Tricuspid Valve Endocarditis Following a Scorpion Sting: A Case Report.

Scorpion sting envenoming is a common pediatric emergency in the Moroccan southern areas. Cardiomyopathy is the most common cardiovascular manifestation of envenoming, resulting from the stimulation of the sympathetic nervous system by the venom or from the direct effect of the venom toxins on the myocardium. Rare cases of infective endocarditis following a scorpion sting have been reported in the literature. We report a case of tricuspid valve infective endocarditis following a scorpion sting in a previously healthy eight-year-old child. The patient initially was managed medically before undergoing tricuspid valve replacement with a bioprosthesis. The postoperative course was uneventful with a full recovery.

Informe especial: Envenenamiento por animal ponzoñoso: Alacranismo / Special report: Poisonous by venomous animal: Scorpions

Presentación de un caso, notificado el 9 de enero de 2017, a la Gerencia Operativa de Epidemiología del Gobierno de la Ciudad de Buenos Aires por un efector privado de la Ciudad, de envenenamiento por animal ponzoñoso (Alacranismo) en un paciente residente en la Ciudad de Buenos Aires. Se describen el cuadro clínico y el tratamiento recibido, la evolución del caso, la importancia de distintas acciones de vigilancia epidemiológica, el procedimiento de notificación, medidas de protección, y medidas de prevención y control de accidentes. Incluye datos de centros públicos nacionales y de la Ciudad de Buenos Aires especializados en asistencia y/o in-formación sobre animales venenosos

First report of scorpionism caused by Tityus serrulatus, described by Lutz and Mello, 1922 (Scorpiones, Buthidae), a species non-native to the state of Pará, Brazilian Amazon

Abstract This reports a case of scorpionism caused by Tityus serrulatus. A male adult was stung while unloading bananas at the supply center in Belém, Pará, Brazil. The bananas originated in another state (Bahia) and were brought to Belém by truck. The patient presented with pain, edema, and erythema at the sting site, and was classified as low-risk. The specimen was identified as T. serrulatus and symptomatic treatment and clinical observation were advised. The patient was discharged later without further complications. This is the first known envenomation caused by T. serrulatus, a non-native species to Pará, in the Brazilian Amazon.

Escorpionismo en pacientes pediátricos internados en terapia intensiva: Serie de casos / Escorpionism in pediatric intensive care patients: Case series

El escorpionismo constituye un problema de salud pública con una incidencia en aumento en Argentina. El veneno contiene varias neurotoxinas capaces de generar una "tormenta autonómica" responsable de las manifestaciones clínicas. Los sistemas cardiovascular y respiratorio son los más afectados y su grado de compromiso determinará la morbimortalidad. Un 10 % de los casos en niños evolucionan a su forma grave. En esta serie retrospectiva, se describe la epidemiología y evolución de 17 pacientes ingresados a la Unidad de Terapia Intensiva Pediátrica entre enero de 2010 y enero de 2014. Si bien no hubo mortalidad, sí una alta morbilidad: 12 pacientes presentaron edema agudo de pulmón que requirió ventilación mecánica; 11 pacientes desarrollaron shock cardiogénico hipotensivo; 7, bajo gasto cardíaco grave y, en 6, se utilizó levosimendán por el carácter refractario de su bajo gasto.

Scorpionism is a public health problem with an increasing incidence in Argentina. The poison contains several neurotoxins capable of generating an "autonomic storm" responsible for the clinical manifestations. The cardiovascular and respiratory systems are the most affected ones and their degree of commitment will determine morbidity and mortality. A 10 % of cases in children evolve to their severe form. In this retrospective series, we describe the epidemiology and evolution of 17 patients admitted to the Pediatric Intensive Care Unit from January 2010 to January 2014. Although there was no mortality, there was a high morbidity: 12 patients had acute lung edema requiring mechanical ventilation, 11 patients developed hypotensive cardiogenic shock, 7 were under severe low cardiac output and in 6 levosimendan was used due to the low refractory output.

Infrared thermography to diagnose and manage venomous animal bites and stings

Abstract INTRODUCTION Infrared imaging (IR) is a noninvasive technique that quantifies body surface temperature, producing a digital color image. IR has been used to study diseases in which skin temperature can reflect the presence of inflammation. METHODS This was an observational pilot study of eight patients envenomed by snakes, spiders, and scorpions. All patients were examined using a thermal camera. RESULTS In all cases, we obtained infrared images that corroborated clinical findings indicating localized effects of venom, specifically inflammation. CONCLUSIONS IR has potential for use as a research, diagnostic, and monitoring tool for localized effects of animal venoms.

Fatal ischemic stroke following Tityus serrulatus scorpion sting in a patient with essential thrombocythemia.

CONTEXT: Stroke following scorpion stings is rare. We report a fatal envenomation involving multiple, extensive brain infarcts in a patient with a previous diagnosis of essential thrombocythemia (ET) who was stung by Tityus serrulatus (T. serrulatus). CASE DETAILS: A 44-year-old woman with a diagnosis of low-risk ET (platelets <1,000,000/mm3, age <60 years and no history of thrombosis; positive JAK2V617F mutation) was admitted to a local ED 1 h after being stung by T. serrulatus on the left foot. She developed signs of severe envenomation, including several episodes of profuse vomiting, pallor and confusion soon after the sting, followed by shock (BP: 90/60 to 60/40 mmHg) and was treated with scorpion antivenom, vasopressors and mechanical ventilation. A brain computed tomography (CT) scan (54-h poststing) revealed diffuse bilateral cerebellar hypodensity, with partial involvement of both occipital lobes and thalamus, obstructive hydrocephaly with signs of cerebrospinal fluid extravasation, and ascending transtentorial herniation, suggestive of bilateral ischemia involving the posterior cerebral circulation. External ventricular drainage resulted in no improvement and brain death was confirmed on day 10. DISCUSSION: Several mechanisms have been proposed to explain stroke following scorpion stings, such as sympathetic stimulation, myocardial dysfunction, hypotension/shock, arrhythmias and coagulopathy. Ischemic stroke is one of the most serious complications of ET. The risk factors for thrombotic/ischemic events in patients with ET include age (≥60 years) and previous vascular events. Severe scorpion envenomation resulting in myocardial dysfunction and systemic inflammatory response syndrome may increase the overall risk of arterial thrombosis in this patient.

Clinical update on scorpion envenoming

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.

Osteomyelitis calcaneum due to a scorpion sting.

Children are susceptible to various injuries, including insect bites, and scorpion bites are common in the lower extremity of children in Middle East countries. In most cases, the sting will produce just a local reaction; however, serious complications that can result in death have occurred. In this case report, we describe a case of osteomyelitis of the calcaneum after a scorpion sting.

Envenomation caused by Rhopalurus amazonicus Lourenço, 1986 (Scorpiones, Buthidae) in Pará State, Brazil

Scorpions, mainly those belonging to the genus Tityus cause many deaths and injuries in Brazil, with tens of thousands of envenomations notified every year. However, injuries involving other scorpion species are scarcely registered. Among the sixteen species of the genus Rhopalurus, Thorell, 1876, described up to date, nine are found in this country, with only a confirmed case of human envenomation provoked by R. agamemnonKoch, 1839. The present case reports, for the first time, a case of scorpion sting in a human victim involving Rhopalurus amazonicus, endemic species of the west region of the Pará state, Amazon, Brazil. The symptoms of envenomation were local pain and paresthesia. This study contributes to develop the knowledge on venomous scorpions, particularly those that may cause envenomations in this region.

Posterior reversible encephalopathy syndrome following a scorpion sting.

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity not yet understood, that is present with transient neurologic symptoms and particular radiological findings. The most common imaging pattern in PRES is the presence of edema in the white matter of the posterior portions of both cerebral hemispheres. The cause of PRES is unclear. We report a case of 13-year-old male who was stung by a scorpion and developed a severe headache, visual disturbance, and seizures and had the diagnosis of PRES with a good outcome. Numerous factors can trigger this syndrome, most commonly: acute elevation of blood pressure, abnormal renal function, and immunosuppressive therapy. There are many cases described showing the relationship between PRES and eclampsia, transplantation, neoplasia and chemotherapy treatment, systemic infections, renal disease acute, or chronic. However, this is the first case of PRES following a scorpion sting.

Escorpionismo: quadro clínico e manejo dos pacientes graves / Scorpion envenomation: clinical presentation and management of severe cases

Os escorpiões representam um grave risco à saúde pública brasileira, especialmente nas ßreas urbanas, devido à alta incidência e potencial gravidade de casos ocorridos por acidentes com esses animais peçonhentos. Do ponto de vista médico-sanitario, o gênero Tityus, com destaque para a espécie Tityus serrulatus é, atualmente, o reponsßvel pelo maior número de casos de picadas de escorpião no país. O objetivo do presente estudo foi relatar e comparar dois casos clínicos de escorpionismo ocorridos no mês de março do ano de 2012, na região metropolitana de Belo Horizonte, Minas Gerais, Brasil. Ambos os acidentes foram classificados como graves. Entre- tanto, as diferenças na abordagem e no manejo entre os dois casos clínicos foram consideradas fatores determinantes nas suas evoluções e prognósticos. Desta forma, fazer o diagnóstico e iniciar a administração de soroterapia antiveneno específica adequada o mais precocemente possível são essenciais nos casos de envenenamento por picada de escorpião, sendo os Centros de Informações e Assistência Toxicológi- cas (CIATs) ferramentas fundamentais...

Scorpions represent a serious risk to public health in Brazil, especial/y in urban areas due to lhe high incidence and potential severity of cases occurred in accidents with these poisonous animais. From the perspective of health care, the Tityus gender, especially the Tityus serrulatus species, is currently responsible for the largest number of cases of scorpion stings in the country. The purpose of the present work was to report and compare two clinical cases of scorpion envenomation occurred in March of 20/2, in the metropolitan region of Belo Horizonte, Minas Gerais, Brazil. Both accidents were classified as severe cases. However, the differences in approach and management between the two clinical cases were considered determinant in their evolution and prognosis. Therefore, make the diagnosis and initiate the administration of properly specific antivenom serotherapy as early as possible are core in cases of poisoning by scorpions sting, and the Centers for Toxicological Information and Assistance (CIATs) are fundamental tools...

Molecular diagnosis of Saksenaea vasiformis cutaneous infection after scorpion sting in an immunocompetent adolescent.

We report the first case of cutaneous mucormycosis after a scorpion sting in Tunisia. Histopathology showed broad aseptate hyphae suggestive of a Zygomycete. Saksenaea vasiformis was identified by PCR amplification and sequencing of the fungal DNA on a cutaneous biopsy. Successful treatment was obtained by surgery and liposomal amphotericin B.

Infective endocarditis associated with a scorpion sting.

We report the successful surgical intervention in two cases of aortic valve bacterial endocarditis after scorpion stings. Infective endocarditis developed in both patients several weeks after they suffered repeated scorpion stings. Both patients had similar, but uncommon features: (1) the isolated organisms were unusual causes of infective endocarditis (streptococcus group G and Streptococcus milleri), (2) annular abscesses developed that required either aortic root replacement with a homograft or annular patch repair with pericardium, and (3) complete heart block developed postoperatively, requiring permanent pacemaker implantation. Both patients completed a 6-week postoperative course of antibiotic therapy and are without recurrent infection.

Relationship between plasmatic levels of various cytokines, tumour necrosis factor, enzymes, glucose and venom concentration following Tityus scorpion sting.

A sandwich enzyme-linked immunosorbent assay was developed for measuring Tityus venom levels in plasma. The method proved capable of distinguishing patients with only local symptoms from controls, and was used to quantify venom in 205 accidental human envenomations. Our results show that the severity of envenoming is related to the patient plasma venom concentration. This depends on time elapsed between the sting and when the plasma was drawn. We observed that 46 and 49% of patients with moderate to severe symptoms (MS, n=41) showed hyperamylasemia and hyperglycemia, respectively. In addition, 39% of cases with MS symptoms had partial thromboplastin time values prolonged or shorted and 6.5% of patients with local symptoms (LS, n=164) had only prolonged prothrombin time values. Interleukin 6 (IL6) increased significantly in patients with MS symptoms. IL6 values increased with hyperamylasemia, envenoming severity and time hyperamylasemia.

Scorpion envenomation as a risk factor for development of dilated cardiomyopathy.

OBJECTIVES: Though scorpion envenomation is known to lead to acute myocarditis and a reversible decrease in left ventricular function, it has not been implicated as an etiological factor in idiopathic dilated cardiomyopathy. We studied the association of idiopathic dilated cardiomyopathy with a history of scorpion sting as well as with socio-economic status, history of smoking and alcoholism, rural habitation, and history of snake bites. METHODS: Consecutive cases of idiopathic dilated cardiomyopathy were recruited for this study: The association with putative risk factors was studied using a case-control study design with two sets of controls. One set of controls were age and sex matched inpatients selected at random, the other set of controls were spouse, or if not available, a close relative, ordinarily resident with the patient. RESULTS: On analysis, none of the factors except scorpion envenomation had a significant association. A past history of scorpion envenomation had an adjusted odds ratio of 8.01 (3.55-18.06) when compared to one set of controls and an odds ratio of 8.33 (6.55-10.59) when compared to the second group of controls. CONCLUSIONS: Our study indicates that a history of scorpion envenomation acts as a risk factor for the subsequent development of idiopathic dilated cardiomyopathy. Despite an apparently complete recovery from a scorpion sting, many patients probably retain sub-clinical deficits that predispose to the development of cardiomyopathy later in life, when other factors get added on. The known association of cardiomyopathy with catecholamine excess in experimental situations in animal studies, and in other disease states in humans, supports this hypothesis.

Cerebrovascular disease in children.

Stroke although rare in children, is an important cause of morbidity in the paediatric age group. Over a period of 8 years, 43 children (17 boys and 26 girls) in the age groups of 1-16 years (mean 8.02 yrs) presented with stroke which constituted 10% of all strokes in the young and 0.7% of all paediatric admissions. The chief clinical features were hemiplegia (86%), convulsions (27%), fever (23%), dysphasia (23%), headache (11%) and altered level of consciousness (11%). Routine laboratory tests were non-contributory. Cranial computerized tomography (CCT) on 21 patients was abnormal in 95% and was useful in revealing the extent of infarction. Infarction was confined to middle cerebral artery territory, often involving basal ganglionic structures and was associated with focal or diffuse atrophy. Angiograms were abnormal in 78% of the patients (18/23) and were complimentary to the CCT. Etiological factors identified were: Moya-moya disease 6, arteritis 5, fibromuscular dysplasia 2, scorpion sting 2, and venous sinus thrombosis and small vessel occlusion one each. Though 23% of the patients had fever at onset, no obvious evidence of systemic or CNS infection was noticed. Stroke in children continues to pose a diagnostic challenge.