Epidemiological study of scorpion stings in the Rio Grande do Norte State, Northeastern Brazil

Epidemiological study in Brazil: Scorpion sting cases in Natal, Rio Grande do Norte

Scorpion sting accidents are a public health problem in the state of Rio Grande do Norte, Brazil. The increasing and high incidence of cases in urban areas reveals the importance of studies to determine the epidemiological profile and the spatial distribution of these accidents. This is a retrospective study that describes and analyzes the cases of scorpion stings in the city of Natal, Rio Grande do Norte, Northeast Brazil, from 2007 to 2018. Data from the Information System database of Notifiable Diseases (SINAN) were obtained from the Secretary of Health of Rio Grande do Norte. 31,368 accidents due to scorpion stings were reported, more frequently in urban areas of Natal, whose Human Development Index is low. The cases occurred predominantly in hot and humid regions, mainly affecting women aged between 30 and 60 years. Most individuals sought medical attention within 3 h of the incident. The severity and mortality of the injured individuals varied according to the area of occurrence, age of the patient, and the local and systemic symptoms presented. Pain, numbness, and edema were the most frequent local symptoms, and systemic symptoms were frequently described as headache, hyperthermia and sweating. Therefore, scorpionism in the city of Natal is an environmental and public health problem, with a significant growth trend (p < 0.05). Through the data collected on the spatial distribution and risks, this approach allows the creation of effective control strategies to prevent accidents.

Scorpion Stings in Minas Gerais (Brazil): A Monocentric Retrospective Study Evaluating All Envenoming Cases of Local Scorpionism

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.

A Hybrid Approach Based on Seasonal Autoregressive Integrated Moving Average and Neural Network Autoregressive Models to Predict Scorpion Sting Incidence in El Oued Province, Algeria, From 2005 to 2020

BACKGROUND

This study was designed to find the best statistical approach to scorpion sting predictions. Study Design: A retrospective study.

METHODS

Multiple regression, seasonal autoregressive integrated moving average (SARIMA), neural network autoregressive (NNAR), and hybrid SARIMA-NNAR models were developed to predict monthly scorpion sting cases in El Oued province. The root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE) were used to quantitatively compare different models.

RESULTS

In general, 96909 scorpion stings were recorded in El Oued province from 2005-2020. The incidence rate experienced a gradual decrease until 2012 and since then slight fluctuations have been noted. Scorpion stings occurred throughout the year with peaks in September followed by July and August and troughs in December and January. Sting cases were not evenly distributed across demographic groups; the most affected age group was 15-49 years, and males were more likely to be stung. Of the reported deaths, more than half were in children 15 and younger. Scorpion's activity was conditioned by climate factors, and temperature had the highest effect. The SARIMA(2,0,2)(1,1,1)12, NNAR(1,1,2)12, and SARIMA(2,0,2)(1,1,1)12-NNAR(1,1,2)12 were selected as the best-fitting models. The RMSE, MAE, and MAPE of the SARIMA and SARIMA-NNAR models were lower than those of the NNAR model in fitting and forecasting; however, the NNAR model could produce better predictive accuracy.

CONCLUSION

The NNAR model is preferred for short-term monthly scorpion sting predictions. An in-depth understanding of the epidemiologic triad of scorpionism and the development of predictive models ought to establish enlightened, informed, better-targeted, and more effective policies.

Predictive Value of Glycemia and Free Fatty Acid Levels upon Admission of Children with Scorpionism in Egypt

Scorpion envenomation is a life-threatening emergency and causes serious health problems in tropical and subtropical regions. The aim of this study was to correlate the serum levels of biochemical parameters at admission in children with scorpion envenomation with subsequent morbidity and mortality. It was a prospective, observational, and descriptive study conducted for scorpion-envenomed children who presented to emergency and intensive care units between April 2019 and September 2019. Demographic, clinical, and laboratory findings of patients were recorded and tabulated. Routine investigations were done for all patients in addition to blood levels of lactate, free fatty acids (FFA), and insulin. All patients were compared according to outcome as survivors and nonsurvivors and according to glucose level as normoglycemic and hyperglycemic groups. There were 62 scorpion sting cases; their mean age was 8.6 ± 3.2 years. Patients aged more than 6 years (74.2%), and males (66.1%) were more affected than others. As regards severity, 25.8% were suffering organ dysfunction, 40.3% suffered systemic manifestations without organ dysfunction, and (33.9%) with only local manifestations. Serum glucose and FFA were significantly higher in nonsurvivors compared with survivors. Shock, convulsion, coma, heart failure, and pulmonary edema were significantly more common in hyperglycemic than normoglycemic group. Hyperglycemia, and raised FFA were associated with severe scorpion envenomation. Raised FFA was well correlated with presence of heart failure, leucocytosis, and hyperglycemia. Adding serum glucose and FFA to monitoring parameters of scorpionism severity can help the prediction of high-risk patients.

Factors involved in the resilience of incidence and decrease of mortality from scorpion stings in Mexico

In Mexico, scorpion sting envenomation (SSE) is a significant public health issue that has engaged the attention of health authorities for more than a century. Rigorously characterized today, scorpion sting incidence is stable around 230 stings per 100,000 population, i.e. 300,000 annual stings treated in Mexican health centers and hospitals. Higher incidence is observed mainly in central and Pacific Mexico. Scorpion populations thrive in populated places, particularly in impoverished areas. Scorpion stings occur in houses. This could explain similar incidence according to gender and age. The number of scorpion stings has remained stable since the mid-2000s. In contrast, mortality, which was over 1500 deaths per year before the 1960s, underwent a dramatic drop after the 1970s, from 500 deaths per year to fewer than 50 annual deaths today. Case fatality rates have shown similar trend. We noted a significantly higher specific mortality in males than in females (0.199 and 0.168 per 100,000 respectively; P < 1.9·10^-6). Three causes explained the drop in mortality and case fatality rate, a) ongoing improvement in hospital care, particularly in terms of supportive standardized treatments, b) the use of highly purified immunoglobulin F(ab')₂ fragments after 1995 and, c) increasing access to health services for most of the Mexican population. The authors retrace the history of the management of SSE, including the development of antivenoms, in Mexico between 1905 and today.

Autopsy Findings in Case of Fatal Scorpion Sting: A Systematic Review of the Literature

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.

Demographic and epidemiological characteristics of scorpion envenomation and daily forecasting of scorpion sting counts in Touggourt, Algeria

OBJECTIVES

This study was conducted to provide better insights into the demographic and epidemiological characteristics of scorpion envenomation in an endemic area in Algeria and to identify the model that best predicted daily scorpion sting counts.

METHODS

Daily sting data from January 1, 2013 to August 31, 2016 were extracted from questionnaires designed to elicit information on scorpion stings from the two emergency medical service providers in Touggourt, Algeria. Count regression models were applied to the daily sting data.

RESULTS

A total of 4,712 scorpion sting cases were documented, of which 70% occurred in people aged between 10 years and 49 years. The male-to-female ratio was 1.3. The upper and lower limbs were the most common locations of scorpion stings (90.4% of cases). Most stings (92.8%) were mild. The percent of people stung inside dwellings was 68.8%. The hourly distribution of stings showed a peak between 10:00 a.m. and 11:00 a.m. The daily number of stings ranged from 0 to 24. The occurrence of stings was highest on Sundays. The incidence of scorpion stings increased sharply in the summer. The mean annual incidence rate was 542 cases per 100,000 inhabitants. The fitted count regression models showed that a negative binomial hurdle model was appropriate for forecasting daily stings in terms of temperature and relative humidity, and the fitted data agreed considerably with the actual data.

CONCLUSIONS

This study showed that daily scorpion sting data provided meaningful insights; and the negative binomial Hurdle model was preferable for predicting daily scorpion sting counts.

Retrospective clinical and epidemiological analysis of scorpionism at a referral hospital for the treatment of accidents by venomous animals in Alagoas State, Northeast Brazil, 2007-2017

Scorpionism has a high incidence rate in Brazil. It is considered a serious public health problem mainly in tropical and subtropical regions around the world. The number of scorpion accidents have increased over the years and the highest frequencies have been reported mainly in the Brazilian Northeast region. Therefore, in this study we report a retrospective clinical and epidemiological analysis of scorpion stings from 2007 to 2017 in Alagoas State, Northeast Brazil, at a referral hospital for assistance and treatment of accidents by venomous animals. During the analyzed period, the referral hospital treated 27,988 cases, and an increase in the number of cases has taken place over the years. The highest frequency of scorpion stings was observed in females, and the age range most affected was from 20 to 29 years old. The most stung body site was the foot, followed by finger, toe or hand. Regarding the severity, most severe cases were reported in children up to 4 years old (69.4%) and 50% of the total cases treated with serotherapy corresponded to patients in this age range. Interestingly, it was also found that the occurrence of systemic manifestations and the severity of the cases were significantly associated with pediatric patients. In this way, this study highlights the scorpionism as an environmental public health problem in Alagoas State, Northeast Brazil, as well as the need to intensify the epidemiological surveillance and educational campaigns to prevent and control scorpion accidents throughout the year.