RESUMO
Envenomation by scorpions of the genus Tityus is an important public health problem in Argentina, involving near 8000 stings and 2 deaths each year. Treatment for envenomation is the use of specific antivenom and intensive hospital care. Antivenom is produced by the Ministry of Health and freely distributed throughout the country. For antivenom production it is necessary to collect scorpion venom, which is a difficult task because although scorpions can be found in Argentina, they are less abundant than in warmer latitudes. For this reason venom collection constitutes a bottleneck for antivenom production. Although in Argentina several species of Tityus can be found, most of the accidents are caused by Tityus trivittatus, and the venom of this scorpion has historically been the venom used for antivenom production. We analyzed retrospectively 26 pools of telson homogenates (6964 telsons) and 37 pools of milked venom obtained by electrical stimulation (equivalent to 6841 milkings). Lethal potencies of samples from different provinces were very similar, although venom from scorpions of Buenos Aires city showed the lowest potency. The venom obtained by milking (median LD50 12.3⯵g), provided batches containing LD50s more potent when compared with the venom obtained from telson homogenates (pâ¯<â¯0.0001). Many batches of telson homogenates (30%) showed lower potencies than acceptable for antivenom production and control. In addition to the study of the venom yield, the records of immunization of horses, the potency of the batches and the protein content of each batch of anti-scorpion antivenom produced were analyzed, comparing those produced using milked venom with those using telson homogenates as immunogens. Batches produced using milked venom required a shorter period of immunization (pâ¯<â¯0.0001), rendered higher neutralizing titers (p 0.0350) and possessed lower protein content (p 0.0092). Results clearly showed that the milking of scorpions is a more efficient tool to obtain venom for antivenom production in comparison to the use of telson homogenates.
Assuntos
Venenos de Escorpião/isolamento & purificação , Escorpiões , Animais , Antivenenos/isolamento & purificação , Antivenenos/uso terapêutico , Argentina , Humanos , Picadas de Escorpião/tratamento farmacológicoRESUMO
In Argentina scorpion stings are the leading cause of venom-related injury to human. Since the beginning of the 20th century Tityus trivittatus is found in Buenos Aires. Scorpion envenomation is a neurotoxic syndrome with local symptoms and systemic manifestations. It could develop cardiac failure, acute pulmonary edema, shock and death. Fortunately, most of the scorpion stings in adult people in Buenos Aires are mild envenomations. A retrospective, descriptive and cross sectional study based on data collected from medical records of patients followed between 1982 and 2013 were done. We compiled a total of 141 human scorpion stings and 115 arthropod captures: 88 T. trivittatus, 10 Bothriurus bonariensis and 17 missed data. The accidents occurred more frequently in the eastern and oldest neighborhoods of the city. Eighteen patients had mild systemic manifestation. There was not any death. Twelve patients received scorpion antivenom. Although recently there was a severe case in 5 years old boy and in some provinces in Argentina death have been reported, most of the envenomations are mild. We observed inadequate treatment in some patients; it is important training on the correct management and prevention of this envenomation.
En Argentina el escorpionismo es el principal envenenamiento por animales ponzoñosos. Desde comienzos del siglo XX, Tityus trivittatus ha sido descripto en Buenos Aires. El escorpionismo es una intoxicación que produce un síndrome neurotóxico con síntomas locales y manifestaciones sistémicas. Puede desencadenar insuficiencia cardiaca, edema agudo de pulmón, shock y muerte. Afortunadamente, la mayoría de los accidentes con escorpiones en adultos en Buenos Aires son intoxicaciones leves. Se realizó un estudio retrospectivo, descriptivo y transversal basado en información recolectada de las historias clínicas desde 1982 hasta 2013. Se recolectó información sobre un total de 141 intoxicaciones por escorpiones y 115 capturas de artrópodos: 88 T. trivittatus, 10 Bothriurus bonariensis y 17 sin identificar. Los accidentes sucedieron más frecuentemente en los barrios del este y más antiguos de la ciudad. Dieciocho pacientes tuvieron síntomas sistémicos leves. No hubo ninguna muerte. Doce pacientes recibieron antiveneno. La mayoría de los envenenamientos fueron leves, aunque recientemente se produjo un caso grave en un niño de 5 años y en algunas provincias se han registrado muertes. Hemos observado un tratamiento inadecuado en algunos pacientes por lo que consideramos que sería importante capacitar en el correcto manejo y prevención de este envenenamiento.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Picadas de Escorpião/epidemiologia , Argentina/epidemiologia , Área UrbanaRESUMO
Se describe el caso de un ejemplar de tortuga mordedora (Chelydra serpentina) que fue hallada con los miembros tetanizados en extensión, midriasis y poca respuesta a estímulos externos, en cuyo recinto se encontró un ejemplar de escorpión Tityus trivittatus. Ante el claro cuadro de envenenamiento, se trató al quelonio con antiveneno escorpiónico específico retornando a un estado de relajación muscular a las seis horas y encontrándoselo totalmente normal a las 24 horas sin mostrar secuelas posteriores. Este es el primer comunicado sobre el envenenamiento de quelonios por escorpiones. Se discuten algunos aspectos de este envenenamiento escorpiónico y su tratamiento con antiveneno específico.
We report the case of a snapping turtle (Chelydra serpentina) found tetanized, with the limbs in extension, mydriasis and poor response to external stimuli, in whose terrarium was found a Tityus trivittatus scorpion. Based on the clear clinical picture of envenoming, the turtle was treated with a specific scorpion antivenin, returning to a state of muscle relaxation after six hours of treatment and it was found totally normal at 24 hours, without envenoming sequelae. This is the first report on turtle envenomation by scorpion. The scorpion envenomation in reptiles and the treatment with specific antivenom is discussed.