Symptom patterns in adult patients stung by scorpions with emphasis on coagulopathy and hemoglubinuria

Rahmani, Ali Hassan; Jalali, Amir

doi:10.1590/s1678-91992012000400011

Cited by 13 publications

(10 citation statements)

References 23 publications

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“…It was found that scorpion envenomations are more common in summer and at night, in line with other studies on scorpion envenomation ( 7 , 28 , 40 - 52 , 65 , 66 , 69 , 70 , 74 - 83 , 87 - 89 ). Moreover, envenomations with Hottentotta scorpions were only reported in summer, and the pain was more prevalent in patients stung by Hottentotta scorpions compared to yellow scorpions.…”

Section: Discussionsupporting

confidence: 90%

Epidemiological and clinical characteristics of scorpionism in Shiraz (2012-2016); development of a clinical severity grading for Iranian scorpion envenomation

Sanaei‐Zadeh

Marashi

Dehghani

2017

Med J Islam Repub Iran

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Background: Scorpionism is a public health problem in some provinces in Iran. The present study aimed to assess the clinical manifestations of scorpion envenomation in Shiraz and determine a clinical severity grading for Iranian scorpion envenomation in order to suggest a treatment guideline for emergency physicians. Methods: In this analytic retrospective study, all medical charts of patients with scorpion sting admitted in the adult medical toxicology center in Shiraz during July 2012 to July 2016 were assessed. Data regarding the patient's age, gender, sting site, month of envenomation, time of sting, clinical manifestations, vital signs, presence of blood or hemoglobin in urine analysis, duration of admission, color of scorpion, received treatments, and administration of scorpion antivenin were recorded. Results: The scorpions in Shiraz and its suburban area were classified into two groups: yellow scorpions ( Mesobuthus eupeus, Mesobuthus caucasicus , and Compsobuthus matthiesseni) and Hottentotta scorpions (Hottentotta jayakari and Hottentotta zagrosensis). A total of 126 cases of scorpion stings were assessed. About 59% (n=74) were males. The patients aged 8-63 years (mean age, 33.8±11.5 years). About 38.4% (n=48) of the stings occurred during summer. More than 40% of patients (n=51) referred to the emergency department (ED) at night. Localized pain was the most frequent presenting complaint (76.2%). The most frequent general symptom was nausea (6.3%). The most prevalent envenomation site was the lower extremities followed by upper extremities (43.5% and 41.9%, respectively). Based on the clinical severity grading for Iranian scorpion envenomation, 65, 43, and 18 patients (51.6%, 34.1%, and 14.3%) were classified in the grades I, II, and III, respectively. Eighty-one (73%) patients stayed in the ED from 1 to 6 hours, and 30 (27%) patients stayed for >6 hours for observation. Severe localized pain was more prevalent in stings with Hottentotta scorpions than yellow scorpions (P=0.01). The season of envenomation with Hottentotta scorpions was summer in all cases, but envenomation with yellow scorpions was seen throughout the year. All patients received symptomatic treatment, and five were given scorpion antivenin. No death was reported. Conclusion: Hottentotta jayakari is recommended to be listed among the medically important scorpions in Iran. Moreover, scorpion-stung patients in geographical regions where Hemiscorpius lepturus and Androctonus crassicauda are not prevalent may be treated in outpatient departments. The presented grading system can be used for treating patients with scorpion envenomation.

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Section: Discussionsupporting

confidence: 90%

Epidemiological and clinical characteristics of scorpionism in Shiraz (2012-2016); development of a clinical severity grading for Iranian scorpion envenomation

Sanaei‐Zadeh

Marashi

Dehghani

2017

Med J Islam Repub Iran

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“…Gadim venom has significant effects on white blood cells and, therefore, causes erythematous rashes and petechial hemorrhagic into the skin [ 90 , 91 ]. Scorpion venoms, especially the one from Gadim, have also demonstrated hemolytic activity in vitro and it has been observed that the larger the amount of venom, the greater the extension of hemolytic damage [ 92 , 93 ]. Patients stung by Gadim, especially children, can report these symptoms, but they are usually mild in adults and their effects may continue for 2 to 3 weeks without treatment [ 86 , 94 ].…”

Section: Introductionmentioning

confidence: 99%

“…Currently in Iran, stung patients, including those stung by H. lepturus , are treated in most clinical centers with intramuscular injection of available multivalent scorpion antivenom [ 93 ]. It has been reported that more than 95% of scorpion sting patients received the polyvalent antivenom.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the immediate administration of one or two doses of polyvalent antivenom intramuscularly at the hospital, in some severe cases, signs and symptoms have been observed. This may be due to the elapsed time between sting and treatment or improper dosage [ 93 ]. It is known that the efficacy of antivenom for reversal of cytotoxic manifestations following envenomation is time-limited.…”

Section: Introductionmentioning

confidence: 99%

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Scorpionism by Hemiscorpius spp. in Iran: a review

Dehghani

Kamiabi

Mohammadi

2018

J Venom Anim Toxins Incl Trop Dis

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Scorpions are distributed throughout Iran and the genus Hemiscorpius is particularly important in this region. Hemiscorpius lepturus is the most significant species within the genus in the country. Since scorpionism provoked by Hemiscorpius comprises a medical emergency, the present study is focused on this important issue. In order to perform the present work, a review of the medical and health-related literature was carried out in several databases. The current findings indicate that six species of Hemiscorpius are found in 15 states of Iran, mainly in the south and southwest. Deaths caused by stings were reported only for two species. The morphological characteristics and geographical distribution of H. lepturus in Iran, its venom and the toxic compounds, epidemiologic data and clinical manifestations of envenomation as well as treatment for affected people are herein reviewed and described. H. lepturus venom toxicity differs from other Iranian scorpions regarding duration and severity. Scorpionism is an important public health problem in Iran, especially in southwest and south regions and in urban areas. It is more prevalent in children and young people. H. lepturus venom is primarily a cytotoxic agent and has hemolytic, nephrotoxic and to some extent hepatotoxic activity. The use of polyvalent antivenom to prevent scorpion sting symptoms is recommended. A well-planned health education program might be useful in preventing scorpionism.

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“…A retrospective study of 290 patients in Iran reported that hemoglobinuria, coagulopathy, transfusion, and kidney problems were more commonly seen in patients admitted more than 24 hours after the sting. 21 All our patients presented within a few hours. This study included only hospitals in Muscat governorate and might not necessarily represent other governorates in term of systemic toxicity and utilization of antivenom.…”

Section: Discussionmentioning

confidence: 83%

Scorpion Sting Management at Tertiary and Secondary Care Emergency Departments

Abri¹,

Rumhi²,

Mahruqi³

et al. 2019

Oman Med J

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ObjectivesWe sought to review the management of scorpion stings in tertiary and secondary care emergency departments in Oman and determine physician’s knowledge of management protocols.MethodsWe conducted a retrospective study of all scorpion stings cases seen in Sultan Qaboos University Hospital (SQUH) emergency department (ED) from March 2016 to July 2017. Additionally, we conducted a survey of ED physicians regarding their management of scorpion stings in three different EDs including SQUH.ResultsThe total number of scorpion stings seen at SQUH during the study period was 128. Localized pain was seen in 97.7% (n = 125), swelling in 14.8% (n = 19), and local redness in 7.0% (n = 9) of patients. Around 13.0% (n = 17) of patients were found to have systemic symptoms with tachycardia being the most common. Bedside clotting test was done for 11.7% (n = 15) of patients. The most commonly used treatment was local anesthesia (54.7%, n = 70). No patient received scorpion antivenom. In the 89 surveyed physicians the main management method used was analgesia (88.8%, n = 71) followed by local anesthesia (81.1%, n = 65). Most physicians (80.0%, n = 64) believed that local anesthesia was the most effective management. However, 32.5% (n = 26) ordered a whole blood bedside clotting test, 69.2% (n = 18) of which were junior doctors.ConclusionsMost scorpion sting cases managed in SQUH had local symptoms. Tachycardia was the most common systemic manifestation. Bedside clotting test was not commonly ordered and mainly requested by junior doctors. Local anesthesia infiltration is the recommended management for scorpion sting. Analgesia was the main management followed by local anesthesia.

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Symptom patterns in adult patients stung by scorpions with emphasis on coagulopathy and hemoglubinuria

Cited by 13 publications

References 23 publications

Epidemiological and clinical characteristics of scorpionism in Shiraz (2012-2016); development of a clinical severity grading for Iranian scorpion envenomation

Epidemiological and clinical characteristics of scorpionism in Shiraz (2012-2016); development of a clinical severity grading for Iranian scorpion envenomation

Scorpionism by Hemiscorpius spp. in Iran: a review

Scorpion Sting Management at Tertiary and Secondary Care Emergency Departments

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