RESUMO
Presentación de un caso, notificado el 9 de enero de 2017, a la Gerencia Operativa de Epidemiología del Gobierno de la Ciudad de Buenos Aires por un efector privado de la Ciudad, de envenenamiento por animal ponzoñoso (Alacranismo) en un paciente residente en la Ciudad de Buenos Aires. Se describen el cuadro clínico y el tratamiento recibido, la evolución del caso, la importancia de distintas acciones de vigilancia epidemiológica, el procedimiento de notificación, medidas de protección, y medidas de prevención y control de accidentes. Incluye datos de centros públicos nacionales y de la Ciudad de Buenos Aires especializados en asistencia y/o in-formación sobre animales venenosos
Assuntos
Humanos , Animais , Criança , Adulto , Escorpiões/patogenicidade , Antivenenos/administração & dosagem , Antivenenos/uso terapêutico , Picadas de Escorpião/complicações , Picadas de Escorpião/patologia , Picadas de Escorpião/prevenção & controle , Picadas de Escorpião/terapia , Picadas de Escorpião/epidemiologia , Prevenção de Acidentes/instrumentação , Prevenção de Acidentes/métodos , Animais PeçonhentosRESUMO
Tityus serrulatus (Ts) is the main scorpion species of medical importance in Brazil. Ts venom is composed of several compounds such as mucus, inorganic salts, lipids, amines, nucleotides, enzymes, kallikrein inhibitor, natriuretic peptide, proteins with high molecular mass, peptides, free amino acids and neurotoxins. Neurotoxins are considered the most responsible for the envenoming syndrome due to their pharmacological action on ion channels such as voltage-gated sodium (Nav) and potassium (Kv) channels. The major goal of this review is to present important advances in Ts envenoming research, correlating both the crude Ts venom and isolated toxins with alterations observed in all human systems. The most remarkable event lies in the Ts induced massive releasing of neurotransmitters influencing, directly or indirectly, the entire body. Ts venom proved to extremely affect nervous and muscular systems, to modulate the immune system, to induce cardiac disorders, to cause pulmonary edema, to decrease urinary flow and to alter endocrine, exocrine, reproductive, integumentary, skeletal and digestive functions. Therefore, Ts venom possesses toxins affecting all anatomic systems, making it a lethal cocktail. However, its low lethality may be due to the low venom mass injected, to the different venom compositions, the body characteristics and health conditions of the victim and the local of Ts sting. Furthermore, we also described the different treatments employed during envenoming cases. In particular, throughout the review, an effort will be made to provide information from an extensive documented studies concerning Ts venom in vitro, in animals and in humans (a total of 151 references).
Assuntos
Neurotoxinas/toxicidade , Venenos de Escorpião/toxicidade , Animais , Sistema Cardiovascular/efeitos dos fármacos , Sistema Digestório/efeitos dos fármacos , Humanos , Sistema Imunitário/efeitos dos fármacos , Sistema Nervoso/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Reprodução/efeitos dos fármacos , Sistema Respiratório/efeitos dos fármacos , Picadas de Escorpião/imunologia , Picadas de Escorpião/patologia , Picadas de Escorpião/terapia , Venenos de Escorpião/química , Escorpiões/anatomia & histologia , Escorpiões/químicaRESUMO
Toxic effects of Peruvian Hadruroides lunatus scorpion venom on different biochemical and enzymatic parameters in blood serum of Wistar rats and Swiss mice were determined after experimental envenomation. An increase in enzymatic activities of Aspartate Aminotransferase (AST), Lactate Dehydrogenase (LDH) and levels of serum protein and albumin were observed while a decrease in creatinine level in serum was perceived after 30 min of envenomation. No alterations in urea levels and in kidney histology were detected in the envenomed rats. The global leukocytes count was diminished, with decrease in lymphocytes, eosinophils and neutrophils levels in the bloodstream, while no alterations were found in hematological parameters of red series in rats injected with H. lunatus venom. IL-2, IL-4, IL-6, INF-γ, TNF, IL-17A and IL-10 levels were evaluated 0.5, 3 and 6 h after experimental envenomation of mice with H. lunatus venom. From all the analyzed cytokines, only IL-6 showed an increase in serum levels. Taken together, these results point out that envenomation by H. lunatus can impair hematological and immunological parameters and therefore might be monitored in accidents involving this species.
Assuntos
Picadas de Escorpião/patologia , Venenos de Escorpião/toxicidade , Escorpiões/metabolismo , Animais , Aspartato Aminotransferases/sangue , Creatinina/sangue , Interferon gama/sangue , Interleucina-10/sangue , Interleucina-17/sangue , Interleucina-2/sangue , Interleucina-4/sangue , Interleucina-6/sangue , L-Lactato Desidrogenase/sangue , Masculino , Camundongos , Ratos , Ratos Wistar , Albumina Sérica/metabolismoRESUMO
Scorpion stings account for most envenomations by venomous animals in Brazil. A retrospective study (1994-2011) of the clinical consequences of Tityus scorpion stings in 1327 patients treated at a university hospital in Campinas, southeastern Brazil, is reported. The clinical classification, based on outcome, was: dry sting (no envenoming), class I (only local manifestations), class II (systemic manifestations), class III (life-threatening manifestations, such as shock and/or cardiac failure requiring inotropic/vasopressor agents, and/or respiratory failure), and fatal. The median patient age was 27 years (interquartile interval = 15-42 years). Scorpions were brought for identification in 47.2% of cases (Tityus bahiensis 27.7%; Tityus serrulatus 19.5%). Sting severity was classified and each accounted for the following percentage of cases: dry stings - 3.4%, class I - 79.6%, class II - 15.1%, class III - 1.8% and fatal - 0.1%. Pain was the primary local manifestation (95.5%). Systemic manifestations such as vomiting, agitation, sweating, dyspnea, bradycardia, tachycardia, tachypnea, somnolence/lethargy, cutaneous paleness, hypothermia and hypotension were detected in class II or class III + fatal groups, but were significantly more frequent in the latter group. Class III and fatal cases occurred only in children <15 years old, with scorpions being identified in 13/25 cases (T. serrulatus, n = 12; T. bahiensis, n = 1). Laboratory blood abnormalities (hyperglycemia, hypokalemia, leukocytosis, elevations in serum total CK, CK-MB and troponin T, bicarbonate consumption and an increase in base deficit and blood lactate), electrocardiographic changes (ST segment) and echocardiographic alterations (ventricular ejected fraction <54%) were frequently detected in class III patients. Seventeen patients developed pulmonary edema, 16 had cardiac failure and seven had cardiogenic shock. These results indicate that most scorpion stings involved only local manifestations, mainly pain; the greatest severity was associated with stings by T. serrulatus and in children <15 years old.
Assuntos
Antivenenos/uso terapêutico , Picadas de Escorpião/patologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos , Picadas de Escorpião/tratamento farmacológico , Picadas de Escorpião/epidemiologia , Resultado do TratamentoRESUMO
Os escorpiões são artrópodes quelicerados da ordem Scorpiones, sendo conhecidos aproximadamente 1.500 espécies agrupadas em 20 famílias e 165 gêneros, sendo a família Buthidaea de maior importância toxicológica.Estão distribuídos por todos os continentes,exceto a Antártida, mas a maior concentração está nas regiões tropicais e subtropicais. Habitam diversificados ambientes, incluindo desertos,cavernas profundas e altitudes superiores a 4.200m, como nos Andes e no Himalaia.
Assuntos
Animais , Escorpiões/anatomia & histologia , Escorpiões/fisiologia , Picadas de Escorpião/diagnóstico , Picadas de Escorpião/patologia , Picadas de Escorpião/terapia , Animais Peçonhentos , Peçonhas/efeitos adversos , ToxicocinéticaRESUMO
UNLABELLED: Scorpion envenomation is a poorly explored problem in French Guiana. The aim of our study was to describe the epidemiological and clinical features of scorpion stings. METHODS: Our study is retrospective. It was conducted in the emergency department (ED) of Cayenne General Hospital, over an 8-year period (2003-2010). RESULTS: During the study period, 253 patients presented to the emergency department with a history of a scorpion sting. The mean incidence was 32 ± 8 cases per year. The peak of incidence was observed in April and May which are the rainiest months in the year. In most cases, the envenomation occurred between 6:00 and 11:00 am. The site of the sting was on the extremities (hand or foot) in 81% of cases. The scorpion was identified or brought to the hospital in 113 cases. It was described as a slim pincers scorpion in 97 cases. The mean time elapsed between the scorpion sting and admission was 4 ± 5 h. The main clinical symptoms at admission to the ED were local signs in 178 cases (70.4%), digestive disorders in 13 cases, neurologic manifestations in 18 cases, and respiratory manifestations in 7 cases. Adrenergic syndrome was found in 117 cases (46.2%), and cholinergic syndrome in 5 cases (2%). Hypertension was found in 80 patients, 14 of them had already a history of chronic hypertension. Overall, a total of 118 patients (46.6%) had Class I envenoming, 131 patients (51.8%) had Class II envenoming, and 4 patients (1.6%) experienced Class III envenoming. The evolution was favorable in all cases and no death was recorded. However, 42 patients (18.2%) were hospitalized in a medical unit and 4 patients were hospitalized in ICU without needing mechanical ventilation, inotropes or vasoactive drugs. CONCLUSION: Scorpion envenomation is an increasing accident in French Guiana. Symptoms vary from mild to severe and can require ICU admission. Practitioners have to be made aware of severe cases found mainly in children.
Assuntos
Picadas de Escorpião/epidemiologia , Picadas de Escorpião/patologia , Guiana Francesa/epidemiologia , Humanos , Estudos Retrospectivos , Picadas de Escorpião/classificação , Estações do Ano , Estatísticas não ParamétricasRESUMO
Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic entity not yet understood, that is present with transient neurologic symptoms and particular radiological findings. The most common imaging pattern in PRES is the presence of edema in the white matter of the posterior portions of both cerebral hemispheres. The cause of PRES is unclear. We report a case of 13-year-old male who was stung by a scorpion and developed a severe headache, visual disturbance, and seizures and had the diagnosis of PRES with a good outcome. Numerous factors can trigger this syndrome, most commonly: acute elevation of blood pressure, abnormal renal function, and immunosuppressive therapy. There are many cases described showing the relationship between PRES and eclampsia, transplantation, neoplasia and chemotherapy treatment, systemic infections, renal disease acute, or chronic. However, this is the first case of PRES following a scorpion sting.
Assuntos
Encéfalo/patologia , Imageamento por Ressonância Magnética/métodos , Síndrome da Leucoencefalopatia Posterior/induzido quimicamente , Síndrome da Leucoencefalopatia Posterior/patologia , Picadas de Escorpião/complicações , Picadas de Escorpião/patologia , Adolescente , Humanos , MasculinoRESUMO
BACKGROUND: Symptomatic acute epileptic seizures may occur in up to 5% of individuals, especially children, with scorpion stings. The occurrence of a long-lasting brain lesion or the development of epilepsy after a scorpion sting has never been observed. OBJECTIVE: To describe the development of epilepsy secondary to an extensive hemispheric destructive brain lesion after a scorpion sting. PATIENT: A 15-year-old with a moderate global cognitive impairment and a mild left hemiparesis, with seizures occurring approximately once monthly. RESULTS: The mother reported that the patient at the age of 4 years was stung by a brown scorpion, Tityus serrulatus. The patient soon developed local pain and paresthesias followed by diaphoresis and somnolence. Approximately 24 hours after the sting, she began to convulse. She was then taken to a hospital where she achieved suboptimal seizure control, with daily tonic-clonic seizures and left hemiplegia during the following week. During our clinical investigation, her routine electroencephalogram showed the presence of interictal spikes and diffuse slowing in the right brain hemisphere. Magnetic resonance imaging showed a widespread destructive lesion of her right cerebral hemisphere affecting both the cortical and subcortical structures. CONCLUSION: This is a rare illustration of the biological effects of the toxin of T serrulatus concerning its excitotoxicity and the potential to induce a brain lesion of an epileptogenic nature.
Assuntos
Encéfalo/patologia , Epilepsia/etiologia , Picadas de Escorpião/complicações , Animais , Pré-Escolar , Epilepsia/patologia , Feminino , Humanos , Picadas de Escorpião/patologia , Venenos de Escorpião/intoxicação , EscorpiõesRESUMO
Scorpion envenomation is a common medical problem in many countries and an important cause of morbidity and mortality, especially among children. The plasma levels of pro-inflammatory (IL-1beta, IL-6, IL-8 and TNF-alpha) and anti-inflammatory (IL-10) cytokines were measured in individuals stung by Tityus serrulatus (Ts) scorpions. According to clinical manifestations patients were classified, as defined by the Brazilian Ministry of Health, as having mild (n=15, mean age=42.2 years), moderate (n=8, mean age=26 years) or severe (n=4, mean age=14 years) envenomation. Blood samples were taken immediately (T1) and 6h (T2) after admission to the hospital. Eighteen age-matched healthy volunteers were used as control. TNF-alpha, IL-1beta, IL-6 and IL-8 levels were significantly increased in moderate and severe cases and the levels of these cytokines were positively correlated with the severity of envenomation, as evaluated by clinical profile and plasma venom concentration. IL-10 levels were increased in severe and moderate cases and reduced in mild cases. The results reported in the present study suggest that the physiopathological manifestation of Ts envenomation may be mediated, at least in part, by cytokines, and that the early treatment after scorpion sting with drugs that inhibit cytokine production, such as glucocorticoids, may have a potential beneficial effect, ameliorating the severity of the clinical manifestations observed, particularly in severe and moderate cases.
Assuntos
Citocinas/sangue , Picadas de Escorpião/imunologia , Escorpiões , Adolescente , Adulto , Idoso , Animais , Brasil , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interleucina-1/sangue , Interleucina-10/sangue , Interleucina-6/sangue , Interleucina-8/sangue , Masculino , Pessoa de Meia-Idade , Picadas de Escorpião/sangue , Picadas de Escorpião/patologia , Índice de Gravidade de Doença , Fator de Necrose Tumoral alfa/metabolismoRESUMO
A 4 years old boy died a few hours after he had been stung by a scorpion (Tityus serrulatus). At necropsy, there were multiple foci of coagulative myocytolysis in the myocardium and pulmonary oedema. Myocardial necrosis was probably associated with the sympathetic storm induced by scorpion envenomation, and may have contributed to cardiac failure and death.