Clinical features and prognosis of severe scorpion envenomation in children

Abstract

Background Scorpionism is endemic and represents a real public health problem in Morocco. The most dangerous arthropod in the central area is Androctonus mauretanicus (Am) scorpion. Its venom can be lethal, especially for children. This study aimed to determine a clinico‐epidemiological profile of severe scorpion envenomation among children and identify risk factors for mortality. Methods This retrospective cohort study included 606 children admitted for severe scorpion envenomation (SSE) from January 2010 to July 2015 in the Pediatric Intensive Care Unit (PICU) of Mohammed VI Teaching Hospital. Results The mean age of envenomed children was 6.3 ± 4.2 years. Seventy‐four percent of them came from rural settings. Envenomation occurred mostly during the summer months and 78.4% of stings were nocturnal. The time between the sting and evaluation was greater than 2 h in 83% of cases. Bivariate analysis indicated that from 1 to 24 months of age (P = 0.001), hyperthermia (P = 0.022), episodes of diarrhea (P < 0.001), tachycardia (P < 0.001), abdominal distention (P < 0.001), skin marbling (P < 0.001), signs of respiratory distress (P < 0.001), irritability (P < 0.001), generalized seizures (P = 0.053), and Glasgow Coma Score (GCS) of 3 to 9 (P < 0.001) were significantly correlated with mortality. On multivariate analysis, diarrhea (P = 0.007), skin marbling (P = 0.006), and respiratory distress (P = 0.002), and GCS 3‐9 (P = 0.007) were found to be independent risk factors for mortality in our patient population. Conclusions Children are at high risk of developing serious complications, even death, from severe scorpion envenomation. Here we identified multiple factors that appear to increase the mortality risk in children after scorpion envenomation, including previously described central nervous system alterations.

Case Report: Fatal Scorpion Envenomation in a Shuar Child by Tityus cisandinus from Amazonian Ecuador: A Call for Specific Antivenom Availability in the Amazon Basin

“…5 hours) contributes to most rural deaths in endemic areas of scorpionism. 20 In this case, a combination of factors associated with the sting-admission delay 15,20 and specificity of antivenom 21 may have played a role in the clinical outcome. In the study by Mazzei de D avila et al, 22 where children stung by Tityus zulianus were treated with specific anti-Tityus antivenom, a reduction in plasmatic catecholamine levels was demonstrated up to 8 hours of elapsed sting/treatment time, with the absolute negative change in plasma norepinephrine progressively decreasing as such time increases.…”