1921
Volume 101, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

This study aimed to identify the clinical and laboratory manifestations that affect outcome of scorpion envenomation in children. It included 154 children admitted with scorpion sting envenomation over a period of 2 years. The epidemiological, clinical, and laboratory findings of patients were recorded, and grading of severity was performed based on local and systemic involvement. Organ failure was determined according to diagnostic criterion of multiple organ dysfunction syndrome, and severity of illness was assessed by the Pediatric Risk of Mortality (PRISM III) score. Of studied children, 58.4% were males and 41.6% were females. Children aged > 5 years suffered more scorpion stings (79.9%) than others did. The place of residence was rural more than urban, outdoor stings more than indoors, nocturnal more than diurnal, and most stings were on the exposed areas of the limbs. Based on clinical evaluation, 37.7% of patients were classified as class I severity followed by class II (48.7%) and class III (13.6%). Among studied cases, 21 deaths (13.6%) were registered; all of them belonged to class III severity. Mortality was significantly higher in children with agitation, coma, convulsions, arrhythmia, heart failure, pulmonary edema, and priapism. There were significantly higher values of leukocytes, platelets, creatinine, liver enzymes, glucose, and creatine phosphokinase in non-survivors than in survivors. The presence of organ failure was associated with mortality. In addition, the need for mechanical ventilation and inotropic support were at increased risk of mortality. Moreover, a significant association was found between PRISM score and the number of failed organs with fatal outcome.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.19-0319
2019-08-12
2020-09-23
Loading full text...

Full text loading...

/deliver/fulltext/14761645/101/4/tpmd190319.html?itemId=/content/journals/10.4269/ajtmh.19-0319&mimeType=html&fmt=ahah

References

  1. Chippaux JP, Goyffon M, 2008. Epidemiology of scorpionism: a global appraisal. Acta Trop 107: 7179.
    [Google Scholar]
  2. Navidpour S, Ezatkhah M, Kovařík F, Soleglad ME, Fet V, 2011. Scorpions of Iran (Arachnida: Scorpiones). Part VII. Kerman province. Euscorpius 131: 132.
    [Google Scholar]
  3. Guerra CM, Carvalho LF, Colosimo EA, Freire HB, 2008. Analysis of variables related to fatal outcomes of scorpion envenomation in children and adolescents in the state of Minas Gerais, Brazil, from 2001 to 2005. J Pediatr (Rio J) 84: 509515.
    [Google Scholar]
  4. Fatani AJ, Ahmed AA, Abdel-Halim RM, Abdoon NA, Darweesh AQ, 2010. Comparative study between the protective effects of Saudi and Egyptian antivenoms, alone or in combination with ion channel modulators, against deleterious actions of Leiurus quinquestriatus scorpion venom. Toxicon 55: 773786.
    [Google Scholar]
  5. Ben-Abraham R, Eschel G, Winkler E, Weinbroum AA, Barzilay Z, Paret G, 2000. Triage for scorpion envenomation in children–is routine ICU hospitalization necessary? Hum Exp Toxicol 19: 663666.
    [Google Scholar]
  6. Petricevich VL, 2010. Scorpion venom and the inflammatory response. Mediators Inflamm 2010: 903295.
    [Google Scholar]
  7. Ouanes B, El atrous S, Aubrey N, Eiayeb M, Abroug F. 2005. Direct vs mediated effects of scorpion venom: an experimental study of the effects of second challenge with scorpion venom. Intensive Care Med 31: 441446.
    [Google Scholar]
  8. Bawaskar HS, 1982. Diagnostic cardiac premonitory signs and symptoms of red scorpion sting. Lancet 319: 552554.
    [Google Scholar]
  9. Bawaskar HS, Bawaskar PH, 2012. Scorpion sting: update. J Assoc Physicians India 6: 4655.
    [Google Scholar]
  10. Cesaretli Y, Ozkan O, 2010. Scorpion stings in Turkey: epidemiological and clinical aspects between the years 1995 and 2004. Rev Inst Med Trop 52: 215220.
    [Google Scholar]
  11. Khattabi A, Soulaymani-Bencheikh R, Achour S, Salmi LR, 2011. Scorpion consensus expert group: classification of clinical consequences of scorpion stings: consensus development. Trans R Soc Trop Med Hyg 105: 364369.
    [Google Scholar]
  12. Goldstein B, Giroir B, Randolph A, 2005. International consensus conference on pediatric sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6: 28.
    [Google Scholar]
  13. Pollack MM, Patel KM, Ruttimann UE, 1997. The pediatric risk of mortality III–acute physiology score (PRISM III-APS): a method of assessing physiologic instability for pediatric intensive care unit patients. J Pediatr 131: 575581.
    [Google Scholar]
  14. Bosnak M, Levent Yilmaz H, Ece A, Yildizdas D, Yolbas I, Kocamaz H, Kaplan M, Bosnak V, 2009. Severe scorpion envenomation in children: management in pediatric intensive care unit. Hum Exp Toxicol 28: 721728.
    [Google Scholar]
  15. Cardozo JLC, França FOS, Wen FH, Málaque CMSA, Haddad V Jr., 2009. Animais Peçonhentos no Brasil: Biologia, Clínica e Terapêutica dos Acidentes, 2nd edition. São Paulo, Brazil. Sarvier.
    [Google Scholar]
  16. Kumar L, Naik SK, Agarwal SS, Bastia BK, 2012. Autopsy diagnosis of a death due to scorpion stinging–a case report. J Forensic Leg Med 19: 494496.
    [Google Scholar]
  17. Mallanagouda M, Bhavana L, Shankargouda V, Arvind S, Raghavendra H, Siddarameshwar S, 2016. Scorpion sting envenomation, Vijayapur, Karnataka, India experience: new observations. Int J Contemp Pediatr 3: 518523.
    [Google Scholar]
  18. Çağlar A, Köse H, Babayiğit A, Öner T, Duman M, 2015. Predictive factors for determining the clinical severity of pediatric scorpion envenomation cases in southeastern Turkey. Wilderness Environ Med 26: 451458.
    [Google Scholar]
  19. Bahloul M, Chabchoub I, Chaari A, Chtara K, Kallel H, Dammak H, 2010. Scorpion envenomation among children: clinical manifestations and outcome (analysis of 685 cases). Am J Trop Med Hyg 83: 10841092.
    [Google Scholar]
  20. Bahloul M, Rekik N, Chabchoub I, Chaari A, Ksibi H, Kallel H, 2005. Neurological complications secondary to severe scorpion envenomation. Med Sci Monit 11: CR196CR202.
    [Google Scholar]
  21. Prasad R, Mishra OP, Pandey N, Singh TB, 2011. Scorpion sting envenomation in children: factors affecting the outcome. Indian J Pediatr 78: 544548.
    [Google Scholar]
  22. Abroug F, Souheil E, Ouanes I, 2015. Scorpion-related cardiomyopathy: clinical characteristics, pathophysiology, and treatment. Clin Toxicol 53: 511518.
    [Google Scholar]
  23. Sofer S, Gueron M, 1988. Respiratory failure in children following envenomation by the scorpion Leiurus quinquestriatus: hemodynamic and neurological aspects. Toxicon 26: 931939.
    [Google Scholar]
  24. Soomro RM, Andy JJ, Kontractor S, El-Hady AM, Eores OA, Ahmed N, 1998. Cardiovascular complications of scorpion stings and the effects of antivenom. J Saudi Heart Assoc 10: 210.
    [Google Scholar]
  25. Osnaya-Romero N, Acosta-Saavedra LC, Goytia-Acevedo R, Lares-Asseff I, Basurto-Celaya G, Perez-Guille G, Possani LD, Calderón-Aranda ES, 2016. Serum level of scorpion toxins, electrolytes and electrocardiogram alterations in Mexican children envenomed by scorpion sting. Toxicon 122: 103108.
    [Google Scholar]
  26. Rahav G, Weiss T, 1990. Scorpion sting induced pulmonary edema. Scintigraphic evidence of cardiac dysfunction. Chest 97: 14781480.
    [Google Scholar]
  27. de Roodt AR, Garcia SI, Salomon OD, Segre L, Dolab JA, Funes RF, de Titto EH, 2003. Epidemiological and clinical aspects of scorpionism by Tityus trivittatus in Argentina. Toxicon 41: 971977.
    [Google Scholar]
  28. Sofer S, Cohen R, Shapir Y, Chen L, Colon A, Scharf SM, 1997. Scorpion venom leads to gastrointestinal ischemia despite increased oxygen delivery in pigs. Crit Care Med 25: 834840.
    [Google Scholar]
  29. Derakhshan A, Al Hashemi GH, Fallahzadeh MH, 2004. Spectrum of in-patient renal disease in children: “a report from southern part Islamic Republic of Iran”. Saudi J Kidney Dis Transpl 15: 1217.
    [Google Scholar]
  30. Viswanathan S, Prabhu C, 2011. Scorpion sting nephropathy. NDT Plus 4: 376382.
    [Google Scholar]
  31. Borges A, Morales M, Loor W, Delgado M, 2015. Scorpionism in Ecuador: first report of severe and fatal envenoming cases from northern Manabí by Tityus asthenes Pocock. Toxicon 105: 5661.
    [Google Scholar]
  32. Sulai NH, Tefferi A, 2012. Why does my patient have thrombocytosis? Hematol Oncol Clin North Am 26: 285301.
    [Google Scholar]
  33. Chtara K, Bahloul M, Turki O, 2015. Incidence and impact outcome of hyperglycaemia in severe scorpion envenomed children requiring intensive care admission. Intensive Care Med 41: 18711872.
    [Google Scholar]
  34. Singhal D, Kumar N, Puliyel JM, Singh SK, Srinivas V, 2001. Prediction of mortality by application of PRISM score in intensive care unit. Indian Pediatr 38: 714719.
    [Google Scholar]
  35. El-Nawawy A, 2003. Evaluation of the outcome of patients admitted to the pediatric intensive care unit in Alexandria using the pediatric risk of mortality (PRISM) score. J Trop Pediatr 49: 109114.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.19-0319
Loading
/content/journals/10.4269/ajtmh.19-0319
Loading

Data & Media loading...

  • Received : 26 Apr 2019
  • Accepted : 12 Jul 2019
  • Published online : 12 Aug 2019
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error