Evaluation of Scorpion Envenomation by Tityus trivittatus in Adults: An Analysis of Variables Related to Severity of Clinical Presentation.

INTRODUCTION: In Argentina, the scorpion species Tityus trivittatus has been the species most commonly associated with serious injury and death. METHODS: We performed a retrospective study of cases of T trivittatus envenomation that presented to the emergency department at an infectious disease hospital in Cordoba, Argentina, between December 2014 and February 2015. All cases were taxonomically confirmed using criteria established in the Argentine Ministry of Health national guidelines. The primary outcome was classification of clinical presentation (mild/moderate/severe). Classification of clinical presentation was performed in a post hoc fashion using the national guidelines and compared to the classification of clinical presentation given to patients at the time of diagnosis in the emergency department. RESULTS: We included 450 individuals with T trivittatus envenomation. The median age of was 36 y (interquartile range 25-52), and 57% were female. In the emergency department, only 5 patients (<1%) were diagnosed as moderate cases and received antivenom; all other cases were diagnosed as mild. Conversely, in our post hoc classification of clinical presentations, 280 patients had mild presentations, 170 had moderate presentations, and no patients had severe presentations. In our cohort, there were no deaths, no inpatient hospital admissions, and no requirements for continuous cardiac monitoring. We found that age >50 y, (odds ratio [OR] 2.5, P<0.001), time from sting to presentation >120 min (OR 2.6, P=0.02), and pre-existing hypertension (OR=3.9, P<0.001) were all independently associated with worse post hoc classification severity. CONCLUSIONS: Our study exposed factors associated with moderate presentations of scorpion envenomation and proposes the option of conservative treatment for affected adults.

Clinical characteristics and outcome of children stung by scorpion.

UNLABELLED: Scorpion envenomation is a health problem in children in tropical and subtropical regions. The aim of this study was to evaluate demographic and clinical characteristics as well as outcomes in referred children to Assiut University Children Hospital during the year 2012 with a history of scorpion sting. The medical files of these patients were reviewed retrospectively for demographic data, time and site of biting, and clinical manifestations. Laboratory investigations of the patients were reviewed for complete blood count (CBC), liver function tests, creatinine phosphokinase (CPK), lactate dehydrogenase (LDH), arterial blood gases, and serum electrolytes. Results showed 111 children with a history of scorpion sting; 69 males and 42 females with a median age of 5 years. Out of the studied patients, 53.2 % were classified as class III of clinical severity with recorded pulmonary edema in 33.3 %, cardiogenic shock in 46.8 %, and severe neurological manifestations in 22.8 %. Twelve patients (10.8 %) were classified as class II with mild systemic manifestations, and 36 % of the patients were classified as class I with only local reaction. Outcomes of these patients were discharge without sequelae in 55.8 %, discharge with sequelae in 26.1 %, and death in 18.1 %. CONCLUSION: more than half of stung children had a severe clinical presentation and about one fifth died. Aggressive treatment regimens are recommended for such patients to improve the outcome.

Epidemiological and clinical study on scorpionism in French Guiana.

UNLABELLED: Scorpion envenomation is a poorly explored problem in French Guiana. The aim of our study was to describe the epidemiological and clinical features of scorpion stings. METHODS: Our study is retrospective. It was conducted in the emergency department (ED) of Cayenne General Hospital, over an 8-year period (2003-2010). RESULTS: During the study period, 253 patients presented to the emergency department with a history of a scorpion sting. The mean incidence was 32 ± 8 cases per year. The peak of incidence was observed in April and May which are the rainiest months in the year. In most cases, the envenomation occurred between 6:00 and 11:00 am. The site of the sting was on the extremities (hand or foot) in 81% of cases. The scorpion was identified or brought to the hospital in 113 cases. It was described as a slim pincers scorpion in 97 cases. The mean time elapsed between the scorpion sting and admission was 4 ± 5 h. The main clinical symptoms at admission to the ED were local signs in 178 cases (70.4%), digestive disorders in 13 cases, neurologic manifestations in 18 cases, and respiratory manifestations in 7 cases. Adrenergic syndrome was found in 117 cases (46.2%), and cholinergic syndrome in 5 cases (2%). Hypertension was found in 80 patients, 14 of them had already a history of chronic hypertension. Overall, a total of 118 patients (46.6%) had Class I envenoming, 131 patients (51.8%) had Class II envenoming, and 4 patients (1.6%) experienced Class III envenoming. The evolution was favorable in all cases and no death was recorded. However, 42 patients (18.2%) were hospitalized in a medical unit and 4 patients were hospitalized in ICU without needing mechanical ventilation, inotropes or vasoactive drugs. CONCLUSION: Scorpion envenomation is an increasing accident in French Guiana. Symptoms vary from mild to severe and can require ICU admission. Practitioners have to be made aware of severe cases found mainly in children.

Classification of clinical consequences of scorpion stings: consensus development.

The objective of our consensus process was to develop a unique classification of the natural history of scorpion stings and their clinical signs and symptoms. The technique used was an adapted Delphi approach completed by a nominal group meeting. Researchers included in a study received a questionnaire in which we listed all terms used in published studies to characterize clinical consequences of scorpion stings and all signs and symptoms belonging to each class. For each term, experts had to judge the relevance for classifying clinical consequences of scorpion stings and state whether they agreed with the terminology; they could also propose new terms or classes. For each sign or symptom, they had to choose in which class it belonged and also propose if any other sign or symptom should be added. Sixteen researchers participated. Consensus was reached to include four classes: local manifestations; minor systemic manifestations; major systemic manifestations; lethal envenomation. Signs and symptoms associated with each class were defined. A second Delphi round is planned to define indicators to follow the epidemiological situation within and across countries and to develop recommendations for an optimal management of scorpion envenomations. These consensus-based tools should facilitate development of international clinical studies.

[Reliability and application of protocols and procedures to be followed in the treatment of scorpion stings in Morocco]. / Fiabilité et application de la conduite à tenir en cas de piqûre de scorpion au Maroc.

This works investigates the reliability of scorpion stings treatment adopted by the Moroccan Poison Control and Pharmacovigilance Center and its application at the provincial level hospital in Kelaa Des Sraghna. The study was based on a sample of 984 cases reviewed from the hospitalization records from this establishment. The results of the distribution of patients according to the level of severity of the cases showed that the Class II category represents 67.45% (n=518 cases) and Class III represents 8.33% (n=64 cases). Although patients ranked in Class I should not be hospitalized, the study found that 24.22% of the cases recorded during the study period belong to this category of patients. Among the 186 cases registered in Class I, 8.06% (n=15) displayed clinical signs; this implies a problem in the classification of these patients. However, the study of the correlation between the classification of those admitted and their respective clinical signs and symptoms revealed that those clinical indicators corresponded well to the categories in which patients were placed. Moreover, the study showed that the evolution of patients depends significantly on the distress signals (Class III) and on some signs indicated severity: priapism, sweating and vomiting (Class II).

Serum levels of IL-6 and its soluble receptor, TNF-alpha and chemokine RANTES in scorpion envenomed children: their relation to scorpion envenomation outcome.

During the present study, 30 children in Upper Egypt (less than 12 years old) were admitted to Pediatric Intensive Care Unit because of scorpion envenomation. They were compared with 20 apparently normal children of matching age and sex as controls. The victims and controls were subjected to complete clinical examination and full blood picture. The serum levels of interleukin-6 (IL-6), soluble IL-6 receptor (sIL-6R), regulated upon activation normal T cells expressed and secreted (RANTES ) and tumour necrosis factor-alpha (TNF-alpha) were determined once for the controls and twice for the victims, the first sample on admission and the second sample after 24h. All victims showed significantly higher mean values of IL-6, sIL-6R, RANTES, TNF-alpha, and leucocytic count both on admission and on the follow up when compared with controls. According to the clinical manifestations of envenomation, 40% of the victims had a mild envenomation manifestation, while 60% of them had severe manifestations. The severely envenomed children showed significantly higher mean values of IL-6, sIL-6R, TNF-alpha, RANTES and leucocytic count both on admission and on the follow up samples when compared with the mild cases. The non-survival victims (five victims) showed significantly higher mean values of IL-6, sIL-6R, TNF-alpha, RANTES and leucocytic count both on admission and on the follow up samples in comparison to the survivals. Furthermore, those fatal cases showed a non-significant decline in the serum levels of IL-6, sIL-6R, TNF-alpha, RANTES and leucocytic count on the following up samples, while the survivals showed a significant decline in the serum levels of these parameters on the following up samples. In conclusion, these data revealed that IL-6, sIL-6R, TNF-alpha and chemokine, RANTES are involved in the pathogenesis of scorpion envenomation and correlated with its severity.

[Scorpion stings in sub-Saharan Africa]. / Le scorpionisme en Afrique sub-saharienne.

Scorpionism in Sub-Saharan Africa is a poorly known problem but regarded as a public health preoccupation in several countries, especially Niger. The lack of knowledge of this question is due to non-existent information concerning mainly the composition of the scorpion fauna in Sub-Saharan areas, the distribution and density of dangerous species and the frequency and severity of scorpion stings in the Sub-Saharan areas. Until now, only the presence of Leiurus quinquestriatus and its involvement in fatal accidents have been attested to. In many areas, the presence of other classically dangerous species has not been confirmed, nor the dangerous potential of certain species belonging for example to the genera Androctonus. Buthus or Hottentota. The efficacy of prevention, treatment and scorpion control depend necessarily on further study of the fauna and medical investigations. Such studies are entirely feasible.