Scorpion Envenomation Research Articles

Evaluation of Antivenom Therapy for Middle East Scorpion Envenomations.

Scorpion envenomation is a leading cause of envenomation in our region. Antivenom has been used successfully to treat the systemic manifestations of envenomations inflicted by toxic scorpions. Toxic scorpions common in our area include Leiurus quinquestriatus, Androctonus australis, and Buthus occitanus. This study describes the outcomes of children envenomated by these scorpions, and treated with SCORPIFAV, a polyvalent scorpion antivenom F(ab')2 (equine), used since 2016 at our institution. A retrospective chart review of all children admitted with symptoms and signs of scorpion envenomation to Soroka University Medical Center, between September 1, 2019, and December 1, 2020, who received antivenom SCORPIFAV. Our center has a protocol mandating antivenom therapy for all patients manifesting autonomic excitation, agitation, and anxiety, or more pronounced symptoms, following suspected scorpion envenomation. Three hundred patients were seen in the pediatric emergency department for scorpion envenomation during the study period, and 49 required antivenom (SCORPIFAV) as per departmental policy. Four of 49 developed allergic reactions during antivenom treatment: 2 manifested minor skin rashes treated with antihistamines only, and a further 2 required intramuscular adrenaline. There were no deaths in the study cohort and all patients recovered fully, with complete resolution of symptoms, signs, and laboratory features. Patients treated with antivenom exhibited rapid resolution of symptoms without severe hypersensitivity. We recommend broadened availability of antivenom at sites where it is needed.

Scorpion Envenoming as an Emerging Public Health Problem in Paraguay, Bolivia, and Midwest Brazil: Involvement of Tityus confluens and the Need for a Panregional Evaluation of Available Antivenoms.

This contribution highlights the emergence of a newly endemic region for scorpion envenoming in South America, covering eastern Bolivia, Paraguay, and the midwestern Brazilian states of Mato Grosso and Mato Grosso do Sul. These areas have not historically been known to harbor life-threatening scorpion species. Tityus confluens, a parthenogenetic species of medical significance in Argentina, has been identified in severe and lethal human cases in Bolivia and Paraguay. Given that the clinical use of scorpion antivenom preparations in the region has often lacked preclinical data and considering the significant burden of scorpion envenoming, we propose a panregional evaluation of available anti-Tityus antivenoms. This evaluation, along with interdisciplinary efforts at a multinational scale to control scorpionism, aims to determine their true neutralization capacity and potential clinical efficacy against known culprits in the Southern Cone of South America and other regions endemic for scorpion envenoming on the continent.

Myocardial Ischemia after Severe Scorpion Envenomation: A Narrative Review.

Myocardial ischemia after severe scorpion envenomation is rarely reported. The aim of this review was to elaborate on a review of myocardial ischemia after severe scorpion envenomation and to detail the mechanism of this myocardial hypoperfusion. We used the PubMed database and entered the following keywords in MeSH research: scorpion envenomation, myocardial ischemia, myocardial perfusion scintigraphy, echocardiography, and troponins. The literature analysis confirmed that severe scorpion envenomation can be complicated by temporary myocardial ischemia, based on electrocardiographic, histopathologic, echocardiographic, myocardial perfusion scintigraphy, and biological studies. The correlation between clinical manifestations, laboratory and electrocardiographic evidence of myocardial damage, echocardiographic studies, perfusion scintigraphy abnormalities, and histopathologic findings are suggestive of lesions of cardiac fibers secondary to myocardial ischemia. Myocardial hypoperfusion may be due to multiple factors. First, catecholamine storms can induce microvascular constriction. On the other hand, the release of catecholamines through a complex neurohormonal interaction with other neuropeptides and cytokine release can produce/induce major coronary microvascular constriction and/or microvascular injury, leading to microvascular acute coronary syndrome with Takotsubo cardiomyopathy. The management of severe scorpion envenomation with severe myocardial failure and pulmonary edema is based on oxygen with invasive or noninvasive ventilator support. Dobutamine improves cardiac function after scorpion envenomation. Antiplatelet therapy is not recommended. In conclusion, severe scorpion envenomation can be complicated by temporary myocardial ischemia, which can be due to multiple factors.

Temporal trend and epidemiological profile of accidents involving venomous animals in the State of Rio de Janeiro, Brazil (2012-2021)

Introduction: Accidents involving venomous animals have significant clinical implications. In Brazil, accidents caused by scorpions (59%), spiders (13.6%), and snakes (10.9%) are the mostfrequently reported, although proportions vary by region. This study describes the temporal trends and epidemiological characteristics of accidents involving venomous animals in the State of Rio de Janeiro. Methods: This is an ecological (time series) study of accidents caused by venomous animals over the last 10 years (2012 to 2021) in Rio de Janeiro. Data were collected from the Brazilian Notifiable Diseases Information System. We estimated incidence rates and analyzed time series using Joinpoint regression, according to geographical region, age, and type of animal. Results: From 2012 to 2021, 17,891 accidents involving venomous animals were reported, with rates increasing from 8.4 to 10.7 per 100,000 inhabitants. Snakes were responsible for the highest number of cases (33.4%), followed by scorpions (27.2%) and spiders (27.0%). Snakebite cases remained stable, while cases of arachnidism and scorpion envenomation increased, marking them as the main types of accidents. The regions with the highest rates were Centro-Sul (65.5 per 100,000 inhabitants), Baía da Ilha Grande (62.3), Médio Paraíba (45.3), and Serrana (43.5). Males and the 40 to 59 age group predominated, but all age groups showed an increase, with a more pronounced rise among children and adolescents. Most accidents were classified asmild, although 51 deaths were recorded.Conclusions: Rio de Janeiro has relatively low rates of accidents involving venomous animals,but some regions have values higher than the national average. Snakebite accidents remainedstable, except in the adolescent group. Accidents involving scorpions and spiders showed anupward trend.

EFFECT OF PUNNAGAVYOSHA CHOORNA PINDASWEDA IN TILATAILA AND PATOLADI GANA KASHAYA IN VRISCHIKA VISHA: A RESEARCH ARTICLE

Scorpion envenomation is a major public health problem in many rural areas of India. The annual number of scorpion sting cases exceeds 1.23 million, with over 32,250 (0.27%) potentially being fatal. Scorpion stings are primarily the result of accidental contact. Vrischika visha (scorpion envenomation) is of significant clinical im-portance due to the severity of local and systemic symptoms like Daha (Burning sensation), Ruk (Pain), Damsa-sopha (Oedema), Jwara (Fever), Chardi (Vomiting), etc. Acharya Vaghbata described Vrischika visha with pre-dominance of Vata dosha & the general line of treatment should be Vatahara. In this context, all ayurvedic text-books have mentioned Swedana as the first treatment procedure as it is Vatahara and Shoolahara. Choornapin-dasweda with Punnagavyosha choorna in Tilataila is one of the formulations mentioned in Keetadivisha prakarana in Kriyakoumudi, a traditional Malayalam Visha Chikitsa textbook. Ushna Teekshna gunas of Pun-nagavyosha choorna can act as Vatashamana. Tilataila is considered as the Agryoushadha for Vata. Patoladi-gana Kashaya which is mentioned in Ashtangahridayam is widely used in Visha conditions. This study was an interventional pre-post study with a sample size of 30. Subjects of the age group 16- 60 years, and those reported by the subject as scorpion sting and within 24 hours of the sting were selected for the study. A detailed case his-tory was taken according to the case proforma that included relevant signs and symptoms of Vrischika visha & Class I Scorpion Sting Syndrome. Subjects who have already undergone any other treatment for the same and with any other systemic or infectious diseases which may interfere with the study were excluded. Punnaga-vyosha choorna Pottali was dipped in warm Tila taila and gently applied over the sting site, after confirming the temperature (42oC – 45 oC), for 15 minutes to 45 minutes maximum or till symptoms are reduced at the affected site. After completing the procedure, 48 ml of Patoladigana Kashaya was given for internal administration. Choornapinda sweda and Patoladigana Kashaya were given for 3 days in total. Symptomatic assessment was done on 1st day - before the treatment, after 1 hour from starting of the treatment, on 2nd day, 3rd day and on 5th day (including follow up period of two days). The result shows there is a decrease in the mean score values of Vedana, Daha, Sopha and raktavarnata after Punnagavyosha choorna pinda sweda in Tila taila and Patoladi-gana Kashaya pana

Assessment of knowledge about first aid methods, diagnosis, and treatment of scorpion stings among health workers in Ouarzazate region, Morocco: A cross-sectional study

Scorpion envenomation (SE) is a critical and immediate medical emergency. It represents a major public health concern with significant cause of illness and death, particularly in rural regions where scorpions are more prevalent. Of note, administering appropriate first aid to scorpion sting victims is one of the most effective ways to reduce mortality. Therefore, it is crucial to understand the level of knowledge of the healthcare workers in managing such cases. This work aims to assess the levels of knowledge on the diagnosis and management of scorpion stings, as well as the attitudes toward scorpion stings, among doctors and nurses in the Ouarzazate region of Morocco. Our results showed that the prevalent health care age group is 30–39 years, and in terms of experience, the majority had less than 5 years. Additionally, the majority of the participants had no knowledge regarding scorpions’ identification. Moreover, only half participants (healthcare workers) received basic training in the management of scorpion stings and almost all of them have not benefited from continuing training. Hence, the current study showed that the understanding of scorpion sting management among healthcare providers in Ouarzazate province is inadequate to ensure proper care for sting patients, and thus including scorpion sting management in the university programs of health care provides along with clinical practice are highly required.

Managing scorpion envenomations: A Gabes emergency department case study of 60 patients.

Scorpion envenomation constitutes a major public health issue in Tunisia, especially in arid regions such as the Gulf of Gabes. It is necessary to understand the epidemiological and clinical characteristics of this condition and the importance of early management. This study aims to assess the epidemiological and clinical profile of patients admitted to the emergency department of Gabes University Hospital for scorpion envenomation, as well as the timing of management and intra-hospital evolution. A retrospective descriptive study of 60 patients admitted for scorpion envenomation to the Acute Assessement unit at the Emergency Department of the Gabes University Hospital from January 2020 to January 2023. The average age was 35 years [1-85 years]. A slight male predominance (51.7%) was noted. Patients with chronic somatic diseases accounted for (25%) of our series. The predominant scorpion species was Androctonus australis (71.7%). The majority of incidents occurred during the nighttime (71.7%). Most patients were of rural origin (58.3%). The most common sting sites were the lower limbs (48.8%) and upper limbs (36.7%). Scorpion envenomation stages at admission were: Stage I (3.3%), Stage II (83.3%), and Stage III (8.33%). The average time to management was 2 hours. Patients classified as Stage II at admission or afterward were seen after an average of 3 hours. Patients initially classified as Stage III were seen after an average of 3 hours and 30 minutes, and those classified as Stage III during the hospitalization were seen after an average of 4 hours. The average time to management for patients transferred from the Emergency Department to the Intensive Care Unit was 4 hours. This study highlights the importance of early management of scorpion envenomation.

Scorpion Bite Mimicking Acute Coronary Syndrome/Myocarditis Later Detected to Have Preexcitation Syndrome—A Case Report and Review of Literature

Abstract Introduction: Scorpion sting-induced myocarditis is a strange and potentially life-threatening problem that merits careful clinical consideration and management. Case Details: Our case, a young male presented with history of scorpion bite over left foot sole associated with local burning an itching with subsequent development of systemic symptoms. The patient received supportive care, including pain management, fluid resuscitation, and close cardiac monitoring. Given the severity of the myocardial involvement, specific interventions targeting the venom’s impact on the heart were initiated. The patient showed significant improvement in symptoms and cardiac function with the implemented management strategies. We present a case report of a patient who suffered myocarditis following a scorpion sting, emphasizing the distinctive clinical features, diagnostic dilemma, and successful management. This case highlights the importance of heightened awareness among healthcare providers when faced with scorpion envenomation, particularly in regions where such encounters are prevalent. Conclusion: This case report contributes to the limited literature on scorpion bite-induced myocarditis, shedding light on the diagnostic intricacies and successful management.

Epidemiological, clinical, biological and evolutionary profile of scorpion envenomed children under one year to 15 years in the Souss Massa region of Morocco

Morocco is one of the main countries affected in North African with the scorpion envenomations. Faced with the threat, significant morbidity and a major risk of death especially in children, a detailed identification of scorpionic profile of stings remains important for health authorities at national or even regional level. The current study aims to establish the epidemiological, clinical, biological and evolutionary data of the scorpionism by analyzing 383 cases of scorpion stings in children from three age groups (<1 year, 1–5 years and >5 years), admitted at the Regional Hospital Hassan II-Agadir in the Souss Massa region during the period of 9 years and 10 months from January 2013 to October 2022. Our results showed that patients under 1 year of age presented the most severe cases and had the highest mortality rate. However, the clinical signs and symptoms observed illustrated severe damages to vital systems, particularly the cardiovascular, neurological and pulmonary systems, although the signs associated with the latter were present only in cases admitted in grades 2 and 3 for the three age categories studied. Fluctuations in vital constants (temperature and peripheral oxygen saturation, blood pressure, heart rate and respiratory rate), biochemical parameters (ASAT, ALAT, urea and blood creatine, as well as blood sugar) and CBC results revealed major functional disturbances in vital organs, especially in envenomated cases admitted in grade 3. A positive correlation was mentioned between the state of evolution and the various epidemiological parameters, digestive symptoms, as well as signs and symptoms linked to hemodynamic state, general and neurological state. The main interest is to illustrate the seriousness of scorpion envenomations, especially in the high-risk population, for whom an improved therapeutic approach in health centers will undoubtedly be reinforced, and the admission of immunotherapy, as a fundamental part of the treatment, remains important.

Corneal ulceration following periocular scorpion sting: a case report

BackgroundScorpion envenomation, a prevalent medical emergency in rural areas, demands immediate attention due to its potential severity. While ocular manifestations are uncommon, they can lead to significant complications such as corneal ulceration. We present a unique case of corneal ulceration subsequent to a yellow scorpion (Hemiscorpius lepturus) sting near the eye, a scenario not previously documented.Case presentationA 34-year-old male sought medical care following a scorpion sting despite prior anti-venom treatment. Clinical examination revealed pronounced ocular inflammation, corneal stromal melting, and anterior chamber inflammation, with microbiological confirmation of Pseudomonas spp infection. Treatment comprised fortified ceftazidime and vancomycin eye drops, alongside topical corticosteroids, leading to visual and corneal healing.ConclusionThis case highlights the urgency of addressing scorpion envenomation and its potential for severe ocular complications, including corneal ulceration. Prompt diagnosis and targeted therapy with antibiotics and corticosteroids are crucial for favorable outcomes. A comprehensive understanding and timely intervention in scorpion sting-induced ocular manifestations are essential for optimal patient management and outcomes in such cases.

EE89 The Economic Impact of Anti-Scorpion Serum in the Management of Scorpion Envenomation in Algeria

EE89 The Economic Impact of Anti-Scorpion Serum in the Management of Scorpion Envenomation in Algeria

Evaluation of the immunoprotective power of a multiple antigenic peptide against Aah II toxin of Androctonus australis hector scorpion

Scorpion envenoming (SE) is a public health problem in developing countries. In Algeria, the population exposed to the risk of SE was estimated at 86.45% in 2019. Thus, the development of a vaccine to protect the exposed population against scorpion toxins would be a major advance in the fight against this disease.This work aimed to evaluate the immunoprotective effect of a Multiple Antigenic Peptide against the Aah II toxin of Androctonus australis hector scorpion, the most dangerous scorpion species in Algeria. The immunogen MAP1Aah2 was designed and tested accordingly. This molecule contains a B epitope, derived from Aah II toxin, linked by a spacer to a universal T epitope, derived from the tetanus toxin.The results showed that MAP1Aah2 was non-toxic despite the fact that its sequence was derived from Aah II toxin. The immunoenzymatic assay revealed that the 3 immunization regimens tested generated specific anti-MAP1Aah2 antibodies and cross-reacted with the toxin. Mice immunized with this immunogen were partially protected against mortality caused by challenge doses of 2 and 3 LD50 of the toxin. The survival rate and developed symptoms varied depending on the adjuvant and the challenge dose used. In the in vitro neutralization test, the immune sera of mice having received the immunogen with incomplete Freund’s adjuvant neutralized a challenge dose of 2 LD50.Hence, the concept of using peptide dendrimers, based on linear epitopes of scorpion toxins, as immunogens against the parent toxin was established. However, the protective properties of the tested immunogen require further optimizations.

Behavioral, biochemical and histopathological alterations induced in Swiss mice by Buthus boumalenii scorpion venom

The yellow scorpion, Buthus boumalenii, has long been recognized as a potentially dangerous species endemic to Morocco. However, there is currently no data on the in vivo toxicity or effects of Buthus boumalenii venom, as it has not been studied to the best of our knowledge. In order to achieve the objective of this study, the LD50 of B. boumalenii venom will be initially calculated, followed by determining its impact on vital organs using histological, biochemical, and behavioral analyses. The investigation also explores potential neurobehavioral impairments in Swiss mice at intervals of 3 hours, 6 hours, and 12 hours post-envenomation. The LD50 for Buthus boumalenii scorpion venom in mice was determined to be 353 µg/kg based on body weight. The findings of the study highlight the potential lethality of B. boumalenii. Observations related to the poisoning provide indications of potential tissue damage in specific vital organs. To sum up, the venom from this scorpion has the potential to result in considerable medical complications, including fatalities, particularly in individuals at risk. Consequently, healthcare practitioners should be knowledgeable about the diverse scorpion species in their regions and adhere to contemporary medical protocols when addressing scorpion envenomation.

Beyond the venom: Exploring the antimicrobial peptides from Androctonus species of scorpion.

Prevalent worldwide, the Androctonus scorpion genus contributes a vital role in scorpion envenoming. While diverse scorpionisms are observed because of several different species, their secretions to protect themselves have been identified as a potent source of antimicrobial peptide (AMP)-like compounds. Distinctly, the venom of these species contains around 24 different AMPs, with definite molecules studied for their therapeutic potential as antimicrobial, antifungal, antiproliferative and antiangiogenic agents. Our review focuses on the therapeutic potential of native and synthetic AMPs identified so far in the Androctonus scorpion genus, identifying research gaps in peptide therapeutics and guiding further investigations. Certain AMPs have demonstrated remarkable compatibility to be prescribed as anticancer drug to reduce cancer cell proliferation and serve as a potent antibiotic alternative. Besides, analyses were performed to explore the characteristics and affinities of peptides for membranes. Overall, the study of AMPs derived from the Androctonus scorpion genus provides valuable insights into their potential applications in medicine and drug development.

Development and Efficacy of the Antivenom Specific to Severe Envenomations in Morocco and North Africa: Advancements in Scorpion Envenomation Management.

Scorpion envenomation poses a global public health issue, with an estimated 1,500,000 cases worldwide annually resulting in 2600 deaths. North Africa, particularly Morocco, experiences severe envenomations, mainly attributed to Androctonus mauretanicus and Buthus occitanus in Morocco, and Buthus occitanus and Androctonus australis hector in Algeria and Tunisia, with case numbers often underestimated. Current treatment relies mainly on symptomatic approaches, except in Morocco, where management is limited to symptomatic treatment due to controversies regarding specific treatment. In Morocco, between 30,000 and 50,000 scorpion envenomation cases are reported annually, leading to hundreds of deaths, mainly among children. Controversies among clinicians persist regarding the appropriate course of action, often limiting treatments to symptomatic measures. The absence of a specific antivenom for the venoms of the most lethal scorpions further exacerbates the situation. This study aims to address this gap by developing a monovalent antivenom against the endemic and most dangerous scorpion, Androctonus mauretanicus. The antivenom was produced by immunizing albino rabbits with a mixture of Androctonus mauretanicus venom collected from high-risk areas in Morocco. Immunizations were performed by subcutaneous injections at multiple sites near the lymphatic system, following an immunization schedule. Production control of neutralizing antibody titers was conducted through immunodiffusion. Once a sufficient antibody titer was achieved, blood collection was performed, and the recovered plasma underwent affinity chromatography. The efficacy of purified IgG was evaluated by determining the ED50 in mice, complemented by histological and immunohistochemical studies on its ability to neutralize venom-induced tissue alterations and the neutralization of toxins bound to receptors in the studied organs. The monovalent antivenom demonstrated specificity against Androctonus mauretanicus venom and effective cross-protection against the venom of the scorpions Buthus occitanus and Androctonus australis hector, highly implicated in lethal envenomations in the Maghreb. This study shows that the developed monovalent antivenom exhibits notable efficacy against local scorpions and a surprising ability to neutralize the most lethal envenomations in North Africa. These results pave the way for a new, more specific, and promising therapeutic approach to countering severe scorpion envenomations, especially in Morocco, where specific treatment is lacking.

Pediatric scorpion envenoming in Western Mexico

Pediatric scorpion envenoming in Western Mexico

Proteolytic Profile Alterations as One of the Scorpion’s &lt;i&gt;Leiurus macroctenus&lt;/i&gt; Envenomation Effects on Kidneys

Scorpion envenomation becomes a serious challenge for the healthcare systems in tropical and subtropical regions. Among the variety of organs being affected by the venom, kidneys can accumulate most of the toxins recently after the sting, therefore, the homeostasis, including the proteolytic homeostasis of the renal system during the envenomation is under question. Using the SDS-PAGE and zymography methods we have investigated the proteolytic profile in the rats’ kidneys during the Leiurus macroctenus scorpion envenomation. As it turned out, envenomation leads to the increase of the relative activity of enzymes with collagenolytic, gelatinolytic and fibrinogenolytic properties with molecular weights of 30-50 kDa and 50-70 kDa, simultaneously decreasing the relative activity of proteases with higher molecular weight (70-100 kDa). We have also observed the major changes occurring in 24 hours after the envenomation. We may assume that the obtained results are most likely related either to the formation of proteolytically active fragments of proteases with higher mass, or the excessive expression of proteases with lower mass, yet additional tests need to be conducted to prove these hypotheses. Significant changes in assessed parameters in 24h after the envenomation suggest the increased danger in this period of envenomation for the proteolytic homeostasis in kidneys and the integrity of the renal system overall. Therefore, the described effects can be an important reason for the kidney dysfunctions during the Leiurus macroctenus envenomation.

Clinical Profile of Patients with Scorpion Envenomation at a Peripheral Center of Western India: A Retrospective Study

Clinical Profile of Patients with Scorpion Envenomation at a Peripheral Center of Western India: A Retrospective Study

Clinical manifestations and management of Tityus species envenoming: A systematic review

Scorpionism, or a clinical picture of envenomation caused by a scorpion sting, is a public health problem in South America. The manifestations clinical and management are varied and complex and there is still no consensus in the literature on these aspects. The aim of this systematic review is to describe the clinical manifestations, as well as treatment after scorpion envenomation by Tityus species. The online databases of PubMed, Scopus, Web of Science, and SciELO were systematically searched for relevant publications until march 2022. No language and age restrictions were imposed. The literature search generated 476 references and 23 studies were included in the systematic review, according to the inclusion criteria of this review. The number of participants studied was 7,781. The specie Tityus serrulatus was found in more studies. The time elapsed between the accident and medical care ranged from 15 minutes to more than 6 hours. The treatments performed in selected studies include scorpion antivenoms, corticosteroids, anesthetics, antiemetics agents, inotropics, antihypertensives and benzodiazepines drugs. In six studies, fatal cases were observed in five children aged 1 to 6-y and one in children &lt; 14 y. We concluded that management of Tityus species envenoming is supportive and focused on the patient’s symptoms. In severe cases, antivenoms, if available, are indicated. Medications to monitor vagal and adrenergic symptoms are encouraged. This study has the potential to help professionals who deal with envenomations caused by the genus Tityus.

Scorpion envenomation in Brazil and its relationship with the social determinants of health: A population-based ecological study

This study comprehensively analyzed cases of scorpion envenomation in Brazil, exploring the temporal trends and geographic patterns of such incidents between January 1, 2012, and December 31, 2022. Simultaneously, we assessed the correlation between scorpion envenomation and social determinants of health and social vulnerability. We conducted a population-based ecological study, gathering information on the number of scorpion envenomation cases in Brazil, as well as socioeconomic data and social vulnerability indicators across the 5,570 Brazilian municipalities. The season-trend model, based on the classical additive decomposition method, informed estimations of scorpion envenomation variations over time. The spatial correlation of scorpion envenomation with socioeconomic and vulnerability indicators was assessed using the Bivariate Moran's I. A total of 1,343,224 cases of scorpion envenomation were recorded in Brazil from Jan 2012 to Dec 2022. A single increasing time trend was observed for the entire country for this period (APC 8.94, P < 0.001). The seasonal analysis was significant for Brazil as a whole and all regions (p < 0.001), with peaks evident between October and November. The spatial distribution of cases was heterogeneous, with spatial clusters concentrated in the high-risk Southeast and Northeast regions. There was a high incidence of scorpion envenomation in municipalities facing social vulnerability, and, paradoxically, in those with better sanitation and waste collection. Our study revealed a heterogeneous geographical distribution of scorpion accidents in Brazil. Municipalities with higher social vulnerability exhibited a high incidence of scorpion envenomation.