol 2017; 37:580-586. [DOI: 10.1177/0960327117722822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Context: Cardiac dysfunction is one of the most serious consequences of scorpion envenomation. The best tool to evaluate cardiac function is echocardiography, but it is not available at all emergency departments. Many studies aimed to describe biological predictive factors of cardiac dysfunction in scorpion envenomation. Troponin is one of these biomarkers but its correlation with myocarditis is not well established. The aim of this study was to evaluate correlation between troponin levels and cardiac dysfunction in moderate scorpion envenomation. Methods: A retrospective monocentric study including patients admitted in the emergency department for moderate scorpion envenomation with troponin measurement during their early management. On arrival, an electrocardiogram and a chest X-ray were realized for all patients. Results: We enrolled 132 patients with a mean age at 31.3 ± 24.4 years and a 1.35 sex-ratio. All patients had moderate systemic manifestations. There were 28 patients with clinical manifestations of cardiac dysfunction without life-threatening troubles (21.2%). Troponin was undetectable in 69 patients (56%). The mean value of troponin level (pg/ml) was higher in patients with clinical manifestations of left ventricular dysfunction (1.80 ± 3.8 vs. 0.11 ± 0.5; p = 0.02). Troponin levels were significantly higher in patients with positive T wave on electrocardiogram. Conclusion: In patients with moderate scorpion envenomation with positive T wave, high values of troponin suggest the presence of cardiac dysfunction.
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Affiliation(s)
- O Chakroun-Walha
- Emergency Department, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
| | - R Karray
- Emergency Department, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
| | - M Jerbi
- Emergency Department, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
| | - A Ben Rebeh
- Emergency Department, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
| | - C Jammeli
- Emergency Department, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
| | - M Bahloul
- Intensive Care Unit, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
| | - R Ammar
- Intensive Care Unit, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
| | - I Chabchoub
- Paediatric Department, University Hospital Hedi Chaker Sfax, Sfax, Tunisia
| | - M Bouaziz
- Intensive Care Unit, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
| | - A Nasri
- Emergency Department, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
| | - N Rekik
- Emergency Department, University Hospital Habib Bourguiba Sfax, Sfax, Tunisia
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Ferreira MG, Duarte CG, Oliveira MS, Castro KLP, Teixeira MS, Reis LPG, Zambrano JA, Kalapothakis E, Michel AFRM, Soto-Blanco B, Chávez-Olórtegui C, Melo MM. Toxicity of crude and detoxified Tityus serrulatus venom in anti-venom-producing sheep. J Vet Sci 2017; 17:467-477. [PMID: 27297422 PMCID: PMC5204024 DOI: 10.4142/jvs.2016.17.4.467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/21/2016] [Accepted: 05/12/2016] [Indexed: 11/20/2022] Open
Abstract
Specific anti-venom used to treat scorpion envenomation is usually obtained from horses after hyperimmunization with crude scorpion venom. However, immunized animals often become ill because of the toxic effects of the immunogens used. This study was conducted to evaluate the toxic and immunogenic activities of crude and detoxified Tityus serrulatus (Ts) venom in sheep during the production of anti-scorpionic anti-venom. Sheep were categorized into three groups: G1, control, immunized with buffer only; G2, immunized with crude Ts venom; and G3, immunized with glutaraldehyde-detoxified Ts venom. All animals were subjected to clinical exams and supplementary tests. G2 sheep showed mild clinical changes, but the other groups tolerated the immunization program well. Specific antibodies generated in animals immunized with either Ts crude venom or glutaraldehyde-detoxified Ts venom recognized the crude Ts venom in both assays. To evaluate the lethality neutralization potential of the produced sera, individual serum samples were pre-incubated with Ts crude venom, then subcutaneously injected into mice. Efficient immune protection of 56.3% and 43.8% against Ts crude venom was observed in G2 and G3, respectively. Overall, the results of this study support the use of sheep and glutaraldehyde-detoxified Ts venom for alternative production of specific anti-venom.
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Affiliation(s)
- Marina G Ferreira
- Department of Veterinary Medicine, College of Veterinary Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31275-013, Brazil
| | - Clara G Duarte
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31270-901, Brazil
| | - Maira S Oliveira
- Department of Veterinary Medicine, College of Veterinary Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31275-013, Brazil
| | - Karen L P Castro
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31270-901, Brazil
| | - Maílson S Teixeira
- Department of Veterinary Medicine, College of Veterinary Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31275-013, Brazil
| | - Lílian P G Reis
- Department of Veterinary Medicine, College of Veterinary Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31275-013, Brazil
| | - José A Zambrano
- Department of Veterinary Medicine, College of Veterinary Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31275-013, Brazil
| | - Evanguedes Kalapothakis
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31270-901, Brazil
| | - Ana Flávia R M Michel
- Department of Veterinary Medicine, State University of Santa Cruz (UESC), Ilhéus, BA 45662-900, Brazil
| | - Benito Soto-Blanco
- Department of Veterinary Medicine, College of Veterinary Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31275-013, Brazil
| | - Carlos Chávez-Olórtegui
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31270-901, Brazil
| | - Marília M Melo
- Department of Veterinary Medicine, College of Veterinary Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG 31275-013, Brazil
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8
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Sifi A, Adi-Bessalem S, Laraba-Djebari F. Role of angiotensin II and angiotensin type-1 receptor in scorpion venom-induced cardiac and aortic tissue inflammation. Exp Mol Pathol 2017; 102:32-40. [DOI: 10.1016/j.yexmp.2016.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 11/12/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
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Daoudi K, Chgoury F, Rezzak M, Bourouah O, Boussadda L, Soukri A, Sabatier JM, Oukkache N. Consequences of Androctonus mauretanicus and Buthus occitanus scorpion venoms on electrolyte levels in rabbits. Heliyon 2017; 3:e00221. [PMID: 28124029 PMCID: PMC5220227 DOI: 10.1016/j.heliyon.2016.e00221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/28/2016] [Accepted: 12/19/2016] [Indexed: 02/02/2023] Open
Abstract
Androctonus mauretanicus (A. mauretanicus) and Buthus occitanus (B. occitanus) scorpions, which belong to the Buthidae family, are the most venomous scorpions in Morocco. For the first time, we investigated the effects of such scorpion venoms on serum electrolytes in subcutaneously injected rabbits. For this purpose, 3 groups of 6 albinos adult male rabbits (New Zealand) were used in this experiment. Two of the groups were given a single subcutaneous injection of either crude Am venom (5 μg/kg) or Bo venom (8 μg/kg) whereas the third group (control group) only received physiological saline solution (NaCl 0.9%). The blood samples were collected from injected rabbits via the marginal vein at time intervals of 30 min, 1 h, 2 h, 4 h, 6 h and 24 h after venom injection. The concentrations of electrolytes in the serum samples were measured. Our study indicates that scorpion envenomation in vivo, rabbit animal model, caused severe and persistent hypomagnesaemia and hypochloremia, which are accompanied of hypernatremia, hyperkalemia and hypercalcaemia. The intensity of electrolytes imbalance was clearly superior in the case of A. mauretanicus scorpion venom (although a lower quantity of venom was injected). This is coherent with the experimental data which indicate that A. mauretanicus venom is more toxic than B. occitanus venom.
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Affiliation(s)
- Khadija Daoudi
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, 1 Place Louis Pasteur, Casablanca, 20360, Morocco
- Laboratory of Physiology and Molecular Genetics, Department of Biology, Faculty of Sciences Ain Chock, B.P 5366 Maarif, Casablanca, Morocco
| | - Fatima Chgoury
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, 1 Place Louis Pasteur, Casablanca, 20360, Morocco
| | - Myriam Rezzak
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, 1 Place Louis Pasteur, Casablanca, 20360, Morocco
| | - Oussama Bourouah
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, 1 Place Louis Pasteur, Casablanca, 20360, Morocco
| | - Lotfi Boussadda
- Experimental Centre, Pasteur Institute of Morocco, Casablanca, 20360, Morocco
| | - Abdelaziz Soukri
- Laboratory of Physiology and Molecular Genetics, Department of Biology, Faculty of Sciences Ain Chock, B.P 5366 Maarif, Casablanca, Morocco
| | - Jean-Marc Sabatier
- Laboratory INSERM UMR 1097, University of Aix-Marseille, 163, Parc Scientifique et Technologique de Luminy, Avenue de Luminy, Bâtiment TPR2, Case 939, Marseille 13288, France
| | - Naoual Oukkache
- Laboratory of Venoms and Toxins, Pasteur Institute of Morocco, 1 Place Louis Pasteur, Casablanca, 20360, Morocco
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Costal-Oliveira F, Guerra-Duarte C, Oliveira MS, Castro KLPD, Lopes-de-Sousa L, Lara A, Gomes ERDM, Bonilla C, Guatimosim S, Melo MM, Chávez-Olórtegui C. Cardiorespiratory alterations in rodents experimentally envenomed with Hadruroides lunatus scorpion venom. J Venom Anim Toxins Incl Trop Dis 2016; 23:2. [PMID: 27429609 PMCID: PMC4947318 DOI: 10.1186/s40409-016-0076-5] [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: 02/22/2016] [Accepted: 07/06/2016] [Indexed: 11/24/2022] Open
Abstract
Background Hadruroides lunatus is the most abundant scorpion species in the Peruvian central coast, where most of the accidents involving humans are registered. In spite of its prevalence, there are only very few studies on H. lunatus envenomation. The aim of the present study was to analyze the cardiorespiratory alterations caused by H. lunatus envenomation in rodents. Methods Wistar rats injected with H. lunatus scorpion venom were submitted to electrocardiography. After euthanasia, rat lungs were collected and histopathologically analyzed. Mouse cardiomyocytes were used to perform immunofluorescence and calcium transient assays. Data were analyzed by ANOVA or Student’s t-test. The significance level was set at p < 0.05. Results It was observed that H. lunatus venom increased heart rate and caused arrhythmia, thereby impairing the heart functioning. Lungs of envenomed animals showed significant alterations, such as diffuse hemorrhage. In addition, immunofluorescence showed that H. lunatus venom was capable of binding to cardiomyocytes. Furthermore, mouse ventricular cardiomyocytes incubated with H. lunatus venom showed a significant decrease in calcium transient, confirming that H. lunatus venom exerts a toxic effect on heart. Conclusion Our results showed that H. lunatus venom is capable of inducing cardiorespiratory alterations, a typical systemic effect of scorpionism, stressing the importance of medical monitoring in envenomation cases.
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Affiliation(s)
- Fernanda Costal-Oliveira
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, CP: 486 CEP: 31270-901 MG Brazil
| | - Clara Guerra-Duarte
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, CP: 486 CEP: 31270-901 MG Brazil
| | - Maira Souza Oliveira
- College of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Karen Larissa Pereira de Castro
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, CP: 486 CEP: 31270-901 MG Brazil
| | - Leticia Lopes-de-Sousa
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, CP: 486 CEP: 31270-901 MG Brazil
| | - Aline Lara
- Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Enéas Ricardo de Morais Gomes
- Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Cesar Bonilla
- Instituto Nacional de Salud, Universidad Nacional Mayor de San Marcos y Universidad Científica del Sur, Lima, Peru
| | - Sílvia Guatimosim
- Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Marília Martins Melo
- College of Veterinary Medicine, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Carlos Chávez-Olórtegui
- Department of Biochemistry and Immunology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, CP: 486 CEP: 31270-901 MG Brazil
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Cupo P. Clinical update on scorpion envenoming. Rev Soc Bras Med Trop 2016; 48:642-9. [PMID: 26676487 DOI: 10.1590/0037-8682-0237-2015] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/04/2015] [Indexed: 11/22/2022] Open
Abstract
Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a significant public health problem globally. Only scorpions of the Tityus genus are of medical importance in Brazil, and Tityus serrulatus is responsible for the most serious envenomations and deaths. The toxic effects of scorpion envenomation are due to a massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. The pathophysiology of cardiac involvement has been discussed for decades and has been attributed to adrenergic discharge and a possible toxic effect of venom on the myocardium, while acute pulmonary edema may have a cardiogenic and/or non-cardiogenic origin. Currently, the clinical data point to catecholamine excess as the cause for reversible scorpion cardiomyopathy . These data include electrocardiographic changes, profiling of cardiac enzymes and troponin I, echocardiographic data with global or regional left ventricle dysfunction, and myocardial perfusion alterations compatible with spasm in the coronary microcirculation. Furthermore, recent data on cardiac magnetic resonance imaging findings, which are similar to those observed for stress-induced cardiomyopathy, have also been linked to catecholamine excess. The efficiency of antivenom serum treatment is controversial in the literature. Our experience in Brazil is that the management of patients with systemic manifestations of scorpion stings is based on three approaches, all of which are extremely important. These include symptomatic treatment, antivenom serum, and cardiorespiratory support.
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Affiliation(s)
- Palmira Cupo
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Abstract
Tityus serrulatus (Ts) is the main scorpion species of medical importance in Brazil. Ts venom is composed of several compounds such as mucus, inorganic salts, lipids, amines, nucleotides, enzymes, kallikrein inhibitor, natriuretic peptide, proteins with high molecular mass, peptides, free amino acids and neurotoxins. Neurotoxins are considered the most responsible for the envenoming syndrome due to their pharmacological action on ion channels such as voltage-gated sodium (Nav) and potassium (Kv) channels. The major goal of this review is to present important advances in Ts envenoming research, correlating both the crude Ts venom and isolated toxins with alterations observed in all human systems. The most remarkable event lies in the Ts induced massive releasing of neurotransmitters influencing, directly or indirectly, the entire body. Ts venom proved to extremely affect nervous and muscular systems, to modulate the immune system, to induce cardiac disorders, to cause pulmonary edema, to decrease urinary flow and to alter endocrine, exocrine, reproductive, integumentary, skeletal and digestive functions. Therefore, Ts venom possesses toxins affecting all anatomic systems, making it a lethal cocktail. However, its low lethality may be due to the low venom mass injected, to the different venom compositions, the body characteristics and health conditions of the victim and the local of Ts sting. Furthermore, we also described the different treatments employed during envenoming cases. In particular, throughout the review, an effort will be made to provide information from an extensive documented studies concerning Ts venom in vitro, in animals and in humans (a total of 151 references).
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Ananda Kumar P, Krishnamurthy S, Srinivasaraghavan R, Mahadevan S, Harichandrakumar K. Predictors of myocardial dysfunction in children with indian red scorpion (Mesobuthus tamulus) sting envenomation. Indian Pediatr 2015; 52:297-301. [DOI: 10.1007/s13312-015-0627-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abroug F, Souheil E, Ouanes I, Dachraoui F, Fekih-Hassen M, Ouanes Besbes L. Scorpion-related cardiomyopathy: Clinical characteristics, pathophysiology, and treatment. Clin Toxicol (Phila) 2015; 53:511-8. [PMID: 25851549 DOI: 10.3109/15563650.2015.1030676] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Scorpion envenomation is a threat to more than 2 billion people worldwide with an annual sting number exceeding one million. Acute heart failure presenting as cardiogenic shock or pulmonary edema, or both is the most severe presentation of scorpion envenomation accounting for 0.27% lethality rate. OBJECTIVE The purpose of this review is to characterize the scorpion-related cardiomyopathy, clarify its pathophysiological mechanisms, and describe potentially useful treatments in this particular context. METHODS We searched major databases on observational or interventional studies (whether clinical or experimental) on the cardiorespiratory consequences of scorpion envenomation and their treatment. No limit of age or language was imposed. A critical appraisal of the literature was conducted in order to provide a pathophysiological scheme that reconciles reported patterns of cardiovascular toxicity and hypotheses and assumptions made so far. RESULTS Early cardiovascular dysfunction is related to the so-called "vascular phase" of scorpion envenomation, which is related to a profound catecholamine-related vasoconstriction leading to a sharp increase in left ventricular (LV) afterload, thereby impeding LV emptying, and increasing LV filling pressure. Following this vascular phase, a myocardial phase occurs, characterized by a striking alteration in LV contractility (myocardial stunning), low cardiac output, and hypotensive state. The right ventricle involvement is symmetric to that of LV with a profound and reversible alteration in right ventricular performance. This phase is unique in that it is reversible spontaneously or under inotropic treatment. Scorpion myocardiopathy combines the features of takotsubo myocardiopathy (or stress myocardiopathy) which is linked to a massive release in catecholamines leading to myocardial ischemia through coronary vasomotor abnormalities (epicardial coronary spasm and/or increase in coronary microvascular resistance). Treatment of pulmonary edema due to scorpion envenomation follows the same principles as those applied for the treatment of cardiogenic pulmonary edema in general: this begins with oxygen supplementation targeting an oxygen saturation of 92% or more, by oxygen mask, continuous positive airway pressure, noninvasive ventilation, or conventional mechanical ventilation. Dobutamine effectively improves hemodynamic parameters and may reduce mortality in severe scorpion envenomation. CONCLUSION Scorpion cardiomyopathy is characterized by a marked and reversible alteration in biventricular performance. Supportive treatment relying on ventilatory support and dobutamine infusion is a bridge toward recovery in the majority of patients.
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Affiliation(s)
- Fekri Abroug
- Intensive Care Unit Centre, Hospitalier Universitaire Fatouma Bourguiba , Monastir , Tunisia
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Bucaretchi F, Fernandes LC, Fernandes CB, Branco MM, Prado CC, Vieira RJ, De Capitani EM, Hyslop S. Clinical consequences of Tityus bahiensis and Tityus serrulatus scorpion stings in the region of Campinas, southeastern Brazil. Toxicon 2014; 89:17-25. [DOI: 10.1016/j.toxicon.2014.06.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/19/2014] [Accepted: 06/25/2014] [Indexed: 01/21/2023]
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Pandi K, Krishnamurthy S, Srinivasaraghavan R, Mahadevan S. Efficacy of scorpion antivenom plus prazosin versus prazosin alone for Mesobuthus tamulus scorpion sting envenomation in children: a randomised controlled trial. Arch Dis Child 2014; 99:575-80. [PMID: 24550184 DOI: 10.1136/archdischild-2013-305483] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the efficacy of combined use of scorpion antivenom (SAV) with prazosin, compared with prazosin alone in children with Mesobuthus tamulus scorpion envenomation. STUDY DESIGN Randomised controlled trial. SETTING A tertiary care hospital in south India. PATIENTS 50 children with definite history and/or systemic manifestations of scorpion envenomation were recruited from the paediatric emergency or outpatient department from February 2012 to July 2013. INTERVENTIONS The children were randomised into two groups. In 25 children, SAV was administrated as a slow intravenous bolus combined with prazosin (group A). Others received prazosin alone (group B). Results were analysed by Student t test and χ(2) test. MAIN OUTCOME MEASURES Time required for resolution of autonomic symptoms, total dose of prazosin, adverse events. RESULTS Children in group A recovered earlier than those in group B (mean difference 9.1 h, 95% CI 6.0 to 12.2). 23 children (92%) in group A were clear of autonomic symptoms within 10 h, compared with 10 children (40%) in group B (mean difference 52%, 95% CI 29% to 75%). The proportion of children deteriorating to clinical grade 3 or 4 was 8% in group A as against 44% in group B (p<0.01). The mean dose of prazosin required was 54 µg/kg versus 130.8 µg/kg in group A and B, respectively (p<0.01). SAV was not associated with severe adverse reactions. CONCLUSIONS Usage of SAV led to faster recovery and reduced the incidence of myocardial dysfunction. Combined therapy with SAV and prazosin is beneficial for children with M tamulus scorpion envenomation. TRIAL REGISTRATION NUMBER CTRI/2013/09/004002 (Clinical Trials Registry of India).
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Affiliation(s)
- Karuppiah Pandi
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Sriram Krishnamurthy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Rangan Srinivasaraghavan
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Subramanian Mahadevan
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Sofer S, Zucker N, Bilenko N, Levitas A, Zalzstein E, Amichay D, Cohen-Lahav M, Bernstein T. The importance of early bedside echocardiography in children with scorpion envenomation. Toxicon 2013; 68:1-8. [DOI: 10.1016/j.toxicon.2013.02.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/20/2013] [Accepted: 02/22/2013] [Indexed: 12/20/2022]
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Gokdemir M, Sezer T. Evaluation of myocardial function using tissue Doppler imaging in children with moderate scorpion envenomation. Clin Toxicol (Phila) 2013; 51:156-61. [DOI: 10.3109/15563650.2013.772622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hmila I, Cosyns B, Tounsi H, Roosens B, Caveliers V, Abderrazek RB, Boubaker S, Muyldermans S, El Ayeb M, Bouhaouala-Zahar B, Lahoutte T. Pre-clinical studies of toxin-specific Nanobodies: Evidence of in vivo efficacy to prevent fatal disturbances provoked by scorpion envenoming. Toxicol Appl Pharmacol 2012; 264:222-31. [DOI: 10.1016/j.taap.2012.07.033] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 06/30/2012] [Accepted: 07/30/2012] [Indexed: 11/15/2022]
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Pucca MB, Zoccal KF, Roncolato EC, Bertolini TB, Campos LB, Cologna CT, Faccioli LH, Arantes EC, Barbosa JE. Serrumab: a human monoclonal antibody that counters the biochemical and immunological effects of Tityus serrulatus venom. J Immunotoxicol 2012; 9:173-83. [PMID: 22424317 DOI: 10.3109/1547691x.2011.649220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In Brazil, the species Tityus serrulatus is responsible for the most severe cases of scorpion envenomation. There is currently a need for new scorpion anti-venoms that are more effective and less harmful. This study attempted to produce human monoclonal antibodies capable of inhibiting the activity of T. serrulatus venom (TsV), using the Griffin.1 library of human single-chain fragment-variable (scFv) phage antibodies. Four rounds of phage antibody selection were performed, and the round with the highest phage antibody titer was chosen for the production of monoclonal phage antibodies and for further analysis. The scFv 2A, designated serrumab, was selected for the production and purification of soluble antibody fragments. In a murine peritoneal macrophage cell line (J774.1), in vitro assays of the cytokines interleukin (IL)-6, tumor necrosis factor (TNF)-α, and IL-10 were performed. In male BALB/c mice, in vivo assays of plasma urea, creatinine, aspartate transaminase, and glucose were performed, as well as of neutrophil recruitment and leukocyte counts. It was found that serrumab inhibited the TsV-induced increases in the production of IL-6, TNFα, and IL-10 in J774.1 cells. The in vivo inhibition assay showed that serrumab also prevented TsV-induced increases in the plasma levels of urea, creatinine, aspartate transaminase, and glucose, as well as preventing the TsV-induced increase in neutrophil recruitment. The results indicate that the human monoclonal antibody serrumab is a candidate for inclusion in a mixture of specific antibodies to the various toxins present in TsV. Therefore, serrumab shows promise for use in the production of new anti-venom.
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Affiliation(s)
- Manuela Berto Pucca
- Department of Biochemistry and Immunology, University of São Paulo at Ribeirão Preto School of Medicine, Ribeirão Preto, Brazil
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Guimarães P, Pinto M, Melo M. Perfis clínico e hematológico de camundongos submetidos ao envenenamento escorpiônico experimental por Tityus fasciolatus. ARQ BRAS MED VET ZOO 2011. [DOI: 10.1590/s0102-09352011000600015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Estudou-se o quadro clínico do veneno decorrente do envenenamento por Tityus fasciolatus e sua ação refletida nos componentes hematológicos no modelo murino. Para o estudo do perfil hematológico, foram utilizados 54 camundongos Swiss CF1, machos, com 30g, distribuídos em três grupos (G) (n=18) inoculados via subcutânea com: 50µL de PBS (G1); 24µg de veneno de T. fasciolatus (G2) e 8µg de veneno de T. serrulatus (G3). Cada grupo foi subdividido em três subgrupos (n=6) de acordo com o momento da coleta de sangue que foi estipulada em uma, oito e 24h após a inoculação do veneno, e foram realizados o hemograma e a dosagem de proteínas totais e fracionadas. O veneno de T. fasciolatus na dose de 24µg causou piloereção, comportamento nociceptivo, secreção nasal e oral acentuada, dispneia, prurido na face e reflexos exacerbados. No exame hematológico, foram observadas policitemia relativa e leucocitose com linfocitose.
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Zayerzadeh E, Koohi MK, Mirakabadi AZ, Fardipoor A, Kassaian SE, Rabbani S, Anvari MS. Amelioration of cardio-respiratory perturbations following Mesobuthus eupeus envenomation in anesthetized rabbits with commercial polyvalent F(ab')2 antivenom. Toxicon 2011; 59:249-56. [PMID: 22118980 DOI: 10.1016/j.toxicon.2011.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 11/01/2011] [Accepted: 11/02/2011] [Indexed: 10/15/2022]
Abstract
Immunotherapy is the only specific treatment for scorpion sting. In the present study, protective effects of polyvalent antivenom against hemodynamic disturbances, biomarkers (troponin T, creatinine kinase isoenzyme MB, Lactate dehydrogenase) changes, electrocardiogram abnormalities and histopathological complications in heart and lung induced by Mesobuthus eupeus scorpion venom was investigated in anesthetized rabbits. Twenty four rabbits were randomized into four equal groups: six rabbits in control group received 1 ml ultra-pure water subcutaneously (group 1). Group two received LD50 of venom (4.5 mg/kg). In the third and fourth groups, 5 ml of scorpion antivenom was administrated intravenously simultaneous with venom injection and 60 min following envenomation, respectively. Results of the present study indicate significant decrease in hemodynamic parameters following envenomation in the second group of animals. Venom injection caused edema, myocytolysis, coagulation necrosis, hemorrhage in heart as well as edema, hemorrhage and vascular thrombus in lungs. Although envenomed rabbits presented rises in LDH and TnT but no alteration in CK-MB was observed. Electrocardiogram monitoring of rabbits showed ST elevation and inverted T waves. Simultaneous administration of antivenom and venom prevented entirely the clinical signs, hemodynamic disturbances, markers changes, ECG abnormalities and histopathological damages. Delayed immunotherapy gradually ameliorated clinical signs, hemodynamic disturbances and markers changes related to envenomation. Histopathological evaluation showed slight alterations such as mild myocytolysis in heart and mild edema in lung following delayed immunotherapy. In conclusion, scorpion antivenom administration has preventive, neutralizing and curative properties for M. eupeus scorpion envenomation, if it would be applied at optimum time, dose and route.
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Abstract
Scorpion envenomation is a dangerous and common global event that can result in a variety of toxic clinical effects. These are typically managed with supportive care or antivenom. Antivenom use is controversial because of conflicting evidence of effectiveness for adrenergic toxicity. However, both controlled and uncontrolled studies have shown that antivenom is effective in resolving neuromotor toxicity associated with envenomations by the scorpions of genus Centruroides.
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Bawaskar HS, Bawaskar PH. Efficacy and safety of scorpion antivenom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthus tamulus) sting: randomised open label clinical trial. BMJ 2011; 342:c7136. [PMID: 21209062 PMCID: PMC3016167 DOI: 10.1136/bmj.c7136] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Envenomation by Mesobuthus tamulus scorpion sting can result in serious cardiovascular effects. Scorpion antivenom is a specific treatment for scorpion sting. Evidence for the benefit of scorpion antivenom and its efficacy compared with that of commonly used vasodilators, such as prazosin, is scarce. We assessed the efficacy of prazosin combined with scorpion antivenom, compared with prazosin alone, in individuals with autonomic storm caused by scorpion sting. DESIGN Prospective, open label randomised controlled trial. SETTING General hospital inpatients (Bawaskar Hospital and Research Centre Mahad Dist-Raigad Maharashtra, India). PARTICIPANTS Seventy patients with grade 2 scorpion envenomation, older than six months, with no cardiorespiratory or central nervous system abnormalities. INTERVENTION Scorpion antivenom plus prazosin (n=35) or prazosin alone (n=35) assigned by block randomisation. Treatment was not masked. Analysis was by intention to treat. MAIN OUTCOME MEASURES The primary end point was the proportion of patients achieving resolution of the clinical syndrome (sweating, salivation, cool extremities, priapism, hypertension or hypotension, tachycardia) 10 hours after administration of study drugs. Secondary end points were time required for complete resolution of clinical syndrome, prevention of deterioration to higher grade, doses of prazosin required overall and within 10 hours, and adverse events. The study protocol was approved by the independent ethics committee of Mumbai. RESULTS Mean (SD) recovery times in hours for the prazosin plus scorpion antivenom group compared with the prazosin alone groups were: sweating 3 (1.1) v 6.6 (2.6); salivation 1.9 (0.9) v 3 (1.9); priapism 4.7 (1.5) v 9.4 (1.5). Mean (SD) doses of prazosin in the groups were 2 (2.3) and 4 (3.5), respectively. 32 patients (91.4%, 95% confidence interval 76.9% to 97.8%) in the prazosin plus antivenom group showed complete resolution of the clinical syndrome within 10 hours of administration of treatment compared with eight patients in the prazosin group (22.9%, 11.8% to 39.3%). Patients from the antivenom plus prazosin group recovered earlier (mean 8 hours, 95% CI 6.5 to 9.5) than those in the control group (17.7 hours, 15.4 to 19.9; mean difference -9.7 hours, -6.9 to -12.4). The number of patients whose condition deteriorated to a higher grade was similar in both groups (antivenom plus prazosin four of 35, prazosin alone five of 35). Hypotension was reported in fewer patients in the antivenom plus prazosin group (12 of 35, 34.3%) than in the prazosin group (19 of 35, 54.3%), but the difference was not statistically significant. No difference was noted in change in blood pressure and pulse rate over time between two groups. CONCLUSION Recovery from scorpion sting is hastened by simultaneous administration of scorpion antivenom plus prazosin compared with prazosin alone. TRIAL REGISTRATION NUMBER CTRI/2010/091/000584 (Clinical Trials Registry India).
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Biochemical profile of dogs experimentally envenomed with Tityus serrulatus scorpion venom. Toxicon 2010; 55:1125-31. [DOI: 10.1016/j.toxicon.2010.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 10/02/2009] [Accepted: 01/02/2010] [Indexed: 11/17/2022]
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Pelander L, Ljungvall I, Häggström J. Myocardial cell damage in 24 dogs bitten by the common European viper (Vipera berus
). Vet Rec 2010; 166:687-90. [DOI: 10.1136/vr.b4817] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- L. Pelander
- Department of Clinical Sciences; University of Agricultural Sciences; 750 07 Uppsala Sweden
| | - I. Ljungvall
- Department of Clinical Sciences; University of Agricultural Sciences; 750 07 Uppsala Sweden
| | - J. Häggström
- Department of Clinical Sciences; University of Agricultural Sciences; 750 07 Uppsala Sweden
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Pinto M, Melo M, Costa M, Labarrere C. Hematological and biochemical profiles of rats submitted to experimental poisoning with Tityus serrulatus venom. ARQ BRAS MED VET ZOO 2010. [DOI: 10.1590/s0102-09352010000200015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The hematological and biochemical profiles of newly weaned rats submitted to experimental poisoning with T. serrulatus venom were evaluated. Fifteen recently weaned male Wistar rats (mean weight 130g) were distributed into three equal groups (n = 5). Animals in the control group (group A) received a subcutaneous injection of 400μL of ultra-pure water, while those in the experimental groups received, by identical route, 400μL of a solution containing 100μg (group B) or 450μg (group C) of scorpion venom dissolved in ultra-pure water. Red blood cells indexes, and differential leukocyte and total platelet counts were determined, together with levels of serum glucose, urea, creatinine, lactic dehydrogenase, aspartate aminotransferase, amylase, insulin, and cortisol. No significant differences between the control and experimental groups regarding red blood cells indexes were found. In contrast, significant increases (P<0.05) in neutrophils, lymphocytes, and monocytes were observed in animals from groups B and C compared with the control group, while the number of platelets decreased. Serum glucose concentration remained unchanged in all groups, but important alterations were observed in the values of urea and creatinine. The results show that scorpion venom was detrimental to renal function as demonstrated by the altered urea and creatinine levels. Pancreatic function was also impaired, as revealed by the increase in amylase activity and the reduction in insulin levels.
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Pinto MCL, Borboleta LR, Melo MB, Labarrére CR, Melo MM. Tityus fasciolatus envenomation induced cardio-respiratory alterations in rats. Toxicon 2010; 55:1132-7. [PMID: 20060851 DOI: 10.1016/j.toxicon.2010.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 12/05/2009] [Accepted: 01/02/2010] [Indexed: 11/15/2022]
Abstract
The present study characterized envenomation in young rats by Tityus fasciolatus, an endemic scorpion to Central Brazilian and state of Minas Gerais. Electrocardiographic examinations were performed prior to treatment and every 5 min during the first 30 min after envenomation. The cardiac blood profile [creatine kinase, CK isoenzyme MB, lactate dehydrogenase, aspartate aminotransferase and troponina] together with macroscopic and microscopic alterations in the lungs and heart were evaluated. Envenomated animals showed ECG changes suggesting electrolytic imbalance, myocarditis and venom interference on the conduction tissue. Biochemical analyses indicated myocardial damage with high levels of CK, CK-MB and LDH. Macroscopic and microscopic findings included detection of pulmonary haemorrhages. In conclusion, T. fasciolatus venom leads to acute cardio-respiratory changes in young rats.
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Affiliation(s)
- M C L Pinto
- Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Abdoon NA, Fatani AJ. Correlation between blood pressure, cytokines and nitric oxide in conscious rabbits injected with Leiurus quinquestriatus quinquestriatus scorpion venom. Toxicon 2009; 54:471-80. [DOI: 10.1016/j.toxicon.2009.05.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2009] [Revised: 05/13/2009] [Accepted: 05/16/2009] [Indexed: 10/20/2022]
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Abroug F, Ouanes-Besbes L, ElAtrous S. Antivenom for children with neurotoxicity from scorpion stings. N Engl J Med 2009; 361:631; author reply 632. [PMID: 19657132 DOI: 10.1056/nejmc091264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ribeiro E, Melo M, Pinto M, Labarrère C, Guimarães P, Paes P, Leme F. Hemograma de cães submetidos ao envenenamento experimental por Tityus serrulatus. ARQ BRAS MED VET ZOO 2009. [DOI: 10.1590/s0102-09352009000100019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Avaliou-se o hemograma de 12 cães adultos, saudáveis (14,2±5,4kg) após a inoculação de veneno do escorpião amarelo (Tityus serrulatus). Os animais foram distribuídos em dois grupos (G), com seis em cada: os do GI foram usados como controle e receberam 0,5mL de salina tamponada com fosfato (PBS) por via subcutânea (SC) na face medial da coxa esquerda (FMCE), e os do GII receberam veneno liofilizado do T. serrulatus (250µg/kg) diluído em PBS por via SC na FMCE. Foram realizadas colheitas de sangue com anticoagulante EDTA a 10% antes da inoculação do veneno (T0) e após 2h, (T1), 6h (T2), 12h (T3), 24h (T4), 48h (T5) e 72h (T6), para contagem de eritrócitos, leucócitos e plaquetas em aparelho contador eletrônico e esfregaços sanguíneos para contagem diferencial de leucócitos. Houve aumento significativo (P<0,05) dos valores de eritrócitos, volume globular e hemoglobina 2h e 6h após o envenenamento, devido à contração esplênica decorrente da dor local causada pelo veneno e pela liberação de catecolaminas. Foi observada leucocitose por aumento significativo (P<0,05) de neutrófilos e linfócitos 2h e 6h após o envenenamento. Concluiu-se que o veneno de Tityus serrulatus na dose de 250µg/kg, é capaz de aumentar os valores do eritrograma e do leucograma dos cães, provavelmente devido à dor local, com liberação de catecolaminas.
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Sami-Merah S, Hammoudi-Triki D, Martin-Eauclaire MF, Laraba-Djebari F. Combination of two antibody fragments F(ab′)2/Fab: An alternative for scorpion envenoming treatment. Int Immunopharmacol 2008; 8:1386-94. [DOI: 10.1016/j.intimp.2008.05.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Revised: 05/18/2008] [Accepted: 05/19/2008] [Indexed: 11/26/2022]
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Barão AAS, Bellot RG, Dorce VAC. Developmental effects of Tityus serrulatus scorpion venom on the rat offspring. Brain Res Bull 2008; 76:499-504. [DOI: 10.1016/j.brainresbull.2008.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Revised: 02/08/2008] [Accepted: 02/25/2008] [Indexed: 12/28/2022]
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Yildizdas D, Yilmaz HL, Erdem S. Treatment of Cardiogenic Pulmonary Oedema by Helmet-delivered Non-invasive Pressure Support Ventilation in Children With Scorpion Sting Envenomation. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n3p230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: The aim of this study was to evaluate the feasibility of non-invasive positive pressure ventilation through a new interface helmet in the treatment of cardiogenic pulmonary oedema due to scorpion sting envenomation in children.
Clinical Picture: Three patients presented with fever, and respiratory distress following scorpion sting. Their cardiac enzymes were abnormal. Electrocardiogram (ECG) of 3 patients showed features of myocardial strain with ST elevation. Bedside chest X-ray taken in emergency showed marked bilateral infiltrates suggestive of pulmonary oedema. M-mode, two-dimensional colour-flow Doppler echocardiogram showed left ventricular dysfunction.
Treatment and Outcome: At paediatric intensive care unit admission, they were treated with antivenom, prazosin (0.03 mg/kg/dose), dopamine (15 mcg/kg/ min), dobutamine (10 mcg/kg/min) and nitroprussid (1 mcg/kg/min). Epinephrine (0.1 mcg/kg/ min) were added later. They were hypoxic and dyspnoeic. A slight sedation was induced with ketamine and/or midazolam. Non-invasive pressure support ventilation (NPSV) was delivered via the helmet by means of an intensive care unit ventilator. We evaluated the effect of NPSV delivered by helmet on oxygenation, respiratory rate, haemodynamics, complications and outcome. An improvement of oxygenation was observed within 2 hours of treatment. The helmet was well tolerated by all the children. No complications occurred in the 3 patients.
Conclusion: This new approach of delivering NPSV through a helmet allows the successful treatment of cardiogenic pulmonary oedema in children with scorpion sting envenomation, assuring a good tolerance without complications. Future studies are needed before recommending the extensive application of this technique in all cases of cardiogenic pulmonary oedema due to scorpion sting envenomation.
Key words: Acute respiratory failure, Child, Helmet interface, Non-invasive ventilation
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Tsai SH, Chu SJ, Hsu CW, Cheng SM, Yang SP. Use and interpretation of cardiac troponins in the ED. Am J Emerg Med 2008; 26:331-41. [DOI: 10.1016/j.ajem.2007.05.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Revised: 05/24/2007] [Accepted: 05/25/2007] [Indexed: 10/22/2022] Open
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El-Alfy AT, Ahmed AA, Fatani AJ, Kader F. Amelioration of the cardiovascular manifestations of the yellow scorpion Leiurus quinquestriatus envenomation in rats by red grape seeds proanthocyanidins. Toxicon 2008; 51:321-33. [DOI: 10.1016/j.toxicon.2007.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Revised: 07/02/2007] [Accepted: 07/03/2007] [Indexed: 10/23/2022]
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Cupo P, Figueiredo AB, Filho AP, Pintya AO, Tavares Júnior GA, Caligaris F, Marin-Neto JA, Hering SE, Simões MV. Acute left ventricular dysfunction of severe scorpion envenomation is related to myocardial perfusion disturbance. Int J Cardiol 2007; 116:98-106. [PMID: 16828898 DOI: 10.1016/j.ijcard.2006.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 02/07/2006] [Accepted: 02/24/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Scorpion envenomation (SE) may present severe cardiac dysfunction with acute pulmonary edema and cardiogenic shock. The pathophysiology of this acute heart failure is still controversial. We aimed at assessing the contribution of the myocardial ischemia to the left ventricular dysfunction in SE by using 99mTc-Sestamibi myocardial perfusion scintigraphy (MPS). METHODS Twelve children (7 males, 1-12 years old) presenting severe Tityus serrulatus envenomation were prospectively submitted to MPS within 72 h (acute) and 15 days (follow-up) after the event. MPS images were interpreted using a visual semi-quantitative uptake score (0 = normal, 4 = absent). Echocardiography was used for the assessment of left ventricular (LV) ejection fraction (EF) and regional wall motion (WM) by using a semi-quantitative score (0 = normal, 4 = akinesia). A 16-segment LV model was used. RESULTS Initial echocardiography showed marked WM abnormalities with a mean score of 31.4+/-13.9, and a reduced EF (36+/-16%). All patients exhibited myocardial perfusion (MP) defects. The mean MP uptake score was 14.6+/-7.8. A significant topographic association between MP and WM changes was obtained (p<0.0001, Fischer exact test). A positive correlation was obtained between the summed WM and MP scores (R=0.68, p=0.016). Follow-up evaluation showed a significant improvement of LVEF (65+/-10%) and WM score (3.9+/-4.2), parallel to the normalization of MP. CONCLUSIONS These observations strongly support the participation of transitory myocardial ischemia in the mechanism of the acute cardiac dysfunction caused by severe scorpion envenoming. Micro vascular spasm related to the catecholamine over stimulation may be the pathophysiologic link triggering the myocardial perfusion disturbance in this syndrome.
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Affiliation(s)
- Palmira Cupo
- Pediatrics Division, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.
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El-Gawad TAA, . HMI, . SAES, . HAS. Study of Cardiac Changes in Egyptian Children with Scorpion Envenomation Before and After Antivenin Therapy. JOURNAL OF MEDICAL SCIENCES 2006. [DOI: 10.3923/jms.2006.1033.1038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yildiz A, Biçeroglu S, Yakut N, Bilir C, Akdemir R, Akilli A. Acute myocardial infarction in a young man caused by centipede sting. Emerg Med J 2006; 23:e30. [PMID: 16549562 PMCID: PMC2579533 DOI: 10.1136/emj.2005.030007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
It is known that insects can cause various clinical effects such as myocardial ischaemia and hypotension from vasospasm and the myocardial toxic effects of the venom and anaphylaxis. Although myocardial ischaemia resulting from centipede sting has been reported once before, myocardial injury has not. In this report, the authors present the case of a 20 year old male patient bitten by a centipede and admitted to the emergency room with chest pain, abnormal electrocardiographic findings, and increased cardiac enzymes (cardiac troponin T) suggesting acute myocardial infarction.
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Affiliation(s)
- A Yildiz
- Special Gazi Hospital, Izmir, Turkey.
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de Sousa Alves R, do Nascimento NRF, Barbosa PSF, Kerntopf MR, Lessa LMA, de Sousa CM, Martins RD, Sousa DF, de Queiroz MGR, Toyama MH, Fonteles MC, Martins AMC, Monteiro HSA. Renal effects and vascular reactivity induced by Tityus serrulatus venom. Toxicon 2005; 46:271-6. [PMID: 16011841 DOI: 10.1016/j.toxicon.2005.04.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Accepted: 04/08/2005] [Indexed: 11/25/2022]
Abstract
Tityus serrulatus, popularly known as yellow scorpion, is one of the most studied scorpion species in South America and its venom has supplied some highly active molecules. The effects of T. serrulatus venom upon the renal physiology in human showed increased renal parameters, urea and creatinine. However, in perfused rat kidney the effects were not tested until now. Isolated kidneys from Wistar rats, weighing 240-280 g, were perfused with Krebs-Henseleit solution containing 6% (g weight) of previously dialysed bovine serum albumin. The effects of T. serrulatus venom were studied on the perfusion pressure (PP), renal vascular resistance (RVR), urinary flow (UF), glomerular filtration rate (GFR), sodium tubular transport (%TNa+), potassium tubular transport (%TK+) and chloride tubular transport (%TCl-). Tityus serrulatus venom (TsV; 10 microg/mL) was added to the system 30 min after the beginning of each experiment (n=6). This 30 min period was used as an internal control. The mesenteric bed was perfused with Krebs solution kept warm at 37 degrees C by a constant flow (4 mL/min), while the variable perfusion pressure was measured by means of a pressure transducer. The direct vascular effects of TsV (10 microg/mL/min; n=6), infused at a constant rate (0.1 mL/min), were examined and compared to the infusion of the vehicle alone at the same rate. TsV increased PP (PP30'=127.8+/-0.69 vs PP60'=154.2+/-14 mmHg*, *p<0.05) and RVR (RVR30'=6.29+/-0.25 vs RVR60'=8.03+/-0.82 mmHg/mLg(-1)min(-1)*, *p<0.05), decreased GFR (GFR30'=0.58+/-0.02 vs GFR60'=0.46+/-0.01mLg(-1)min(-1)*, *p<0.05) and UF (UF30'=0.135+/-0.001 vs UF60'=0.114+/-0.003mLg(-1)min(-1)*, *p<0.05). Tubular transport was not affected during the whole experimental period (120 min). On the other hand, the infusion of TsV (10 microg/mL/min) increased the basal perfusion pressure of isolated arteriolar mesenteric bed (basal pressure: 74.17+/-3.42 vs TsV 151.8+/-17.82 mmHg*, *p<0.05). TsV affects renal haemodynamics probably by a direct vasoconstrictor action leading to decreased renal flow.
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Affiliation(s)
- Renata de Sousa Alves
- Department of Physiology and Pharmacology, Institute of Biomedicine and Clinical Research Unit, Federal University of Ceara, Fortaleza, Ceara 60430-270, Brazil
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Abstract
Cardiac troponin (cT) is released after myocardial damage. In the appropriate clinical setting, a measured elevation of cT can increase the diagnostic rate of myocardial infarction and acute coronary syndrome. Elevations of cT, however, can occur in a wide variety of other clinical situations. Failure to recognize this can lead to an over-diagnosis of myocardial infarction (MI). We present clinical cases from our institution that illustrate this diagnostic problem, and review similar cases in the literature. We also discuss the implications of an erroneous diagnosis of myocardial infarction, for the patient and for the health services.
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Affiliation(s)
- C E Burness
- Department of Cardiology, Royal Hallamshire Hospital, Sheffield, UK
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Bahloul M, Kallel H, Rekik N, Ben Hamida C, Chelly H, Bouaziz M. [Cardiovascular dysfunction following severe scorpion envenomation. Mechanisms and physiopathology]. Presse Med 2005; 34:115-20. [PMID: 15687982 DOI: 10.1016/s0755-4982(05)88241-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The seriousness of scorpion envenomation results essentially from left cardiac function with pulmonary oedema and/or a state of shock. Adrenergic myocarditis, toxic myocarditis and myocardial ischemia are the 3 mechanisms that explain the cardiac dysfunction. Myocardial ischemia is not only due to the release of catecolamines but also the effect of the cytokines and/or neuropeptide Y on the coronary vessels. The cardiac damage can be due or enhanced by the depressive effect of the cytokines on the myocardial cells. The frequently observed hyperglycaemia only enhances the state of the already damaged myocardium.
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Affiliation(s)
- Mabrouk Bahloul
- Service de réanimation médicale, CHU Habib Bourguiba, Sfax, Tunisie.
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Abstract
This article focuses on the medically relevant arachnid species found in North America and selected other arachnids from around the world. While it is largely still true that the geographic location of the envenomation assists in determining the species responsible, the booming trade in arachnids as exotic pets should prompt the clinician to inquire into this possibility. Expert advice should be sought in either case; species identification is critical in determining the need for and proper type of antivenom therapy.
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Affiliation(s)
- John R Saucier
- University of Vermont School of Medicine, Burlington 05405, USA.
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Abstract
Right ventricular dysfunction in hemodynamically stable patients with acute pulmonary embolism may be a harbinger of adverse outcomes and may potentially result in the early use of thrombolytic therapy. Risk stratification of these patients is an area of recent and intense investigation with a focus on the assessment of right ventricular function after the embolic event. Echocardiography has been used to identify right ventricular dysfunction but is potentially hampered by a number of limitations. With the onset of right ventricular dilation and possible ischemia in acute pulmonary embolism, elevated serum troponins may be an early and reliable marker of right ventricular dysfunction. In acute pulmonary embolism, both right ventricular dysfunction by echocardiogram and elevated troponin levels have been shown to predict an adverse outcome. Therefore, serum troponin levels should help stratify patients with submassive acute pulmonary embolism into a group in which aggressive medical or surgical intervention would be considered.
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Affiliation(s)
- Kenneth T Horlander
- Division of Pulmonary, Allergy and Critical Care Medicine, Emory University School of Medicine, Atlanta, GA 30308, USA.
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