Scorpion envenomation and serotherapy in Morocco.

Abstract

Abstract.A clinical and biologic study was conducted in Morocco to assess the efficiency of antivenom therapy for treating victims of scorpion stings. Epidemiologic and clinical data were collected from 275 patients envenomed by Androctonus mauretanicus mauretanicus and Buthus occitanus scorpions. Patients received antivenom or other drugs. Blood samples were collected at the time of hospital admission and 1 hr and 3 hr after treatment. Serum venom levels were quantified by using an ELISA. An association was found between clinical signs of envenoming and the level of venom in serum. Patients classified as grade II (moderate envenoming) had higher serum levels of venom level than patients classified as grade I (mild envenoming). At admission to the hospital, the mean venom concentration was not significantly different between the group not treated with antivenom, the group who received 2-5 ml of antivenom, and the group who received 10 ml of antivenom. A significant decrease in serum venom levels and an improvement in the clinical conditions were observed in patients administered 10 ml of antivenom. The lower decrease in serum venom levels in patients who received 2-5 ml of antivenom was due to lower doses of antivenom. No difference in the venom concentration was observed in patients who were not treated with antivenom. The absence of administration of antivenom increased the risk of developing clinical signs at the end of the hospitalization period. However, this risk was much higher when more than 1 hr elapsed between the time of the scorpion sting and the time of hospital admission. The results demonstrate that antivenom is effective in decreasing circulating venom and morbidity. Serotherapy is more efficient when given as soon as possible after envenomation and with adequate quantities of antivenom.In north Africa, as in numerous tropical countries, envenomation by scorpion stings is a major public health problem, particularly in children. [1][2][3][4] The black scorpion (Androctonus mauretanicus mauretanicus) and the yellow scorpion (Buthus occitanus) are the most dangerous scorpions and are responsible for the majority of stings in Morocco. The epidemiologic data are incomplete, but the number of scorpion stings is estimated to be 40,000 per year in Morocco.Scorpion venoms are a complex biochemical mixture containing numerous neurotoxic polypeptides. 5,6 These polypeptides enhance excitability of nerve and muscle cells in scorpion sting victims and also cause death, particularly in children. 7 The onset of clinical symptoms is rapid (within 5-30 min) following the sting. 8,9 Respiratory failure and cardiovascular manifestations are the usual causes of death. 9-11 The toxicity of A. mauretanicus mauretanicus venom is due to the presence of neurotoxins that are specifically active on sodium and potassium channels. 6,12 The severity of scorpion envenoming and the rapid diffusion of inoculated venom require that appropriate treatment be started as soon as possible after the sting. Most investigators consider a...

Systemic envenomation caused by the wandering spiderPhoneutria nigriventer, with quantification of circulating venom

“…Using the ELISA described here, we have also measured a similar venom level (67.8 ng/ mL) in a fatal case of a 4-year-old boy bitten by a Phoneutria spider in the southern Brazilian state of Santa Catarina (unpublished case attended at the State Poison Control Center of Santa Catarina, in Florianópolis, SC, Brazil). Although the venom level observed in our case was higher than those reported by Chávez-Olórtegui et al (22), it was nevertheless compatible with that reported for other arachnids, particularly scorpions such as Androctonus mauretanicus mauretanicus and Buthus occitanus (venom levels 15.9-49.7 ng/mL) (27), Androctonus australis (venom levels 17-29 ng/mL) (28), and Tityus serrulatus (venom levels 4.0-50.0 ng/mL) (29).…”

Epidemiological and clinical characteristics of scorpion stings in children in fez, Morocco

“…While several authors argue that a correct clinical management of Buthidae envenomation treatment eliminates the need for specific antivenom (3,(36)(37)(38), other authors recommend the use of scorpion antivenom (5,8,14,(39)(40).…”

Analysis of variables related to fatal outcomes of scorpion envenomation in children and adolescents in the state of Minas Gerais, Brazil, from 2001 to 2005

“…anos, sendo atribuídos à proporção de veneno inoculado em relação à superfície corpórea, com níveis séricos conseqüen-temente mais elevados 21 …”