Emerging options for the management of scorpion stings

Abstract

Scorpion stings are common in many tropical countries. Although most scorpion stings cause only localized pain without life-threatening envenoming, about one third of stings cause systemic envenoming which can result in death. Children are particularly sensitive to scorpion envenoming. The severity of scorpion stings is related to the presence of neurotoxins in the venom that cause a sudden release of neurotransmitters from the autonomic nervous system, predominantly sympathetic. There is also a strong inflammatory response that worsens symptoms, including those of a respiratory nature. Several vital functions may be directly affected, including the cardiovascular, respiratory, and neuromuscular systems. Hypertension is constant at the beginning of systemic envenoming and sometimes has a severe cardiac and respiratory impact. Although controversial, immunotherapy is the only etiological treatment. Administered early, it prevents many complications and improves the outcome. New antivenoms are highly purified immunoglobulin fragments, the efficacy and safety of which are excellent. As a consequence, adverse reactions to antivenoms are now very rare and usually mild, which should limit any reluctance regarding their routine use. Symptomatic treatment is still necessary to support immunotherapy, especially in cases of delayed arrival at hospital. A combination of both approaches should be considered, based on local resources and constraints.

Scorpion sting envenomation, Vijayapur, Karnataka, India experience: new observations

“…Similar to our observation, others also found stings to be nocturnal, more in fields and commonest sites were over the extremities. [5][6][7] Face and ear pinna was also affected in infants in our study which was also noticed by others. 5 Stings near to head and torso are described to be more severe due to more venom absorption.…”

“…8 Serum electrolytes (sodium and potassium) if deranged have been found to be of prognostic significance. 6 We could not correlate serum electrolytes and outcome as major abnormalities were not found. Chest x-ray was found useful only if pulmonary edema was present and this itself is an ominous sign.…”

“…Studies. [5][6][7] which compared adults with children reported more severe involvement in children though sting is more common in adults. As children have less weight same amount of injected venom becomes more toxic.…”

“…Low voltage QRS and arrhythmias also suggest Myocardial injury and may indicate fatal illness. 1,6 It is reported that only 30% of scorpion sting cases have systemic manifestations, rest are dry stings. 6 As ours is a tertiary care hospital we get cases with systemic symptoms.…”

Incidence and severity of scorpion stings in Algeria

“…The efficiency and rapid use of the antivenom might promote a beneficial neutralization of the neurotoxins before their binding to their targets. Immunotherapy could be also associated with the symptomatic treatment according to the symptoms observed by the physicians, in order to shorten significantly the duration of envenomation (14)(15)(16).…”