Clinical update on scorpion envenoming

Abstract

Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a signifi cant 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, profi ling 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 fi ndings, which are similar to those observed for stress-induced cardiomyopathy, have also been linked to catecholamine excess. The effi ciency 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.

Cocuklarda Troponin Yuksekliginin Nedenleri ve Yardimci Tanisal Degerlendirmeler

“…CO intoksikasyonu karboksihemoglobin nedeniyle myokard oksijenasyonunun bozulmasına ve myokard hasarına neden olmaktadır(9,10). Akrep sokmalarında ise; zehrin direk myokarda toksik etkisi, dolaşımın bozulması veya antivenom tedavinin etkileri ile bir çok şekilde myokard hasarı oluşabilmektedir (11,12). Çocuklarda troponin yüksekliğinin sebepleri erişkinlerden farklıdır ve uluslar arası literatürde sunulan önde gelen sebepler kardiyomyopati ve myokardit gibi pirimer kardiyak nedenler olmasına rağmen (8) bizim çalışmamızda intoksikasyonlar ve akrep sokması ilk sıralarda yer almaktadır.…”

Profiling the short, linear, non-disulfide bond-containing peptidome from the venom of the scorpion Tityus obscurus

“…In addition, the victims of T. obscurus stings have systemic manifestations, including neurological disorders in 97.2% cases and electric shock-like sensations throughout the body (in 88.9% patients) [4]. In addition, some publications have reported severe health problems following scorpion stinging; Torrez et al [5] reported 58 accidents presumably caused by T. obscurus in the Brazilian Amazon, with symptoms such as cerebellar ataxia, dysdiadochokinesia, dysmetry, dysarthria, nausea and vomiting in most patients; cardiomyopathy is also frequently reported [4,6]. Apparently, the venom from T. obscurus is less toxic than that of T. serratus but is still able to cause lethality in mice, as well other typical effects of Tityus venoms with reduced intensities [7].…”

Infrared thermography to diagnose and manage venomous animal bites and stings

“…The venom of these scorpions contains neurotoxins that act mainly on ion channels (sodium and potassium voltage-gated channels), leading to intense and prolonged depolarization and neuronal excitation. This in turn induces the release of mediators such as acetylcholine, adrenaline, and noradrenaline, which are responsible for the onset of clinical manifestations 10 . Although systemic signs and symptoms such as cardiac arrhythmias and acute pulmonary edema can occur in cases of severe envenoming, 85-90% of cases are classified as mild, with only localized manifestations observed, particularly pain with variable intensity 10 .…”

“…This in turn induces the release of mediators such as acetylcholine, adrenaline, and noradrenaline, which are responsible for the onset of clinical manifestations 10 . Although systemic signs and symptoms such as cardiac arrhythmias and acute pulmonary edema can occur in cases of severe envenoming, 85-90% of cases are classified as mild, with only localized manifestations observed, particularly pain with variable intensity 10 . In addition, recent studies have shown that scorpion venom can induce the production of inflammatory mediators and inflammatory reactions 11 .…”