Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon.

Scorpion envenomations are a major public health problem in Brazil, and most medically important cases are attributable to the Tityus genus. The objective of this study is to describe the clinical and epidemiological aspects of a series of 151 cases of confirmed scorpion stings, which were treated at the hospitals of two cities in the Western Brazilian Amazon, between June 2014 and December 2019. This study shows that the genus Tityus was the most prevalent. Tityus (Atreus) metuendus (Pocock, 1897) was responsible for the greatest number of cases (68.2%), followed by Tityus (Archaeotityus) silvestris (Pocock, 1897) (14.6%). Most of the envenomations involved males (53.6%), and analysis showed a slight predominance in the group from 40 to 49 years (22.5%). The most affected body regions were feet (49.0%) and hands (31.8%). The time elapsed between the accident and medical care was ≤6 h in 92.1% of cases. Regarding clinical severity, classes I (80.8%) and II (15.9%) predominated. However, there were five (3.3%) class III cases; four for T. metuendus and one for T. silvestris. The most frequent local and systemic manifestations were, respectively, pain (84.1%), paresthesia (34.4%) and mild edema (25.8%), and nausea (9.3%) and myoclonia (8.6%). The clinical manifestations were similar among the patients stung by the different species of scorpions. There were no differences between the manifestations of envenomation caused by T. metuendus, T. silvestris and T. raquelae. For victims of T. apiacas, a higher frequency of piloerection and myoclonia was observed, and was described by the affected patients as a 'sensation of receiving an electric shock' throughout the body. No deaths were registered. The species of greatest epidemiological importance in Manaus is T. metuendus, a species that leads to clinical pictures that do not differ substantially from those observed in other Brazilian regions. T. apiacas causes neurological manifestations that differed from other Tityus species. Our findings suggest that the available antivenoms have little effectiveness when used in the treatment of envenomations by some Amazonian scorpions.

Perspectives and recommendations towards evidence-based health care for scorpion sting envenoming in the Brazilian Amazon: A comprehensive review.

Although underreported across the Amazon region, scorpion stings are very prevalent in some areas and can be potentially life-threatening, especially in children. The most vulnerable populations are those living in locations far from the capitals, hence having limited access to the health system where the appropriate structure for the treatment of severe cases is found. An abundant and diverse fauna of scorpions is found in the region, but few studies have been conducted to decipher the clinical characteristics and therapeutic response of the available antivenoms in envenomings caused by the various species. Antivenom underdosage as well as delayed medical assistance are common among indigenous populations, resulting in poor outcome rates. An in depth understanding of the epidemiological, clinical and therapeutic aspects of scorpion sting envenomings in the Amazon is necessary to improve the outcome of these cases.

Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon

Scorpion envenomations are a major public health problem in Brazil, and most medically important cases are attributable to the Tityus genus. The objective of this study is to describe the clinical and epidemiological aspects of a series of 151 cases of confirmed scorpion stings, which were treated at the hospitals of two cities in the Western Brazilian Amazon, between June 2014 and December 2019. This study shows that the genus Tityus was the most prevalent. Tityus (Atreus) metuendus (Pocock, 1897) was responsible for the greatest number of cases (68.2%), followed by Tityus (Archaeotityus) silvestris (Pocock, 1897) (14.6%). Most of the envenomations involved males (53.6%), and analysis showed a slight predominance in the group from 40 to 49 years (22.5%). The most affected body regions were feet (49.0%) and hands (31.8%). The time elapsed between the accident and medical care was ≤6 h in 92.1% of cases. Regarding clinical severity, classes I (80.8%) and II (15.9%) predominated. However, there were five (3.3%) class III cases; four for T. metuendus and one for T. silvestris. The most frequent local and systemic manifestations were, respectively, pain (84.1%), paresthesia (34.4%) and mild edema (25.8%), and nausea (9.3%) and myoclonia (8.6%). The clinical manifestations were similar among the patients stung by the different species of scorpions. There were no differences between the manifestations of envenomation caused by T. metuendus, T. silvestris and T. raquelae. For victims of T. apiacas, a higher frequency of piloerection and myoclonia was observed, and was described by the affected patients as a ‘sensation of receiving an electric shock’ throughout the body. No deaths were registered. The species of greatest epidemiological importance in Manaus is T. metuendus, a species that leads to clinical pictures that do not differ substantially from those observed in other Brazilian regions. T. apiacas causes neurological manifestations that differed from other Tityus species. Our findings suggest that the available antivenoms have little effectiveness when used in the treatment of envenomations by some Amazonian scorpions.

Perspectives and recommendations towards evidence-based health care for scorpion sting envenoming in the Brazilian Amazon: a comprehensive review

Although underreported across the Amazon region, scorpion stings are very prevalent in some areas and can be potentially life-threatening, especially in children. The most vulnerable populations are those living in locations far from the capitals, hence having limited access to the health system where the appropriate structure for the treatment of severe cases is found. An abundant and diverse fauna of scorpions is found in the region, but few studies have been conducted to decipher the clinical characteristics and therapeutic response of the available antivenoms in envenomings caused by the various species. Antivenom underdosage as well as delayed medical assistance are common among indigenous populations, resulting in poor outcome rates. An in depth understanding of the epidemiological, clinical and therapeutic aspects of scorpion sting envenomings in the Amazon is necessary to improve the outcome of these cases.

Perspectives and recommendations towards evidence-based health care for scorpion sting envenoming in the Brazilian Amazon: a comprehensive review

Although underreported across the Amazon region, scorpion stings are very prevalent in some areas and can be potentially life-threatening, especially in children. The most vulnerable populations are those living in locations far from the capitals, hence having limited access to the health system where the appropriate structure for the treatment of severe cases is found. An abundant and diverse fauna of scorpions is found in the region, but few studies have been conducted to decipher the clinical characteristics and therapeutic response of the available antivenoms in envenomings caused by the various species. Antivenom underdosage as well as delayed medical assistance are common among indigenous populations, resulting in poor outcome rates. An in depth understanding of the epidemiological, clinical and therapeutic aspects of scorpion sting envenomings in the Amazon is necessary to improve the outcome of these cases.