Informe especial: Envenenamiento por animal ponzoñoso: Alacranismo / Special report: Poisonous by venomous animal: Scorpions

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

clinical evaluation of the effectiveness of antivenom in scorpion envenomation

From 1985 to 1991, 950 cases of scorpion stings were admitted and treated with 0 to 1 ampule of scorpion antivenom at King Fahd Hospital, Al Baha. Antivenom policy was changed in mid 1991, therefore, from January, 1992 to December, 1998, 968 admitted cases of scorpion stings were treated with 5 or more ampules of antivenom. All patients with severe envenomation and pulmonary edema were treated in the intensive care unit. The protocol of treatment had remained the same [1985 - 1998], except for prompt high antivenom dosage. The occurrence of pulmonary edema and cardio-pulmonary arrest in the two years preceeding the policy change [1990-1991] was compared with the period when high dose serotherapy was made mandatory [1992-1998]. After the new antivenom dose, mortality rate fell from 16 of 950 [1.7%] to 0 of 968 [p=0.00015]; occurrence of pulmonary edema decreased from 18 of 162 [11.1%] in 1990-1991 to 12 of 968 [1.2%] in 1992-1998 [p<0.001] and cardio-pulmonary arrest from 7.4% to 0.4% [p<0.001]. The last death recorded due to scorpion sting was of a patient in 1991 who had received no antivenom. The excellent outcome is attributed to scorpion antivenom

clinical evaluation of the effectiveness of antivenom in scorpion envenomation

From 1985 to 1991, 950 cases of scorpion stings were admitted and treated with 0 to 1 ampule of scorpion antivenom at King Fahd Hospital, Al Baha. Antivenom policy was changed in mid 1991, therefore, from January, 1992 to December, 1998, 968 admitted cases of scorpion stings were treated with 5 or more ampules of antivenom. All patients with severe envenomation and pulmonary edema were treated in the intensive care unit. The protocol of treatment had remained the same [1985 - 1998], except for prompt high antivenom dosage. The occurrence of pulmonary edema and cardio-pulmonary arrest in the two years preceeding the policy change [1990-1991] was compared with the period when high dose serotherapy was made mandatory [1992-1998]. After the new antivenom dose, mortality rate fell from 16 of 950 [1.7%] to 0 of 968 [p=0.00015]; occurrence of pulmonary edema decreased from 18 of 162 [11.1%] in 1990-1991 to 12 of 968 [1.2%] in 1992-1998 [p<0.001] and cardio-pulmonary arrest from 7.4% to 0.4% [p<0.001]. The last death recorded due to scorpion sting was of a patient in 1991 who had received no antivenom. The excellent outcome is attributed to scorpion antivenom

Escorpionismo y pulmón / Lung and scorpionism

Este trabajo analiza el empozoñamiento por escorpiones y su repercusión pulmonar, con énfasis en la situación en nuestro país

Brotes epidémicos de picaduras de escorpión en habitantes de viviendas urbanas de construcción reciente / Scorpion sting outbreaks in recently constructed urban dwellings inhabitants

Scorpion stings are unfrequent in Chile. Most of cases occur in rural areas during the warm season. Clinical manifestations have a low to moderate intensity and consist in local pain and inflammation, sometimes associated with headache and hyperthermia. Two autbreaks of scorpion stings affecting six and five adult residents (18-42 years old) of recently built urban dwelling complexes have been recorded in Chile in summertime of 1957 and 1998. The first took place in the town of Maipú dwelling complex was constituted by 112 one story houses in which lived 504 people. In Villa Alborada live 1,050 persons distributed in 158 apartments, 86 of which are in the main floor and in 26 of these last the occupants have observed scorpions inside. All the 11 cases occurred into the dwelling: four when sleeping ath night, three performing different activities (trying to find a tool, searching a kee, housekeeping), two when putting their shoes, and two walking with bare feet in dormitory. In all the cases the causative scorpion was observed, captured or destroyed. Identification of six specimens from Maipú corresponded to Brachistoternus ehrenbergi and of two from Villa Alborada to Bothriurus borrelianus. All the patients presented mild to moderate symptomatology. Treatment consisted basically in oral antihistamanic and/or antinflammatory tablets. recovery was observed within one to seven days with a mean of three days. Prophylactic measures consisted in health education and physical destruction of scorpions in Maipú and insecticide spraying on floors of basement apartments and surrounding areas in Villa Alborada. Though the majority of accidents by scorpion stings happens in rural areas, also may occur in urban areas rural in the near past where dwellings have been constructed in fields which in not to much preterit times constituted the habitat of the referred arthropod, phenomenom that have occurred in summertime in the two dwelling complexes described in the present communication

Pancreatitis aguda por emponzoñamiento escorpiónico: estudio prospectivo / Acute pancreatitis by the scorpion tityus trinitatis bites prospective study

Se realizó estudio prospectivo y descriptivo de 53 pacientes ingresados con escorpionismo por Tityus Discrepans para evaluar la pancreatitis producida por el escorpión en un lapso de 2 años. Los síntomas predominantes fueron colinérgicos: Vómitos (98,11) por ciento y dolor abdominal(79,24 por ciento). Se les realizó amilasemia y glicemia al ingreso y controles, encontrándose hiperglicemia durante las primeras 10 horas e hiperamilasemia hasta 48 horas. La ecosonografía demostró pancreatitis en 27,71 por ciento de los pacientes, aún cuando fue realizada tardíamente. El suero antiescorpiónico fue administrado antes de las 6 horas post-accidente. La realimentación se inició con dieta líquida basada en carbohidratos aproximadamente a las 29 horas, coincidiendo con la desaparición de la sintomatología y normalización de la amilasemia. El promedio de hospitalización fue de 2,55 días. La pancreatitis inducida por el veneno del escorpión debe ser incluida dentro de la etiología de esta entidad. En Venezuela hay alta morbilidad en zonas cuyo clima sea frío y húmedo, propicio para el hábitad del escorpión. En virtud de que el tratamiento específico debe administrarse en las primeras 6 horas, se recomienda el traslado de los pacientes a la brevedad a centros que dispongan del suero antiescorpiónico, con lo cual se logrará la evolución satisfactoria y resolución de la complicación más frecuente que es la pancreatitis

Scorpion sting syndrome: epidemiology, clinical presentation and management of 2240 cases

All cases of scorpion stings [2240] that attended all primary health care centres and hospitals in Hail region, Saudi Arabia, from 1 June 1994 to 31 August 1995 were recorded and analysed. The incidence of scorpion stings and treatment by antivenom were studied. A total incidence of 1.87% was found for the 15-month period. The severity of symptoms and signs were marked among infants. Guidelines for the management of scorpion stings are suggested and the importance of local treatment of stings affecting infants and preschool children is emphasized

Diagnósticos hechos a 1384 pacientes que consultaron por probable mordedura de arañas o picaduras de insectos / Diagnosis done to 1384 patients which had consulted for a probable spider bite or insect sting

Accumulate experience, from 1955 to 1995, in an outpatient univesity parasitology clinic in Santiago, which 1384 patients referred from diverse public and private medical institutions because of a probable spider bite or insect stings, is presented. It is noteworthy that only 618 (44,7 percent) of consultations corresponded to clinical conditions originated by arthropods, whereas from the remaining 766, 612 (44,2 percent) were due to a bacterial, viral or parasitic etiology and 154 (11,1 percent) were caused by physical or chemical agents. Frecuency of diagnosis was: loxoscelism 16,6 percent, spider bites (excluded loxosceles laeta) 1,3 percent, scorpion stings 0,9 percent, tick stings 2,2 percent insect bites 23,7 percent, impetigo 6,6 percent, folliculitis 11,3 percent, boil 22,7 percent, erysipelas 0,1 percent, pustula maligna 0,3 percent, herpes simplex 2,5 percent, palpebral herpes zoster 0,3 percent, acute Chagas's disease 0,4 percent, angioneurotic edema 0,1 percent, ecchymosis 3,0 percent, contact dermitis 7,8 percent and chemical dermitis 0,2 percent. These frequencies do not indicate the real occurrence of the diagnosed nosologies, but what happened in a specialized outpatient clinic dealing cheafly with parasitic diseases and arthropod envenomations. Description of relevant clinical features and epidemiological considerations of pathology observed conjointly with differential diagnosis are presented

Acidente escorpiônico de evoluçäo fatal / Scorpion accident of fatal evolution

Relatamos o caso de uma criança de cinco anos de idade, vítima de acidente escorpiônico pelo "Tityus serrulatus"(escorpiao amarelo), com evoluçao fatal mesmo após soroterapia específica. Sao analisados o quadro clínico e a evoluçao do caso com o resultado da necropsia. Mostra-se, pois, a importância desse problema sanitário haja vista a freqüente possibilidade de complicaçao dos casos, principalmente em crianças.

Clinical patterns of scorpions stings at El-Quawayah general hospital, Riyadh region, Saudi Arabia

To study the clinical symptoms and signs of scorpion venom sting. Between May and October 1993, 48 cases of scorpion stings were seen. The following data were recorded for each patient: age, sex, nationality, time and site of sting, type of scorpion and physical examination. EI-Quawayah General Hospital, Riyadh region, Saudi Arabia. This study involved 26 males and 22 females; 20 of the patients were children. Main outcome measures: The following investigations were done for every patient: leucocyte count, serum creatinine, serum aspartate aminotransferase, serum alanine aminotransferase and serum lactate dehydrogenase. The scorpions encountered as mentioned by the patients were 27 yellow scorpions [Leiurus quinquestriatus], 19 black scorpions [Androctonus crassicauda], and two unknown. Thirty-eight [79.1%] stings occurred between 6 a.m. and 9 p.m. The lower extremity was the most common sting site. Local pain was the most common symptom while tachycardia was the most common sign encountered. Forty-three [89.5%] patients were given scorpion antivenom. Scorpion stings are not always safe. They are associated with manifestations of envenoming which include: severe local pain, tachycardia, vomiting, hypertension, pulmonary oedema and priapism and these manifestations are more commonly seen in children than adults. The mortality rate among children was 10%

Scorpion sting syndrome- A ten year experience

A 10-year retrospective review was undertaken of patients presenting with "scorpion sting" to the Emergency Department of the King Fahad National Guard Hospital in Riyadh. The purpose of the study was 1] to assess the risk of morbidity and mortality following scorpion envenomation in the Riyadh area; 2] to define patient demographics of the study group and identify high risk groups for systemic toxicity; 3] to develop guidelines for patient management. Four hundred and thirty-four cases were studied. Local pain was the primary presenting complaint [92%]. Systemic toxicity occurred in 25.6% [n=111]. Anxiety-related presentations were the most common systemic symptoms [6%]. Hypertension [17%] and/or tachycardia [4%] were the most common systemic signs. Only four patients [<1%] had signs of serious envenomation requiring admission. There were no deaths. The higher risk groups for systemic toxicity were identified as those with age less than eight years or greater than 30 years, with highest risk in those over 50 years, those with history of hypertension or diabetes, and patients with multiple stings. The great majority of patients can be treated with analgesia, local application of ice, and a period of observation dictated by clinical findings. The use of antivenin should be restricted to patients with signs of serious systemic toxicity only

Emponzoñamiento escorpiónico: clínica y laboratorio usando antivenina / Scorpionid poisoning: clinic and laboratory using antivenins

Se trata de demostrar el efecto estimulador de la Tytuystoxina sobre el Sistema Nervioso Autónomo: fase colinérgica y adrenérgica. Determinar cambios en Amilasas, Glicemia y Fórmulas Blanca en fase aguda. Relacionar las variables anteriores con el del suero antiescorpiónico. Se tomaron pacientes pediátricos de ambos sexos con Emponzoñamiento Escorpiónico en áreas adyacentes al Hospital Victorino Santaella Ruíz, incluyéndose todos con signos y síntomas colinérgicos y catecolinérgicos, con un período no mayor de ocho (8) horas antes del emponzoñamiento y su ingreso a la emergencia. Se excluyeron emponzoñamientos tratados con simpaticomiméticos o cardiopatía previa. Se determinaron Amilasas, Glicemias y Fórmula Blanca al ingreso y a las ocho (8) horas. Se administró suero antiescorpiónico elaborado en la Universidad Central de Venezuela (UCV) a pacientes con clínica moderada y grave. Se obtuvo desaparición de la sintomatología en las primeras ocho (8) horas post-emponzoñamiento en un 95 por ciento de los pacientes correlacionándose los signos y síntomas con las modificaciones en los parámetros de laboratorio: Hipoglicemia. Amilasemia y Leucocitosis en fase aguda

Prevalencia de la picadura de alacrán en la ciudad de Querétaro / Prevalence of scorpion sting at Queretaro city

La picadura de alacrán es un motivo importante de ingreso a los servicios de urgencias. Con el fin de conocer su prevalencia y características clínicas se informa la experiencia obtenida en 126 pacientes en la ciudad de Querétaro. Qro. Del presente estudio se obtuvo una tasa de prevalencia de 27.9 por cada 100,000 habitantes, no existiendo predominio en cuanto a uno u otro sexo; la casa habitación fue el lugar que registró la mayor proporción de piquete del artrópodo, 55 por ciento de los pacientes sufrieron la picadura en las extremidades superiores, los sintomas principales fueron dolor local, parestesias, edema laríngeo, sialorrea y eritema. En más de 50 por ciento de los casos se clasificó la sintomatología como moderada. Es importante resaltar la ausencia de defunciones durante le tiempo en que se realizó la investigación. La información contenida en el presente estudio permite observar que la picadura de alacrán reviste características de importancia que permiten considerarla como un problema de salud pública

Estudio del accidente por picadura de escorpion y su manejo en el Hospital Ramon Gonzalez Valencia de Bucaramanga, Santander / Study on scorpion poisoning and its handling in the Hospital Ramon Gonzalez Valencia, Bucaramanga, Santander

En el presente articulo se analizan diez casos de intoxicacion que fueron atendidos en el Servicio de Urgencias del Hospital Universitario Ramon Gonzalez Valencia durante el periodo de 1978 a 1987. Se estudio la distribucion segun sexo, edad, porocedencia, tiempo de consulta luego de la picadura, expresion clinica, grado de intoxicacion, terpaia empleada y permanencia hopsitalaria. Al final se discuten los signos y sintomas de la experiencia y la revision de la literatura