Abstract
Background
More than 1500 scorpion species exist worldwide, with a few scorpion species potentially
lethal to humans. About 1 million stings annually result in >3000 deaths, but the
incidence and mortality vary greatly by species and location. Physicians working internationally
must recognize that resulting toxidromes vary significantly by region. Over the past
few decades, South America has reported relatively few deaths and low case mortality
rates from envenomations. In Guyana, a small tropical country on its northeast coast,
they have been extremely rare. A sudden fatal case cluster suggests an extension of
the black scorpion's habitat, an increase in venom toxicity, or both.
Case Reports
During a 12-month period, Guyana experienced 3 deaths, including 1 adult, from black
scorpion (Tityus obscurus) envenomation. The 30-year-old man and 2 young children experienced the same symptom
complex, initially appearing well except for pain at the sting site. They soon developed
persistent emesis and leukocytosis. All were flown from remote jungle areas to the
only public tertiary care hospital where they received maximal available medical support.
They gradually developed profound cardiopulmonary failure requiring ventilation and,
eventually, dysrhythmias. None had hyperglycemia or pancreatitis, and they had no
neurologic abnormalities until developing progressive obtundation immediately before
intubation.
Why Should an Emergency Physician be Aware of This?
Scorpion envenomation symptoms, outcomes, and treatment are geographically specific.
Patients benefit when clinicians recognize the worldwide variations in grading systems
and treatment options, which we discuss and compare to our patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Guyana. The World Fact Book.2019 (Available at:)https://www.cia.gov/library/publications/the-world-factbook/geos/gy.htmlDate accessed: February 28, 2019
- Epidemiology of scorpionism: a global appraisal.Acta Trop. 2008; 107: 71-79
- Neurological effects of venomous bites and stings: snakes, spiders, and scorpions.Handb Clin Neurol. 2013; 114: 349-368
- 2013 update about arthropod envenomations in French Guyana.Bull Soc Pathol Exot. 2014; 107: 31-38
- Scorpion envenoming in Morona Santiago, Amazonian Ecuador: molecular phylogenetics confirms involvement of the Tityus obscurus group.Acta Trop. 2018; 178: 1-9
- Spatial distribution of envenomation by scorpions in Pará state, Brazil.Rev Patol Trop. 2017; 46: 94-104
- Scorpions (scorpiones).in: Mullen G.R. Stockwell S.A. Medical and Veterinary Entomology. Elsevier, New York2002: 411-423
- Fauna attacks in French Guiana: retrospective 4-year analysis [in French].Med Trop. 2006; 66: 69-73
- Aspects épidémiologiques, cliniques et biologiques de l’envenimation scorpionique au centre hospitalier de Cayenne [thesis].Cayenne: Université des Antilles et de la Guyane, Nuremberg, Germany2011
- Die Arachniden. Nürnberg: C. H.Zeh’sche Buchhandlung. 1836; 5: 17-104
- What do we know about some of the most conspicuous scorpion species of the genus Tityus? A historical approach.J Venom Anim Toxins Incl Trop Dis. 2015; 1: 20
- Tityus obscurus (Gervais, 1843).(Available at:)www.ntnu.no/ub/scorpion-files/t_obscurus_biography.pdfDate accessed: January 5, 2019
- Identification and phylogenetic analysis of Tityus pachyurus and Tityus obscurus novel putative Na+-channel scorpion toxins.PLoS One. 2012; 7: e30478
- The distribution of noxious species of scorpions in Brazilian Amazonia: the genus Tityus CL Koch, 1836, subgenus Atreus Gervais, 1843 (Scorpiones, Buthidae).Entomol Mitt Zool Mus Hamburg. 2011; 15: 287-301
- Envenimation. IV. Le scorpionisme en Afrique.Med Trop. 2007; 67: 439-446
- Scorpion envenomation.N Engl J Med. 2014; 371: 457-463
- The treatment of the scorpion envenoming syndrome: the Saudi experience with serotherapy.Toxicon. 1994; 32: 1019-1026
- Some pharmacological effects of Tityus obscurus venom in rats and mice.Toxicon. 2017; 126: 51-58
- Effects of Brazilian scorpion venoms on the central nervous system.J Venom Anim Toxins Incl Trop Dis. 2018; 24: 3
- Clinical aspects of envenomation caused by Tityus obscurus (Gervais, 1843) in two distinct regions of Pará state, Brazilian Amazon basin: a prospective case series.J Venom Anim Toxins Incl Trop Dis. 2014; 20: 3
- Œdème pulmonaire et scorpionisme: mécanisme cardiogénique ou lésionnel?.in: Mion G. Goyffon M. Les envenimations graves. Rueil-Malmaison, Arnette, France2000: 149-154
- Tityus serrulatus scorpion venom and toxins: an overview.Protein Pept Lett. 2009; 16: 920-932
- Classification of clinical consequences of scorpion stings: consensus development.Trans R Soc Trop Med Hyg. 2011; 105: 364-369
- Envenomation by the scorpion Tityus breweri in the Guayana Shield, Venezuela: report of a case, efficacy and reactivity of antivenom, and proposal for a toxinological partitioning of the Venezuelan scorpion fauna.Wilderness Environ Med. 2010; 21: 282-290
- Is scorpion antivenom cost-effective as marketed in the United States?.Toxicon. 2013; 76: 394-398
- Neurotoxic animal poisons and venoms.in: Dobbs M.R. Clinical neurotoxicology syndromes, substances, environments. Elsevier, Philadelphia, PA2009: 463-489
- A canine study of immunotherapy in scorpion envenomation.Intensive Care Med. 2003; 29: 2266-2276
- Efficacy and safety of scorpion antivenom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthus tamulus) sting: randomised open label clinical trial.BMJ. 2011; 342: c7136
- Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials.Syst Rev. 2017; 6: 74
Article info
Publication history
Published online: September 26, 2019
Accepted:
July 18,
2019
Received in revised form:
July 4,
2019
Received:
April 20,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
