Scorpion sting envenomation outbreak in Mexico. Strategies for prevention and control.

In Mexico occurs 25% of all worldwide cases of scorpion sting envenomation (SSE). An outbreak of SSE was identified in Villa Unión, Sinaloa, Mexico. The objective of this study is to describe the outbreak, and prevention and control strategies implemented. The design was a cross-sectional study. Eligibility criteria included confirmed cases (n = 425) identified from the date the outbreak was recognized (from November 08, 2023 to July 10, 2023). The cases from Villa Unión (n = 231) were included for the analysis of epidemiological and clinical findings. The research followed the recommendations of the Initiative Reporting of studies Conducted Using Observational Routinely collected Data (RECORD). Of the total cases (n = 425), 398 (93.6%) were from the municipality of Mazatlán, and 231 (58%) were from Villa Unión. The incidence rate was 13.64 per 1000 persons. The average cases per week was 51.5(SD ± 12). The male-to-female ratio was 3:4, the average age was 30.7(SD ± 19) years. Most of cases occurred in the 25-44 age group. The sting occurred mostly inside houses (n = 200, 86.5%). The predominant symptoms were local pain (95.2%), and local paresthesia (75.8%). The Case fatality rate was 0%. Implementation of prevention and control strategies based on field epidemiological research and scientific evidence are necessary to reduce the incidence and prevent fatal complications.

[The use of gloves as protector factor against scorpion stings during corn picking in the state of Guerrero, Mexico]. / El uso de guantes como factor protector contra picaduras de alacrán durante la pizca de maíz en el estado de Guerrero, México.

OBJECTIVE: Identify factors associated with scorpion stings among farm workers who pick corn in the Mexican state of Guerrero. MATERIAL AND METHODS: Cross-sectional survey in 14 randomly selected communities in the state of Guerrero.Simple frequencies were obtained and bivariate analysis was used to identify factors associated with scorpion stings while picking corn. Odds ratio was estimated to evaluate the magnitude of the effect. RESULTS: The incidence of scorpion stings was 15% (500/3 294) in 2003. Use of gloves was associated with a dramatic reduction in risk of scorpion stings to the hands (OR = 0.11; IC95% 0.06-0.18). Scorpion stings are a frequent occupational health issue for farm workers. If the results of this survey were reproduced in an unbiased trial, the implication would be that gloves could prevent 133 stings per 1,000 farm workers who currently do not use gloves. The cost of medical attention, transportation and time away from work due to a scorpion sting totaled 505.90 pesos (46 US dollars). CONCLUSIONS: The use of gloves by farmers who live in regions where scorpions are endemic should be promoted. The supply network for anti-scorpion serum should also be extended to all rural areas where very toxic species are predominant and farmers should be educated about the importance of seeking timely medical care at health clinics.

Epidemiological and clinical characteristics of scorpionism in children in Sanliurfa, Turkey.

The epidemiological and clinical findings of scorpion stings in Sanliurfa region of Turkey were evaluated in this investigation from May to September 2003, because of the high incidence of scorpionism cases during this season. Scorpion envenomation is an important health problem in all South-eastern Anatolia, specifically in Sanliurfa. The sting cases mostly occurred in the month of July (37.6%) when yearly temperature is the highest. Scorpion species causing the envenomation in children were not identified. More of the patients were adolescents (54.1%). Most of the stings were seen in exposed extremities (87.7%), mainly in the upper limbs (47.1%). One single village, Birecik, had the highest number of incidents (36.5%). Patients at the emergency units showed signs of local and systemic effects, but no lethality occurred. Local and autonomic nervous system effects were most frequently characterized by local pain, hyperemia, swelling, burning, hypotension, hypertension, dry mouth, thirst and sweating. We propose that public awareness and physician readiness combined with the availability of effective antivenom significantly reduced lethality in this region.

Arizona bark scorpion venom resistance in the pallid bat, Antrozous pallidus.

The pallid bat (Antrozous pallidus), a gleaning bat found in the western United States and Mexico, hunts a wide variety of ground-dwelling prey, including scorpions. Anecdotal evidence suggests that the pallid bat is resistant to scorpion venom, but no systematic study has been performed. Here we show with behavioral measures and direct injection of venom that the pallid bat is resistant to venom of the Arizona bark scorpion, Centruroides sculpturatus. Our results show that the pallid bat is stung multiple times during a hunt without any noticeable effect on behavior. In addition, direct injection of venom at mouse LD50 concentrations (1.5 mg/kg) has no effect on bat behavior. At the highest concentration tested (10 mg/kg), three out of four bats showed no effects. One of the four bats showed a transient effect suggesting that additional studies are required to identify potential regional variation in venom tolerance. Scorpion venom is a cocktail of toxins, some of which activate voltage-gated sodium ion channels, causing intense pain. Dorsal root ganglia (DRG) contain nociceptive neurons and are principal targets of scorpion venom toxins. To understand if mutations in specific ion channels contribute to venom resistance, a pallid bat DRG transcriptome was generated. As sodium channels are a major target of scorpion venom, we identified amino acid substitutions present in the pallid bat that may lead to venom resistance. Some of these substitutions are similar to corresponding amino acids in sodium channel isoforms responsible for reduced venom binding activity. The substitution found previously in the grasshopper mouse providing venom resistance to the bark scorpion is not present in the pallid bat, indicating a potentially novel mechanism for venom resistance in the bat that remains to be identified. Taken together, these results indicate that the pallid bat is resistant to venom of the bark scorpion and altered sodium ion channel function may partly underlie such resistance.

Control y prevención de los accidentes causados por Tityus trivittatus (Scorpiones: Buthidae) / Control and prevention of accidents caused by Tityus trivittatus (Scorpiones: Buthidae)

Resumen Las picaduras por alacranes pueden producir cuadros de intoxicación aguda y conducir a la muerte por falla cardíaca y distrés respiratorio, siendo la población pediátrica la de mayor riesgo, tanto en Argentina como en el resto del mundo. Muchasde las especies de escorpiones en el mundo son sinantrópicas, y en Argentina, las que se han relacionado con muertes, comoTityus trivittatus y Tityus confluens, poseen esas características. La sinantropía, aumenta la posibilidad de contacto humano -escorpión y por lo tanto la ocurrencia de accidentes, por lo que las medidas de prevención en este caso, deben tomarse no soloconductualmente sino ambientalmente para evitar ese contacto. Las características biológicas de los escorpiones del géneroTityus dificultan las labores de prevención. Muchas son las herramientas para disminuir el contacto con los escorpiones y de esamanera prevenir los accidentes como los controles químicos, biológicos y ambientales, así como la búsqueda y eliminación deescorpiones. Sin embargo, no todas son efectivas si no son aplicadas racionalmente y si no son combinadas. En ocasiones lamala planificación o uso de las diferentes medidas para el combate de escorpiones pueden ser contraproducentes y no solo serinefectivas sino aumentar la probabilidad de ocurrencia de accidentes. En esta revisión se exponen los diferentes métodos deprevención del escorpionismo, con especial referencia a las especies de Tityus de Argentina.

Abstract Scorpion stings may produce acute envenoming and lead to death from heart failure and respiratory distress, being the pediatric population that with the highest risk of severe envenomation and death, in Argentina as in the rest of the world. Manyof the scorpion species in the world are synanthropic, including Tityus trivittatus and Tityus confluens, which are responsible forhuman deaths in Argentina. Synanthropy increases the possibility of human-scorpion contact and therefore the occurrence ofaccidents, so preventive measures to avoid the contact must be taken not only behaviorally but environmentally. The biologi-cal characteristics of scorpions of the genus Tityus make prevention of the contact with humans rather difficult. There are manychemical, biological and environmental tools to reduce the possibility of contact between humans and scorpions. However, notall these measures are effective if they are not rationally applied and if these are not combined. Sometimes the poor planningor use of different measures to control scorpions' population can be counterproductive and not only ineffective, increasing theprobability of accidents. In this review, we discuss the different methods of prevention and combat of scorpionism, with specialreference to the prevention of accidents with Tityus species from Argentina.

Associação ecológica entre fatores socioeconômicos, ocupacionais e de saneamento e a ocorrência de escorpionismo no Brasil, 2007-2019 / Asociación ecológica entre factores socioeconómicos, ocupacionales y de saneamiento y la ocurrencia de escorpionismo en Brasil, 2007-2019 / Ecological association between socioeconomic, occupational and sanitation factors and the occurrence of scorpionism in Brazil, 2007-2019

Objetivo: Analisar associação ecológica entre características socioeconômicas, ocupacionais e de infraestrutura/saneamento com escorpionismo no Brasil. Métodos: Estudo ecológico, com dados dos acidentes escorpiônicos notificados no Sistema de Informação de Agravos de Notificação (2007-2019). Empregou-se regressão binomial negativa para estimar razões de taxas de incidência (RTI) e intervalos de confiança (IC95%). Resultados: No período, ocorreram 1.079.333 acidentes, com incidência acumulada de 41,5/100 mil habitantes. Na análise ajustada, houve associação com percentual municipal de mulheres (RTI=1,65 - IC95% 1,18;2,30) e homens (RTI=0,90 - IC95% 0,88;0,91) na construção civil, mulheres (RTI=1,21 - IC95% 1,18;1,25) e homens (RTI=0,73 - IC95% 0,69;0,77) no serviço doméstico, mulheres (RTI=1,03 - IC95% 1,02;1,04) e homens (RTI=0,93 - IC95% 0,92;0,93) na agropecuária, domicílios com lixo coletado (RTI=0,99 - IC95% 0,98;0,99) e lixo no entorno (RTI=1,02 - IC95% 1,01;1,02), expectativa de anos de estudo (RTI=0,88 - IC95% 0,83;0,92) e taxa de desocupação (RTI=1,07 - IC95% 1,05;1,09). Conclusão: O escorpionismo associou-se a precária infraestrutura/saneamento, oferta de emprego, educação e ocupação feminina.

Objetivo: Analizar la asociación ecológica entre características socioeconómicas, ocupacionales y sanitarias y el escorpionismo en Brasil. Métodos: Estudio ecológico con datos de accidentes con escorpiones reportados al Sistema de Información de Enfermedades de Notificación (2007-2019). Se utilizó la regresión binomial negativa para estimar las razones de las tasas de incidencia (RTI) e intervalos de confianza (IC95%). Resultados: Ocurrieron 1.079.333 accidentes con escorpiones (41,5/100.000 habitantes), 2007-2019. Se encontró asociación con porcentaje municipal de: mujeres (RTI=1,65 - IC95% 1,18;2,30) y hombres (RTI=0,90 - IC95% 0,88;0,91) en la construcción civil, mujeres (RTI=1,21 - IC95% 1,18;1,25) y hombres (RTI=0,73 - IC95% 0,69;0,77) en el servicio doméstico, mujeres (RTI=1,03 - IC95% 1,02;1,04) y hombres (RTI=0,93 - IC95% 0,92;0,93) en la agricultura, hogares con recolección de basura (RTI=0,99 - IC95% 0,98;0,99) y basura en los alrededores (RTI=1,02 - IC95% 1,01;1,02), expectativa en años de estudio (RTI=0,88 - IC95% 0,83;0,92) y tasa de desempleo (RTI=1,07 - IC95% 1,05;1,09). Conclusión: El escorpionismo se asoció con infraestructura/saneamiento precario, oferta de trabajo, educación y ocupación femenina.

Objective: To analyze ecological association between socioeconomic, occupational and sanitation characteristics and scorpionism in Brazil. Methods: This was an ecological study with data on scorpion sting accidents reported on the Notifiable Health Conditions Information System (2007-2019). Negative binomial regression was used to estimate incidence rate ratios (IRR) and confidence intervals (95%CI). Results: In the study period there were 1,079,333 scorpion sting accidents, with a cumulative incidence rate of 41.5/100,000 inhabitants. In the adjusted analysis, there was association with the municipal percentages of: women (IRR=1.65 - 95%CI 1.18;2.30) and men (IRR=0.90 - 95%CI 0.88;0.91) working in the construction industry, women (IRR=1.21 - 95%CI 1.18;1.25) and men (IRR=0.73 - 95%CI 0.69;0.77) working in domestic service, women (IRR=1.03 - 95%CI 1.02;1.04) and men (IRR=0.93 - 95%CI 0.92;0.93) working in farming, households with refuse collection (IRR=0.99 - 95%CI 0.98;0.99) and households with refuse left nearby (IRR=1.02 - 95%CI 1.01;1.02), expected years of schooling (IRR=0.88 - 95%CI 0.83;0.92), and unemployment rate (IRR=1.07 - 95%CI 1.05;1.09). Conclusion: Scorpionism was associated with precarious infrastructure/sanitation, job availability, education and female occupation.

Treatment of the scorpion envenoming syndrome: 12-years experience with serotherapy.

The pathophysiology of the scorpion envenoming syndrome is described with emphasis on the body systems commonly affected. Concepts of the mechanisms underlying venom action, as can be explained by the recently discovered effects on ionic channels, are discussed. A protocol for the treatment of scorpion stings based mainly on antivenom therapy was applied nationwide in Saudi Arabia. A list of drugs with alternatives was specified to be used in adjunctive therapy, when required. Analysis of the outcome from 1,033 cases at Al-Baha region, 791 cases at Al-Qassim region and more than 2,000 cases from 12 central and specialist hospitals in the Central Province, Saudi Arabia gave impressive results. The incidence of severe venom toxicity following antivenom administration was almost negligible. The period of stay in the hospital was reduced. The early reaction to antivenom administration was lower than expected the severity of the reaction consisting mainly of skin rashes, urticaria, wheezing and bronchial hypersensitivity, but no anaphylaxis. About 13.8% of the victims had been previously treated with antivenom but only 1.7% of the patients showed positive skin tests. This might be due to the low protein content of the antivenom and the action of the venom in releasing massive amounts of catecholamines.

[A control program for an outbreak of the scorpion Tityus serrulatus, Lutz and Mello 1922 in the town of Aparecida, São Paulo state (Scorpiones, Buthidae)]. / Programa de controle de surto de escorpião Tityus serrulatus, Lutz e Mello 1922, no município de Aparecida, SP (Scorpiones, Buthidae).

A scorpion control program was proposed for the town of Aparecida (SP), an endemic region of Tityus serrulatus. Clusters of scorpions in urban and rural areas, environmental degradation of the town's outskirts and new scorpion procreation and dispersal habitats were studied. In addition, infrastructure problems such as the disposal and collection of residential and municipal refuse, sanitation (sewage and storm sewer), condition of vacant lots and constructions in the urban area were evaluated. After an epidemiological study, educational measures such as the distribution of pamphlets, cleaning group work, visits to residences and cooperation from High School teachers and students were also suggested. Chemical control was indicated in high-risk sites, especially those of near-school buildings. Furthermore, the use of natural predators was also mentioned within the present sanitation regulations for urban areas. The authors assert that these procedures must be integrated and continued uninterruptedly for several years. They also suggest a collaborative work with those responsible for the dengue eradication program, as well as the institution of the "scorpion study week", which would greatly contribute to the education of the population, to preventive programs and to scorpion control.

[National strategy in the battle against scorpion stings and envenomations. Application and evaluation]. / Stratégie nationale de lutte contre les piqûres et envenimations scorpioniques. Application et évaluation.

Scorpion stings represent the first cause of poisoning with an incidence of 30 to 50% of all declared cases in the Centre Anti Poison of Morocco (CAPM). Aware of this increasing problem, the CAPM paid special attention to this pathology. Thanks to its retrospective and prospective studies, the scorpion species mapping has been determined as well as the demographic features of stung patients, the nature and the chronology of clinical events in scorpion envenimation, and the epidemiological, clinical and therapeutical factors of severity. On this basis, the CAPM worked out a national strategy to struggle against scorpion stings whose aim was to decrease the morbidity and mortality caused by stings of scorpion as well as to rationalise economic expenses. The components of this strategy were based on the training of the medical and paramedical staff, on information, education, communication involving different sectors, on identification of needs and on follow-up and assessment. A nationwide campaign was implemented to change the population and health-care staff's behaviour regarding this pathology. Its evaluation permitted to improve the compilation of cases with census of 14104 cases, to reduce lethality rate and to rationalise expenses while banishing some medicines and avoiding useless hospitalization.

[Fifteen years' experience in scorpion envenomation control in Algeria]. / Expérience de quinze années de lutte contre l'envenimation scorpionique en Algérie.

In Algeria, scorpion envenomation is real public health problem. Since the creation of the National Committee of Control of Scorpion envenomations (CNLES), several steps have been taken to deal with this problem. After a brief historical introduction, we present the main elements of the action carried out both in terms of treatment and of prevention of scorpion proliferation. The epidemiological situation is presented by stressing the difficulties involved in collecting reliable data. We also address the question of citizen and stakeholder awareness since public participation is crucial in all prevention programmes. Training for healthcare providers is also one of the principal axes of the Committee's programme which includes national, regional, and even local seminars. We describe the improvement of production and research on venoms carried out by the Institute Pasteur of Algeria. We conclude by discussing the action plan for 2001 and prospects for an enhanced strategy in the fight against the scorpion envenomation.

[Snakes and scorpions: what are the risks for the traveler?]. / Serpents et scorpions: quels risques pour le voyageur?

The risk of being bitten by a snake or stung by a scorpion is low for the ordinary, non-thrill-seeking traveler. Travelers who plan hazardous outdoor activities should be advised to be careful and bring along adequate protective clothing (boots, long trousers, and gloves). If envenomation occurs, the victim should be immobilized and rushed to a treatment center. Administration of antivenin using massive doses in severe cases is the best therapy. For quickest and most efficient results, antivenins should be administered by the intravenous route. Packing antivenins is necessary only under special circumstances when high-risk activities are scheduled. In this case contingency planning may also be necessary taking into account health care facilities in the destination country and the availability of antivenins.

[Study of the protective capacity of scorpion venom Buthus occitanus tunetanus polymerised to glutaraldehyde in mice strains with different haplotypes]. / Edude de la capacité protectrice du venin du scorpion Buthus occitanus tunetanus (Bot) polymérisé au glutaraldehyde chez des souches de souris d'haplotypes différents.

The immune response obtained against the toxic fraction of the scorpion venom Buthus occitanus tunetanus detoxified by polymerisation with glutaraldehyde, was analysed for low inbred mice having different haplotypes: C57BL/6 (H-2b) et BALB/c (H-2d) and the SWISS outbred mouse. This three strains of mice, immunized with the polymeric form of Bot-G50 are able to induce an immune response with bumoral mediation. The anti-polymers antibodies obtained from immunized mice, cross-react with the native Bot-G50 fraction. Indeed, in vitro protection experiments demonstrated that immune sera were neutralizing (between 150 and 235 micrograms of Bot-G50 ml). The in vivo protection assays showed that immunized mice could resist the challenge by high amount of toxic fraction (between 70 and 80 micrograms of Bot-G50). This protection was found to be long-lived, since immunized SWISS mice could resist the challenge by 4 DL50 of the toxic fraction (80 micrograms) six month after the start of the immunized program.

Comments on Environmental and Sanitary Aspects of the Scorpionism by Tityus trivittatus in Buenos Aires City, Argentina.

Deaths by venomous animals are medical emergencies that can lead to death and thus constitute sanitary problems in some regions of the world. In the South of America, the accidents by these animals are a common sanitary problem especially in warm, tropical or subtropical regions, related with rural work in several countries. Argentina is located in the extreme South of South America and a minor part of the continental surface is in tropical or subtropical regions, where most of the accidents by venomous animals happen. However, in the big cities in the center and South of the country, with no relation to rural work, scorpionism, mostly due to the synanthropic and facultative parthenogenetic scorpion Tityus trivittatus, has become a sanitary problem in the last few decades. This scorpion is present in the biggest cities of Argentina and in the last decades has killed over 20 children in provinces of the center and north of the country, mostly in big cities. In addition, it seems that this species is growing and spreading in new regions of the cities. In this revision, some characteristics of this scorpion regarding its habitat, spreading in Buenos Aires city, combat measures and available treatments are discussed.

Scorpionism by Hemiscorpius spp. in Iran: a review

Scorpions are distributed throughout Iran and the genus Hemiscorpius is particularly important in this region. Hemiscorpius lepturus is the most significant species within the genus in the country. Since scorpionism provoked by Hemiscorpius comprises a medical emergency, the present study is focused on this important issue. In order to perform the present work, a review of the medical and health-related literature was carried out in several databases. The current findings indicate that six species of Hemiscorpius are found in 15 states of Iran, mainly in the south and southwest. Deaths caused by stings were reported only for two species. The morphological characteristics and geographical distribution of H. lepturus in Iran, its venom and the toxic compounds, epidemiologic data and clinical manifestations of envenomation as well as treatment for affected people are herein reviewed and described. H. lepturus venom toxicity differs from other Iranian scorpions regarding duration and severity. Scorpionism is an important public health problem in Iran, especially in southwest and south regions and in urban areas. It is more prevalent in children and young people. H. lepturus venom is primarily a cytotoxic agent and has hemolytic, nephrotoxic and to some extent hepatotoxic activity. The use of polyvalent antivenom to prevent scorpion sting symptoms is recommended. A well-planned health education program might be useful in preventing scorpionism.(AU)

Ocorrência de uma população do escorpião amarelo (tityus serrulatus) no norte do Rio Grande do Sul / Occurrence of a population of the yellow scorpion (tityus serrulatus) in northern Rio Grande do Sul

O presente estudo objetiva registrar a ocorrência de uma população do escorpião amarelo na região Norte do Rio Grande do Sul. Este dado é de relevância no âmbito das ações da Vigilância Ambiental em Saúde no Estado. (AU)

Identificación de los escorpiones de importancia médica en la Argentina / Identification of scorpions with medical importance in Argentina

. Los escorpiones de importancia médica en el mundo pertenecen mayoritariamente a la familia Buthidae. En Argentina, los miembros de esta familia no son numerosos, siendo mucho mayor el número de especies de la familia Bothriuridae, cuyos miembros hasta el momento no revisten importancia médica. Dentro de los tres géneros de Buthidae que viven en el país, el género Tityus es el que posee especies cuya picadura e inoculación de veneno puede provocar accidentes severos. En general, la diferenciación entre Tityus trivittatus, el escorpión de mayor importancia médica de Argentina, respecto a otros escorpiones, es fácil en las provincias de la zona central del país. Sin embargo, las reglas a utilizar para la diferenciación entre escorpiones de importancia médica de aquellos que no la tienen, no son similares en todo el país. En esta actualización, se brindan elementos sencillos y claros para que el personal de salud pueda diferenciar entre las especies de Tityus de importancia médica de los escorpiones de la familia Bothriuridae, ampliamente distribuidos en la superficie del país. De esta forma, se espera que el diag­nóstico acertado sobre la especie de escorpión pueda mejorar la atención en el caso de la picadura por animales potencialmente peligrosos. Por otro lado, permitirá diferenciar a los escorpiones sin importancia médica lo que redundará en la mejor utilización de los recursos disponibles en los niveles de atención primaria, ante la emergencia que representa una picadura de alacrán.

The scorpions of medical importance in the world mostly belong to Buthidae family. In Argentina, members of this family are not numerous, being much most numerous the species from the Bothriuridae family, whose members so far are of no medical importance. Within the three genera of Buthidae that inhabit in the country, only species from Tityus genus can cause severe ac­cidents. The differentiation between the scorpions of highest medical importance in Argentina (Tityus trivittatus), regarding other scorpions, is easy in the provinces of the central region. However, the rules used for the differentiation of medically important scorpions regarding those not dangerous, is not similar through the country. In this update, we provide simple and clear tools for the health personnel to differentiate between species of Tityus with medical importance and the scorpions from Bothriuridae fam­ily, widely distributed in the country. Thus it is expected that the accurate diagnosis of the species of scorpions may improve the attention in the case of the sting of potentially dangerous scorpions. On the other hand, the differentiation of the not dangerous scorpions from those with medical importance will result in the best use of the available resources in primary care level, consider­ing the emergency that represents a scorpion sting.