Management of scorpion sting: prazosin or dobutamine

A Pre-clinical Study of Jeerakadi Lepa against Indian Red Scorpion Venom Poisoning

Scorpion stings are very common in India, especially in the Konkan region of Maharashtra state. Scorpion stings show various signs and symptoms. A preclinical study to validate the efficacy of an Ayurvedic preparation called Jeerakadi Lepa was done in Swiss albino mice. A total of 18 Swiss albino mice (n = 18) were divided into 3 groups: the control group (n = 6), the standard group (n = 6) and the experimental group (n = 6). Only Indian red scorpion venom was administered by the SC route in the control group. In contrast, the venom was administered by SC in the standard group, followed by an oral tablet. Prazosin, and in the experimental group, the venom was administered by SC route, followed by local Jeerakadi Lepa. Kruskal-Wallis’s test was applied at a 95% confidence interval to assess various toxicity parameters like lacrimation, salivation, etc. The P-value was 0.04433 in toxicity symptoms (P < 0.05), but it was 0.3366 (P > 0.05) in the number of deaths of Swiss albino mice in the above groups. It was concluded that Jeerakadi Lepa effectively eliminated all the signs and symptoms of toxicity due to scorpion venom in Swiss albino mice. Still, it should not be used independently among humans.

French Scorpionism (Mainland and Oversea Territories): Narrative Review of Scorpion Species, Scorpion Venom, and Envenoming Management

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.

Echocardiographic Evaluation of the Response to Prazosin Treatment in Scorpion Sting

BACKGROUND

Scorpion envenomation is a major public health problem in children that can induce lethal neurological, respiratory and cardiovascular complications. We aimed to evaluate cardiovascular complications with a follow-up of envenomed children for 1 month for possibility of incomplete recovery.

METHODS

This was a prospective study conducted for children who presented with scorpion sting to Emergency and Intensive Care units. Demographic, clinical and laboratory findings of patients were recorded. Cases with suspected clinical and electrocardiographic manifestations of myocarditis were subjected to bedside echocardiography with follow-up at the end of the first week and the first month.

RESULTS

Scorpion sting cases presented to our hospital were 81 cases during 1-year study; of them, 17 cases were stable without systemic manifestations after 12 h observation and discharged. Sixty-four cases suffered systemic organic complications and needed ICU admission; their mean age was 11.52 ± 3.74 and 64% of them were males. Twenty-eight of admitted cases showed manifestations of myocarditis and by echocardiography, all of them had evidence of left ventricular dysfunction. On follow-up, there was significant improvement at the end of first week and complete improvement at the end of first month except three cases who died due to pulmonary edema and cardiogenic shock.

CONCLUSION

Acute toxic myocarditis is a common and an important cause of morbidity and mortality following scorpion envenomation that necessitates early and aggressive management. High index of suspicion, serial electrocardiogram monitoring and echocardiography are three integrative lines required to recognize this serious complication. Lay summaryAcute toxic myocarditis is a common cause of morbidity and mortality following scorpion envenomation that necessitates rapid medical treatment. We aimed to evaluate cardiovascular complications after scorpion sting with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Tachycardia was the most frequent observed cardiac sign followed by hypotension, while the least was bradycardia and hypertension. All cases with manifestations suggestive of myocarditis were evaluated by bedside two-dimensional echocardiography and showed evidence of left ventricular dysfunction, that begin to regress within 1 week of treatment unless progressive pulmonary edema and resistant cardiogenic shock occurred. On follow-up for survivors, complete improvement at the end of first month was noticed. Clinical suspicion, serial ECG monitoring and echocardiography are required for rapid and early diagnosis. Early use of prazosin therapy can prevent long-term residual damage as evidenced by echocardiographic evaluation.

Blistering skin lesion: A new observation of Hottentotta tamulus (white scorpion) sting

White scorpion (Hottentotta tamulus) stings are an emerging health hazard in northern Sri Lanka and are increasingly recognized particularly during the last decade. The stings are usually harmless; however, fatal cardiovascular sequelae ensues following severe envenomation. It is often difficult to identify this miniature creature and its site of sting due to its nature of habitat and nonspecific local symptoms that develop after the sting. Here, we report a patient who had developed a blistering skin lesion soon after the sting which is not reported in the literature to date by the sting of this particular species. Recognizing it would help the clinicians of this subcontinent to consider scorpion sting as a differential diagnosis for the above presentation in the future.

Saudi medicinal plants for the treatment of scorpion sting envenomation

Scorpion sting envenoming poses major public health problems. The treatment modalities include antivenoms, chemical antidotes and phytotherapy, with varying degrees of effectiveness and side effects. In this investigation, we reviewed the use of Saudi medicinal plants for the treatment of scorpion sting patients. The relevant literature was collected using the online search engines including Science Direct, Google and PubMed with the help of specific keywords. We also used the printed and online resources at our institutional library to gather the relevant information on the use of medicinal plants for the treatment of scorpion sting patients. A descriptive statistics was used for data compilation and presentation. The results of this survey showed the use of at least 92 medicinal plants with beneficial effects for treating victims of stings of different scorpion species. These commonly used herbs spanned to 37 families whilst different parts of these plants were employed therapeutically for alleviation of envenomation symptoms. The application of leaves (41%) was preferred followed by roots (19%), whole plant (14%) and seeds (9%). The use of latex (4%), stem (3%), flowers (3%) and bark (3%) was also reported. In some cases, tannin (2%), rhizome (1%) and shoot (1%) were also used. In conclusion, herbal medicines are effectively used for the treatment of patients with scorpion envenomation. This type of medication is free from side effects as observed with chemical antidotes or antivenom therapy. It is important to identify the active ingredients of herbal drugs for improving their therapeutic potential in traditional medicine.

Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials

BACKGROUND

Scorpion stings cause an estimated 3000 deaths per annum worldwide. We conducted a systematic review of all controlled clinical trials related to scorpion sting management.

METHODS

We searched PubMed, EMBASE, Scopus, Web of Science and CINAHL and included controlled prospective clinical trials (randomized or non-randomized). The following interventions were assessed: adults and children with scorpion stings treated with (a) steroids vs. placebo, (b) different methods of pain relief, (c) antivenom vs. supportive treatment, (d) prazosin vs. supportive treatment, (e) antivenom vs. prazosin and (f) antivenom plus prazosin vs. prazosin alone. When trials had comparative outcomes, they were combined in a meta-analysis. Data was analysed with Review Manager 5. Dichotomous data were compared with relative risk (RR), and continuous data were compared with mean differences using a fixed effect model. There is no PROSPERO registration number for this study.

RESULTS

Antivenom against Centruroides sp. are effective in reversing the clinical syndrome faster than no antivenom treatment in children (RR, 0.02; 95% CI, 0.01 to 0.06; 322 participants; three trials). Antivenom (against Mesobuthus tamulus) and prazosin combination is better than prazosin alone for faster resolution of symptoms (mean difference, -12.59 h; 95% CI, -14.01 to -11.17; 173 participants; three trials).

CONCLUSIONS

The polyvalent antivenom against Centruroides sp. in USA/Mexico and the monovalent antivenom against M. tamulus in India are effective for rapid resolution of symptoms. Prazosin is useful as an add-on therapy for M. tamulus stings.

Doxazosin in the treatment of scorpion envenomation

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.

Pharmacophore mapping based inhibitor selection and molecular interaction studies for identification of potential drugs on calcium activated potassium channel blockers, tamulotoxin

Background:

Tamulotoxin (TmTx) from Buthus tamulus was found to be a highly venomous toxin which accelerates the neurotransmitter release that directly affects the cardiovascular tissues and the respiratory system leading to death. TmTx from red Indian scorpion is a crucial inhibitor for Ca²⁺ activated K⁺ channel in humans.

Objective:

The study is aimed at the identification of potential inhibitors of TmTx through pharmacophore based inhibitor screening and understanding the molecular level interactions.

Materials and Method:

The potential inhibitors for TmTx were identified using pharmacophore model based descriptor information present in existing drugs with the analysis of pharmacokinetic properties. The compounds with good ADMET (Absorption, Distribution, Metabolism, Excretion and Toxicity) descriptors were subjected to molecular interaction studies. The stability of bound toxin-inhibitor complex was studied using molecular dynamics simulation over a period of one nanosecond.

Results:

From a dataset of 3406 compounds, few compounds were selected as potential inhibitors based on the generated best pharmacophore models, pharmacokinetic analysis, molecular docking and molecular dynamics studies.

Conclusion:

In conclusion, two compounds containing better inhibition properties against TmTx are suggested to be better lead molecules for drug development in future and this study will help us to explore more inhibitors from natural origin against tamulotoxin.

Scorpion anti-venom activity of botanicals: a pharmacological approach

Scorpion bite is considered as one of the common and dangerous phenomenon throughout the world. The clinical manifestations include pulmonary edema, myocardial damage, intracerebral haemorrhage, brachial plexopathy, renal failure etc. which sometimes leads to mortality. The common antivenin therapy includes anti-scorpion venom serum or prazosin. In the vast rural areas of the third world countries phytotherapy is considered as an alternative system of medicine and scorpion sting is treated with the help of medicinal botanicals. As the safety and efficacy are considered as important aspects of anti venin therapy, conventional treatment can be supported by the herbal remedy. The present review compiles a number of medicinal plants pharmacologically evaluated in vitro and/or in vivo for scorpion antivenin properties. Considering the aspects like cost effectiveness, availability, lesser side effects and development of drug resistance, plant based anti venin therapy may be considered as a possible remedy against scorpion envenomation.

Emerging options for the management of scorpion stings

Scorpion stings are common in many tropical countries. Although most scorpion stings cause only localized pain without life-threatening envenoming, about one third of stings cause systemic envenoming which can result in death. Children are particularly sensitive to scorpion envenoming. The severity of scorpion stings is related to the presence of neurotoxins in the venom that cause a sudden release of neurotransmitters from the autonomic nervous system, predominantly sympathetic. There is also a strong inflammatory response that worsens symptoms, including those of a respiratory nature. Several vital functions may be directly affected, including the cardiovascular, respiratory, and neuromuscular systems. Hypertension is constant at the beginning of systemic envenoming and sometimes has a severe cardiac and respiratory impact. Although controversial, immunotherapy is the only etiological treatment. Administered early, it prevents many complications and improves the outcome. New antivenoms are highly purified immunoglobulin fragments, the efficacy and safety of which are excellent. As a consequence, adverse reactions to antivenoms are now very rare and usually mild, which should limit any reluctance regarding their routine use. Symptomatic treatment is still necessary to support immunotherapy, especially in cases of delayed arrival at hospital. A combination of both approaches should be considered, based on local resources and constraints.