Socio-demographic, clinical, laboratory profile and outcome in children with scorpion envenomation

Background: Aim was to study clinical, socio- demographic and laboratory profile and outcome in children with scorpion envenomation up to 12 years of age. This study conducted to provide better insights in to the socio-demographic, clinical, laboratory profile of scorpion envenomation in rural health setting in India.Methods: This was a hospital based, prospective observational study done in children up to 12 years of age admitted in a tertiary care centre between March 2018 to April 2020 with history of scorpion envenomation, presence of sting mark or scorpion seen in vicinity of child by parents or near family members. Unknown bites or stings and cases were the clinical manifestations are not compatible with scorpion sting were excluded.Results: During the study period, 28 children were admitted for scorpion sting. Maximum number of cases were noted in the age group of 3-6 years and there is equal distribution of cases among males and females .Majority of cases from rural areas, 46.42% of the cases had black scorpion sting, most of the stings occurred during evening time and spring season. The most common sting sites were the distal part of the extremities. Pain at the sting site and local swelling were the most common presenting symptoms. The common signs noted were tachycardia. The most common ECG changes were noted in the present study was sinus tachycardia (46.42%) fallowed by ST segment changes noted in 21.4% of children. Commonest complications noted myocarditis, pulmonary edema, myocardial dysfunction, peripheral circulatory failure. One patient died due to pulmonary edema. Majority of the cases recovered without any sequale.Conclusions: Scorpion envenomation is a preventable emergency among children and closely associated with environmental condition, socioeconomic status and child activities. Supervised outdoor play, early hospitalization, close monitoring of vitals and management of complications and supportive care may reduce the mortality and morbidity.

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Severe scorpion envenomation in Brazil: clinical, laboratory and anatomopathological aspects

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46651994000100011 ◽

1994 ◽

Vol 36 (1) ◽

pp. 67-76 ◽

Cited By ~ 64

Author(s):

Palmira Cupo ◽

Mauro Jurca ◽

Marisa M. Azevedo-Marques ◽

João Samuel M. Oliveira ◽

Sylvia E. Hering

Keyword(s):

Heart Failure ◽

Pulmonary Edema ◽

Continuous Monitoring ◽

Cardiac Involvement ◽

Clinical Laboratory ◽

Laboratory Data ◽

Scorpion Envenomation ◽

The Hours ◽

Scorpion Stings

Scorpion stings in Brazil are important not only because of their incidence but also for their potential ability to induce severe, and often fatal, clinical situations, especially among children. In this report we present the clinical and laboratory data of 4 patients victims of scorpion stings by T. serrulatus, who developed heart failure and pulmonary edema, with 3 of them dying within 24 hours of the sting. Anatomopathologic study of these patients revealed diffuse areas of myocardiocytolysis in addition to pulmonary edema. The surviving child presented enzymatic, electrocardiographic and echocardiographic changes compatible with severe cardiac involvement, which were reversed within 5 days. These findings reinforce the need for continuous monitoring of patients with severe scorpion envenoming during the hours immediately following the sting.

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Echocardiographic Evaluation of the Response to Prazosin Treatment in Scorpion Sting

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa063 ◽

2020 ◽

Author(s):

Khaled A Abdel Baseer ◽

Mohamed Gamil Aboelela ◽

Heba M Qubaisy

Keyword(s):

Cardiogenic Shock ◽

Pulmonary Edema ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Cardiovascular Complications ◽

Left Ventricular ◽

Scorpion Sting ◽

Scorpion Envenomation ◽

Echocardiographic Evaluation

Abstract Background Scorpion envenomation is a major public health problem in children that can induce lethal neurological, respiratory and cardiovascular complications. We aimed to evaluate cardiovascular complications with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Methods This was a prospective study conducted for children who presented with scorpion sting to Emergency and Intensive Care units. Demographic, clinical and laboratory findings of patients were recorded. Cases with suspected clinical and electrocardiographic manifestations of myocarditis were subjected to bedside echocardiography with follow-up at the end of the first week and the first month. Results Scorpion sting cases presented to our hospital were 81 cases during 1-year study; of them, 17 cases were stable without systemic manifestations after 12 h observation and discharged. Sixty-four cases suffered systemic organic complications and needed ICU admission; their mean age was 11.52 ± 3.74 and 64% of them were males. Twenty-eight of admitted cases showed manifestations of myocarditis and by echocardiography, all of them had evidence of left ventricular dysfunction. On follow-up, there was significant improvement at the end of first week and complete improvement at the end of first month except three cases who died due to pulmonary edema and cardiogenic shock. Conclusion Acute toxic myocarditis is a common and an important cause of morbidity and mortality following scorpion envenomation that necessitates early and aggressive management. High index of suspicion, serial electrocardiogram monitoring and echocardiography are three integrative lines required to recognize this serious complication. Lay summary Acute toxic myocarditis is a common cause of morbidity and mortality following scorpion envenomation that necessitates rapid medical treatment. We aimed to evaluate cardiovascular complications after scorpion sting with a follow-up of envenomed children for 1 month for possibility of incomplete recovery. Tachycardia was the most frequent observed cardiac sign followed by hypotension, while the least was bradycardia and hypertension. All cases with manifestations suggestive of myocarditis were evaluated by bedside two-dimensional echocardiography and showed evidence of left ventricular dysfunction, that begin to regress within 1 week of treatment unless progressive pulmonary edema and resistant cardiogenic shock occurred. On follow-up for survivors, complete improvement at the end of first month was noticed. Clinical suspicion, serial ECG monitoring and echocardiography are required for rapid and early diagnosis. Early use of prazosin therapy can prevent long-term residual damage as evidenced by echocardiographic evaluation.

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Asymmetric pulmonary edema after scorpion sting: a case report

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652008000600007 ◽

2008 ◽

Vol 50 (6) ◽

pp. 347-350 ◽

Cited By ~ 9

Author(s):

Ebrahim Razi ◽

Elaheh Malekanrad

Keyword(s):

Emergency Department ◽

Case Report ◽

Pulmonary Edema ◽

Good Condition ◽

Clinical Manifestations ◽

Scorpion Sting ◽

Scorpion Envenomation ◽

X Ray ◽

Chest X Ray ◽

The Right

A 12-year-old boy was referred with acute asymmetric pulmonary edema (APE) four-hour after scorpion sting to Emergency department. On admission, the main clinical manifestations were: dyspnea, tachypnea, and tachycardia. Chest x-ray revealed APE predominantly on the right hemithorax. The patient was treated with oxygen, intravenous frusemide and digoxin and discharged on the sixth hospital day in a good condition. This case report emphasizes the occurrence of asymmetric pulmonary edema after severe scorpion envenomation within few hours immediately after the sting.

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Severe Troponin I Elevation and Myocardial Dysfunction in a Child with Scorpion Sting

Journal of Pediatric Intensive Care ◽

10.1055/s-0038-1673624 ◽

2018 ◽

Vol 07 (04) ◽

pp. 219-224

Author(s):

Dincer Yildizdas ◽

Ozden Horoz ◽

Didar Arslan ◽

Celal Varan ◽

Sevcan Erdem ◽

...

Keyword(s):

Troponin I ◽

Parasympathetic Nervous System ◽

Myocardial Dysfunction ◽

Pediatric Population ◽

Systolic Dysfunction ◽

Cardiac Injury ◽

Clinical Manifestations ◽

Scorpion Sting ◽

Mortality And Morbidity ◽

Scorpion Envenomation

Background Scorpion sting is a common medical problem and major cause of mortality and morbidity in many countries. The symptoms of envenomation are more severe in the pediatric population. The clinical manifestations of scorpion envenomation appear by activation of sympathetic and parasympathetic nervous system. Envenomation can cause multiorgan dysfunction and death. Case Presentation and Findings In this case report, we present a pediatric patient from Adana, Southeast Anatolia, with severe scorpion envenomation with Leiurus abdullahbayrami which is an especially dangerous species for children. Severe systolic dysfunction was detected by echocardiography. Troponin I levels elevated significantly and rapidly responded to three doses of antivenom therapy. Conclusion Early echocardiographic examination is an important procedure for patients with scorpion envenomation. Troponin I is a significant parameter to monitor the degree of cardiac injury. Antivenom therapy is the only recommended specific therapy for children with severe scorpion envenomation due to Leiurus abdullahbayrami. Abnormal echocardiography findings may require repeated doses of scorpion antivenom.

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