Scorpion stings in Turkey: epidemiological and clinical aspects between the years 1995 and 2004 / Picadas de escorpião na Turquia: aspectos epidemiológicos e clínicos entre os anos de 1995 e 2004

The most important health-threatening scorpions found in Turkey are; Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus and M. eupeus species, all of which belong to the Buthidae family. The epidemiological and clinical findings of scorpion stings in Turkey were evaluated between the years 1995 and 2004 based on data recorded in the National Poison Information Center (NPIC). A total of 930 cases were recorded. The cases mostly occurred in the month of July. The gender distribution was 50.22 percent female and 45.48 percent male. It was shown that the 20-29 age group presented more scorpion stings. Most of the stings occurred in Central Anatolia and Marmara regions of Turkey. Patients at the hospital showed signs of localized (pain, hyperemia, edema and numbness) and systemic effects (hyperthermia, nausea and vomiting, tachycardia, shivering and lethargy) but no lethality was notified. According to records, 33 percent of the poisoned patients were treated with antivenin in healthcare facilities.

Os mais importantes escorpiões que comprometem a saúde na Turquia são: Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus e M. eupeus, todos eles pertencentes à família Buthidae. Os achados clínicos e epidemiológicos da picada de escorpiões na Turquia foram avaliados no período entre os anos de 1995 a 2004 baseados em dados do Centro Nacional de Informações de Envenenamentos (NPIC). Foram registrados 930 casos que ocorreram principalmente no mês de julho. A distribuição por sexo foi 50,22 por cento femininos e 45,48 por cento masculinos. Demonstrou-se que o grupo etário de 20 a 29 anos apresentou maior número de picadas de escorpião. A maior parte das picadas ocorreu na Anatólia Central e na região de Marmara, na Turquia. Os pacientes hospitalizados mostraram sinais localizados (dor, hiperemia, edema e confusão mental) e sistêmicos (hipertermia, náusea e vômitos, taquicardia, arrepios de frio e letargia), mas não houve notificação de letalidade. De acordo com os prontuários 33 por cento dos pacientes foram tratados com antiveneno nas unidades de saúde.

Snakebites in Turkey: epidemiological and clinical aspects between the years 1995 and 2004

The venom of poisonous snakes comprises a complex mixture of several proteins with other less significant constituents, resulting in principles capable of changing viable tissues. The hemotoxic factor is the main responsible for necrosis and tissue sloughing. Envenomations are common in rural areas of Turkey caused by snake species that present hepatotoxic venom, which causes local swelling, ecchymosis and alterations in blood profile. The epidemiological and clinical findings of snake envenomations in Turkey were evaluated based on data recorded by the National Poison Information Center (NPIC) between 1995 and 2004, in a total of 550 snakebite cases. The month of peak incidence was June (24.3 percent) while most incidents occurred in Marmara, Central Anatolia and Black Sea regions of Turkey. The victims were mainly adults (54.1 percent). Hospitalized patients displayed clinical signs of local (75.2 percent) and systemic effects (24.7 percent). Local clinical symptoms comprised edema, pain, hyperemia, numbness and ecchymosis, while systemic clinical symptoms included nausea, vomiting, hypotension, tachycardia, dyspnea, dry mouth, paresthesia, generalized edema, cyanosis and compartment syndrome. Occasionally, convulsions, confusion, loss of consciousness, hyperthermia, hepatic and circulation failure, hematoma, drowsiness, epistaxis, chest and abdominal pain, venous spasm, thrombocytopenia and bradycardia were recorded. Approximately one third (34.2 percent) of the patients were treated symptomatically, while 10.5 percent required antivenom therapy along with symptomatic treatments and 26.3 percent of all patients were exclusively treated with antivenom. Although a significant number of incidents were reported, no deaths occurred. These findings emphasize the presence of multiple medically important snake species in Turkey and that public awareness and therapeutic approaches appear sufficient to manage snakebite incidents.(AU)

Evaluation of scorpion sting incidence in turkey

Scorpion stings are common in Turkey due to its geographical location, climate and socioeconomic structure. Scorpion envenomation cases are a considerable public health problem in all regions of the country. Important health-threatening scorpions in Turkey are Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus and M. eupeus, all of which belong to the Buthidae family. They are described to be potentially dangerous to humans. So far, there is no study about scorpion sting incidence covering all geographical regions of Turkey; therefore, in this study, we analyzed the frequency of scorpion sting cases in the country. A total of 24,261 scorpion sting cases were reported during 2005. Most of which (about 80 percent) occurred in the Southeastern Anatolia (30.4 percent), Mediterranean Sea (24.9 percent) and Aegean regions (23.5 percent), where medically important scorpion species are found. The sting cases mostly occurred during the summer period. Our results suggest that scorpion stings are an important problem in Turkey. This simple descriptive study will help develop interventions to prevent scorpion stings, which should take local sting cases into consideration.(AU)

Evaluation of scorpion sting incidence in turkey

Scorpion stings are common in Turkey due to its geographical location, climate and socioeconomic structure. Scorpion envenomation cases are a considerable public health problem in all regions of the country. Important health-threatening scorpions in Turkey are Androctonus crassicauda, Leiurus quinquestriatus, Mesobuthus gibbosus and M. eupeus, all of which belong to the Buthidae family. They are described to be potentially dangerous to humans. So far, there is no study about scorpion sting incidence covering all geographical regions of Turkey; therefore, in this study, we analyzed the frequency of scorpion sting cases in the country. A total of 24,261 scorpion sting cases were reported during 2005. Most of which (about 80%) occurred in the Southeastern Anatolia (30.4%), Mediterranean Sea (24.9%) and Aegean regions (23.5%), where medically important scorpion species are found. The sting cases mostly occurred during the summer period. Our results suggest that scorpion stings are an important problem in Turkey. This simple descriptive study will help develop interventions to prevent scorpion stings, which should take local sting cases into consideration.

Determination of potency and paraspecific effects of Androctonus crassicauda (Olivier, 1807) antivenom against Mesobuthus gibbosus (Brullé, 1832) venom (Scorpiones: Buthidae)

Scorpion envenomation remains a real health problem in many countries. In scorpionism cases, it is often recommended that patients be treated with species-specific antivenom. Androctonus crassicauda venom has been used as antigen for antivenom production in Turkey, where this antivenom, called Turkish antivenom, has also been effective in the treatment of envenomation caused by species other than A. crassicauda. The present study aimed at determining the paraspecific effects and potency of the Turkish antivenom against Mesobuthus gibbosus (Brullé, 1832) venom. To assess the venom toxicity and the antivenom efficacy, we determined the Minimum Lethal Dose (MLD) and the Minimum Effective Dose (MED) instead of LD50 and ED50, respectively. Androctonus crassicauda antivenom was capable of neutralizing M. gibbosus venom (20 MLD). This was the first study indicating that A. crassicauda antivenom can be used for the treatment of Mesobuthus gibbosus stings, especially in Aegean Region, Turkey.(AU)

Effects of Androctonus crassicauda (Olivier, 1807) (scorpiones: buthidae) venom on rats: correlation among acetylcholinesterase activities and electrolytes levels

Scorpions can be considered living fossils because they have changed so little during the last 400 million years. They are venomous arthropods of the Arachnida class and regarded as relatives of spiders, ticks and mites. The aim of the present study was to evaluate the toxicity of Androctonus crassicauda (Olivier, 1807) venom and its effects on the acetylcholinesterase (AchE) activity and on electrolytes levels in rats. Animals were divided into seven groups of five rats each. Test groups received 250æg/kg of venom solution while control group was treated with 200æl of physiological saline solution (PSS). Blood samples were collected from the animals on the 1st, 2nd 4th, 8th, 12th, and 24th hours after subcutaneous injection of venom. Animals were monitored for 24 hours. Androctonus crassicauda venom significantly reduced AchE activity on the 12th hour when compared with control group. A statistically negative correlation between Na+ and K+ (p<0.05) and a positive correlation between Na+ and CL- (p<0.001) ions levels were observed after the administration of A. crassiccauda venom to rats. We can conclude that the differences in the electrolytes levels are due to acute renal failure, since elimination of toxin occurs primarily via the kidney.(AU)