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

Expansión de la distribución de escorpiones del género Tityus C. L. Koch 1836 en Argentina: Implicancias sanitarias / Expansion of the distribution of scorpions of the genus Tityus C. L. Koch 1836 in Argentina: Implications in public health

Se ha observado la presencia de especies de Tityus en diferentes regiones del país, en las cuales su presencia no había sido comunicada previamente: 1- Tityus bahiensis en las provincias de Entre Ríos y Buenos Aires, en esta última en la localidad de Lanús y en San Clemente del Tuyú, y 2- Tityus confluens en la Ciudad Autónoma de Buenos Aires (CABA) y en la provincia de Buenos Aires en las localidades de Pilar, La Plata, Mar del Plata y Bahía Blanca. Estos hallazgos modifican el mapa de la distribución de escorpiones de importancia sanitaria en Argentina por lo que ante la picadura de escorpiones deben considerarse estos nuevos hallazgos. Esto es especialmente importante en el ámbito de la CABA y la provincia de Buenos Aires, en donde la enorme mayoría de los accidentes por escorpiones han sido causados por T. trivittatus y en donde ahora, al menos en algunas de sus regiones se pueden encontrar T. confluens y T. bahiensis. Se discuten posibles razones de esta nueva distribución así como la ocurrencia de accidentes graves en zonas donde no ocurrían históricamente y de sus posibles causas. En base a los casos graves producidos en los últimos tiempos y a este nuevo mapa de distribución, se hace énfasis en la necesidad de capacitación al personal de salud en general y de los médicos de guardia y terapistas en particular, para tratar adecuadamente los accidentes por escorpiones.

Several species of Tityus have been described in regions of Argentina where their presence had not been previously described. These are: 1- Tityus bahiensis in the provinces of Entre Ríos and Buenos Aires (in the localities of Lanús and San Clemente del Tuyú), and 2- Tityus confluens in the city of Buenos Aires and in the province of Buenos Aires in the localities of Pilar, La Plata, Mar del Plata and Bahía Blanca. These findings modify the distribution map of scorpions of sanitary importance in Argentina, reason for which this new distribution must be considered when facing a scorpion sting. This is especially important in the city of Buenos Aires and the province of Buenos Aires, where most of the accidents by scorpions are caused by Tityus trivittatus, and where at least in some of their regions, T. confluens or T. bahiensis can be found at present. The possible reasons of this new distribution, as well as the possible causes for the occurrence of severe envenomations in regions where these were not observed historically, are discussed. Based on the severe envenomations observed and on this new distribution map, emphasis is placed on the need to capacitate health personnel in general and intensivists or critical care physicians in particular to adequately treat scorpion accidents.

Escorpionismo en pacientes pediátricos internados en terapia intensiva: Serie de casos / Escorpionism in pediatric intensive care patients: Case series

El escorpionismo constituye un problema de salud pública con una incidencia en aumento en Argentina. El veneno contiene varias neurotoxinas capaces de generar una "tormenta autonómica" responsable de las manifestaciones clínicas. Los sistemas cardiovascular y respiratorio son los más afectados y su grado de compromiso determinará la morbimortalidad. Un 10 % de los casos en niños evolucionan a su forma grave. En esta serie retrospectiva, se describe la epidemiología y evolución de 17 pacientes ingresados a la Unidad de Terapia Intensiva Pediátrica entre enero de 2010 y enero de 2014. Si bien no hubo mortalidad, sí una alta morbilidad: 12 pacientes presentaron edema agudo de pulmón que requirió ventilación mecánica; 11 pacientes desarrollaron shock cardiogénico hipotensivo; 7, bajo gasto cardíaco grave y, en 6, se utilizó levosimendán por el carácter refractario de su bajo gasto.

Scorpionism is a public health problem with an increasing incidence in Argentina. The poison contains several neurotoxins capable of generating an "autonomic storm" responsible for the clinical manifestations. The cardiovascular and respiratory systems are the most affected ones and their degree of commitment will determine morbidity and mortality. A 10 % of cases in children evolve to their severe form. In this retrospective series, we describe the epidemiology and evolution of 17 patients admitted to the Pediatric Intensive Care Unit from January 2010 to January 2014. Although there was no mortality, there was a high morbidity: 12 patients had acute lung edema requiring mechanical ventilation, 11 patients developed hypotensive cardiogenic shock, 7 were under severe low cardiac output and in 6 levosimendan was used due to the low refractory output.

Scorpionism by Hemiscorpius spp. in Iran: a review

Scorpions are distributed throughout Iran and the genus Hemiscorpius is particularly important in this region. Hemiscorpius lepturus is the most significant species within the genus in the country. Since scorpionism provoked by Hemiscorpius comprises a medical emergency, the present study is focused on this important issue. In order to perform the present work, a review of the medical and health-related literature was carried out in several databases. The current findings indicate that six species of Hemiscorpius are found in 15 states of Iran, mainly in the south and southwest. Deaths caused by stings were reported only for two species. The morphological characteristics and geographical distribution of H. lepturus in Iran, its venom and the toxic compounds, epidemiologic data and clinical manifestations of envenomation as well as treatment for affected people are herein reviewed and described. H. lepturus venom toxicity differs from other Iranian scorpions regarding duration and severity. Scorpionism is an important public health problem in Iran, especially in southwest and south regions and in urban areas. It is more prevalent in children and young people. H. lepturus venom is primarily a cytotoxic agent and has hemolytic, nephrotoxic and to some extent hepatotoxic activity. The use of polyvalent antivenom to prevent scorpion sting symptoms is recommended. A well-planned health education program might be useful in preventing scorpionism.(AU)

Clinical characteristics and outcome of children stung by scorpion referred to Assiut University Children Hospital

Scorpion envenomation continues to be a health problem in tropical and subtropical regions particularly among children. The aim of this study was to evaluate demographic and clinical characteristics as well as outcomes in referred children to Assiut University Children Hospital during the year 2010 with history of scorpion sting, and to describe features that may be associated with poor outcome. The medical files of these cases were reviewed retrospectively for demographic data, time and site of singing, and clinical presentation with recording of local reaction and systemic manifestations especially neurological, cardiopulmonary and gastrointestinal manifestations. According to Abrougs clinical severity classification, cases were divided into three classes of severity. Laboratory investigations of the cases were reviewed for CBC, blood urea nitrogen, liver function tests, creatinine phosphokinase [CPK], lactate dehydrogenase [LDH], arterial blood gases and serum electrolytes including sodium, potassium, and calcium. Referral to the ICU, connection to mechanical ventilation and death were also recorded. Results showed that 111 children presented to the Emergency Unit with history of scorpion sting; 69 males and 42 females with the mean age was 6.1 +/- 3.5 years [range 1-16 years]. Out of the studied cases, 53.2% were classified as class III of clinical severity with recorded pulmonary edema in 33.3%, cardiogenic shock in 46.8% and severe neurological manifestations in 22.8%. Connection to mechanical ventilation was recorded in 25.2%. Twelve cases [10.8%] were classified as class II with mild systemic manifestations, and 36% of cases were classified as class I with only local reaction. Outcome of these cases were discharge without sequelae in 55.8%, discharge with sequelae in 26.1% and death in 18.1%. Stung children with scorpion who died were significantly presented with lower GCS, pulmonary edema and cardiogenic shock than cases who survived. Regarding laboratory studies, died cases showed significantly higher levels of total leukocytic count, blood glucose level, serum sodium level, CPK and LDH than cases who survived. In conclusion more than half of stung children with scorpion suffered severe clinical presentation and about one fifth died. Aggressive treatment regimens are recommended for such cases to improve the outcome