Scorpion Poisoning Research Articles

Pharmacognostical studies of "Maha Agad": A research article

Nature is the best combinatorial chemistry and possesses solutions to all ailments for the mankind. Evidences suggests that two thirds of the worlds herbal species bear therapeutic values, and these plants have been used in the traditional system of medicine since the onset of human civilization. In Ayurveda, Ashtang Sangrah UttarSthan, Acharya Vagbhatta has also mentioned one such formulation known as Maha Agad which is used in the context of treatment of snake, spider, rat and scorpion poisoning. Also used in the conditions like gastro enteritis, indigestion, artificial poison, fever & have bhutaghna properties. In today's scenario, the quality assurance of herbal medicine is an important factor and basic requirement for herbal drug industry. Standardized ayurvedic formulations of good quality are essential for beneficial therapeutic use. So, an attempt has been made to highlight this herbal preparation through the pharmacognostic studies and was analyzed by employing various parameters which included pharmacological, physicochemical parameters, and T.L.C profiling. The evolved parameters will be useful for quality control and standardization of Maha Agad.

ECMO FOR THE TREATMENT OF MODS DUE TO ORAL SCORPION TOXICOSIS: A CASE REPORT

TYPE: Abstract Publication TOPIC: Cardiovascular Disease PURPOSE: Scorpion sting poisoning kills 3,000 people worldwide every year. However, multiple organ dysfunction syndrome (MODS) induced by oral scorpion venom is rarely reported. Using extracorporeal membrane oxygenation (ECMO) as a treatment for scorpion poisoning has not been reported. METHODS: The purpose of this report was to describe a case of oral scorpion toxicosis observed in Shanghai, China, in a 64-year-old man with "arthritis". The patient rapidly developed toxic myocarditis, liver injury, renal injury and polyserositis due to the neurotoxic activity of the venom. Cardiomyopathy that can lead to fatal acute heart failure is a risk after scorpion toxicosis. Decreased blood pressure, pulmonary wedge pressure >20 mmHg, cardiac index <2.0 L/min/m2, urine output <20 ml/h, metabolic acidosis, and hyperlactacidaemia, even if not improved with large-dose positive vasoactive agents, all indicate severe scorpion toxicosis, and the condition requires close patient monitoring and symptomatic treatment using ECMO. Notably, plasmapheresis treats progressive bilirubin elevation, and continuous renal replacement therapy treats acute renal failure. With aggressive medical management, the patient recovered within a few days. RESULTS: We presented this case because of its unusual clinical presentation, unexpected complications, and prompt resolution. CONCLUSIONS: It is particularly important to clarify the medical history, diagnosis and use of multiple organ support treatment for scorpion poisoning as soon as possible to reduce the death rate. CLINICAL IMPLICATIONS: It is particularly important to clarify the medical history, diagnosis and use of multiple organ support treatment for scorpion poisoning as soon as possible to reduce the death rate. DISCLOSURE: No significant relationships. KEYWORDS: ECMO, MODS, scorpion toxicosis

Pathophysiology and treatment of cardiovascular and pulmonary effects in scorpion poisoning

Pathophysiology and treatment of cardiovascular and pulmonary effects in scorpion poisoning

Effect of climate change on spatial distribution of scorpions of significant public health importance in Iran

Objective: To establish a spatial geo-database for scorpions in Iran, and to identify the suitable ecological niches for the most dangerous scorpion species under different climate change scenarios. Methods: The spatial distribution of six poisonous scorpion species of Iran were modeled: Hemiscorpius lepturus, Androctonus crassicauda, Mesobuthus eupeus, Hottentotta saulcyi, Hottentotta zagrosensis, and Odontobuthus (O.) doriae, under RCP2.6 and RCP8.5 climate change scenarios. The MaxEnt ecological niche model was used to predict climate suitability for these scorpion species in the 2030s and 2050s, and the data were compared with environmental suitability under the current bioclimatic data. Results: A total of 73 species and subspecies of scorpions belonging to 19 genera in Iran were recorded. Khuzestan Province has the highest species diversity with 34 species and subspecies. The most poisonous scorpion species of Iran are scattered in the semi-arid climates, at an altitudinal range between 11 m and 2 954 m above sea level. It is projected that O. doriae, Androctonus crassicauda and Mesobuthus eupeus species would be widely distributed in most parts of the country, whereas the most suitable ecological niches for the other species would be limited to the west and/or southwestern part of Iran. Conclusions: Although the environmental suitability for all the species would change under the two climate change scenarios, the change would be more significant for O. doriae under RCP8.5 in the 2050s. These findings can be used as basis for future studies in the areas with the highest environmental suitability for the most dangerous scorpion species to fill the gaps in the ecology of scorpion species in these areas.

Effect of hyperbaric oxygen therapy in an animal model of C. Infamatus poisoning

IntroductionScorpions are arachnids distributed globally, cases of accidental sting are quiet common in dessert countries, and can cause lethal poisoning in humans especially in children. Sting symptoms begins immediately with burning pain in the area and progresses to its maximum severity within 5 hours. In this period there is a massive release of neurotransmitters that produces sweating, nausea and vomiting. The victims usually presents the main signs, the most common are mydriasis, nystagmus, hypersalivation, dysphagia and restlessness, in addition severe neurological signs such as convulsions, coma and death can occur. In adittion to this, some scorpions species poisoning, produces damage to organs such as heart, kidney, spleen and liver. The scorpion venom has been characterized with multiple proteins of different molecular weight, however it has been demonstrated that the toxins structure are selective antagonists of voltage‐dependent channels at K +, Na + and Ca2 +. Those that explains its effect on the central nervous, cardiovascular and muscular systems. It has also been described that the immune system does not have a direct participation on the pathophysiology of the venom, however it is thought that it has a relation on the organic alterations in spleen, liver and kidney mainly. The especific treatment is the antivenon Alacramyn and has been shown to have many beneficial effects on multiple pathologies, especially neurological, cardiovascular and metabolic, however its effects on the systemics symptoms have not been described. Due to its pathophysiology the hyperbaric oxygen chamber could have beneficial effects on the systemic poisoning evolution.ObjectiveCompare the effects of the hyperbaric oxygen therapy versus the antivenom Alacramyn on the systemic reactions of the scorpion venom Centruroides infamatus.Material and methodsWistar male rats of 45 days of life were used, different study groups were formed, the negative control group (C−) which was only exposed to 7 sessions of hyperbaric chamber at 2ATA for one hour, the positive control group (C +) which was inoculated with C. infamatus poison intraperitoneally, the group with hyperbaric chamber and poisoning (PHBO), which 24 hours after being inoculated with the poison was submitted to 15 sessions of hyperbaric oxygen chamber at 2 ATA, the poisoning group and Alacramyn (PAlc) and the poisoning group with Alacramyn and 15 sessions of hyperbaric chamber (PAH). Oxygen free radicals (ROS) and antioxidant agents were measured, in addition to performing histomorphological analyzes.ResultsChanges in the morphological pattern are observed with remarkable improvement when combining both therapies more than just the antivenom, in addition there is a decrease of free oxygen radicals and an increase of antioxidant agents in the same group.ConclusionThe addition of the hyperbaric chamber to the conventional treatment of scorpion poisoning can contribute to improve the evolution of the systemic reactions provoked by the C. infamatus venomSupport or Funding InformationSection of postgraduate studies and research and national council of science and technologyThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Scorpion stings and spider bites in the Upper Juruá, Acre – Brazil

Introduction: Epidemiological information on poisonings by venomous animals is fundamental in order to elaborate proposals for educational campaigns for prevention of poisonings, and may contribute to the improvement of the care of patients admitted to health facilities.&#x0D; Objective: Thus, the objective is to analyze the epidemiological profile of spider and scorpion poisoning in the Upper Juruá region, Western Amazonia, Brazil, from 2012 to 2017.&#x0D; Methods: Epidemiological data were obtained from the records of SINAN (Information System of Notifiable Diseases) in the Epidemiological Surveillance Sector of the Juruá Regional Hospital located in Cruzeiro do Sul.&#x0D; Results: There were 207 cases of accidents with arachnids, predominantly stinging by scorpions (148 cases, 71.9%), in the Regional Epidemiological Surveillance Sector of the Juruá Regional Hospital located in Cruzeiro do Sul. The average morbidity coefficient during the study period was 12 cases per 100,000 inhabitants for spider bites and 29.28 for scorpion stings. There was no correlation between spider and scorpion incidents with rainfall over the months during the study period.&#x0D; Conclusion: The average incidence of spider and scorpion incidents in the Upper Juruá region is one of the highest recorded for the Brazilian Amazon and is higher than the averages for Brazil, the Northern region and the state of Acre. Incidents with spiders and scorpions were not correlated with rainfall, and other factors associated with species biology or with human activities related to the temporal distribution, therefore there could be a risk of an arachnid incident throughout the year.&#x0D;

Should All Scorpion Stings be Followed Up in the Intensive Care Unit?

Aim: In Turkey, as throughout the world, the incidence of scorpion sting cases and the wide-ranging clinical table, extending from local symptoms to death have not been previously estimated. Therefore, through an examination of patients followed up in the Intensive Care Unit (ICU) and the complications, the aim of this study was to evaluate the indications for acceptance of these cases into ICU. Method: A retrospective examination was made of 59 patients admitted to the ICU of Adiyaman Training and Research Hospital because of a scorpion sting between 2013 and 2016. Results: All the patients had a unilateral extremity sting, presented at the Emergency Department within 8 hours and were administered anti-venom. In respect of local or systemic complications, thrombus developed in the proximal of the extremity in only 2 patients. With the exception of these 2 patients, all the other cases were discharged within 2 days without complications. Conclusion: Although the most poisonous scorpion in the world can be found in our region, no case admitted to the ICU in this 3-year period experienced any systemic complications. This is thought to be due to the early presentation at ED within the first 8 hours and that antivenom is produced in our region. In conclusion from this study, it can be recommended that patients with no requirement for the equipment of ICU should not be admitted and patients with local symptoms only should be monitored on the ward.

Effects of Tityus stigmurus (Thorell 1876) (Scorpiones: Buthidae) venom in isolated perfused rat kidneys.

Scorpions belonging to the Tityus genus are of medical interest in Brazil. Among them, Tityus stigmurus is the main scorpion responsible for stings in the Northeast region. After a sting, the scorpion venom distributes rapidly to the organs, reaching the kidneys quickly. However, there are few studies concerning the renal pathophysiology of scorpion poisoning. In this study, we evaluated the effects of T. stigmurus venom (TsV) on renal parameters in isolated rat kidneys. Wistar rats (n = 6), weighing 250-300 g, were perfused with Krebs-Henseleit solution containing 6 g/100 mL bovine serum albumin. TsV at 0.3 and 1.0 μg/mL was tested, and the effects on perfusion pressure (PP), renal vascular resistance (RVR), urinary flow (UF), glomerular filtration rate (GFR), and electrolyte excretion were analyzed. Effects were observed only at TsV concentration of 1.0 μg/mL, which increased PP (controlPP40' = 92.7 ± 1.95; TsVPP40' = 182.0 ± 4.70* mmHg, *p < 0.05), RVR (controlRVR40' = 3.28 ± 0.23 mmHg; TstRVR40' = 6.76 ± 0.45* mmHg, *p < 0.05), UF (controlUF50' = 0.16 ± 0.04; TstUF50' = 0.60 ± 0.10* mL/g/min,*p < 0.05), GFR and electrolyte excretion, with histological changes that indicate renal tubular injury. In conclusion, T. stigmurus venom induces a transient increase in PP with tubular injury, both of which lead to an augmented electrolyte excretion.

Hyperhidrosis–Hypertension–Hypotension in Scorpion Envenoming Syndrome: Insulin–Glucose Infusion Reverses All the Clinical Manifestations Caused by Massive Release of Counter-Regulatory Hormones due to Killer Scorpion (Buthidae family) Stings

Death due to poisonous scorpion (Buthidae family) stings is common in many of the developing countries all over the world. Severe uncontrollable pain at the site of sting (without local oedema) results in autonomic storm, release massive quantities of catecholamines, angiotensin II, ACTH, glucocorticoids, glucagon, ADH, aldosterone, either suppressed insulin secretion/or hyperinsulinemia – insulin resistance causing hyperglycemia and a sudden increase in Free Fatty Acid levels (FFA). The increase in catecholamine and angiotensin II hormonal levels cause hyperhidrosis, initial transient hypertension, hyper salivation, hypotension, mydriasis, miosis, DIC, acute pancreatitis, and many other clinical manifestations. Suddenly increased FFA levels are toxic, produce inactivation of Na+–K+ATPase activities, arrhythmias, conduction defects, myocardial infarction, cardiogenic pulmonary oedema, Acute Respiratory Distress Syndrome (ARDS), multisystem organ failure and death. Hyperhidrosis is harmful and wasteful loss of fluid and electrolytes resulting in peripheral circulatory failure, hypotension and death. Based on our animal experimental studies and treating the scorpion sting victims with insulin glucose infusion, we consider that insulin has a primary metabolic role in preventing and reversing hyperhidrosis, hypertension, hypotension, cardiovascular changes, cardiogenic and non-cardiogenic pulmonary (ARDS) oedema. Treatment: Continuous infusion of regular crystalline insulin at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48–72 hour, supplementation of potassium (if required), and maintenance of acid–base fluid and electrolyte balance.

Unique diversity of the venom peptides from the scorpion Androctonus bicolor revealed by transcriptomic and proteomic analysis

Androctonus bicolor is one of the most poisonous scorpion species in the world. However, little has been known about the venom composition of the scorpion. To better understand the molecular diversity and medical significance of the venom from the scorpion, we systematically analyzed the venom components by combining transcriptomic and proteomic surveys. Random sequencing of 1000 clones from a cDNA library prepared from the venom glands of the scorpion revealed that 70% of the total transcripts code for venom peptide precursors. Our efforts led to a discovery of 103 novel putative venom peptides. These peptides include NaTx-like, KTx-like and CaTx-like peptides, putative antimicrobial peptides, defensin-like peptides, BPP-like peptides, BmKa2-like peptides, Kunitz-type toxins and some new-type venom peptides without disulfide bridges, as well as many new-type venom peptides that are cross-linked with one, two, three, five or six disulfide bridges, respectively. We also identified three peptides that are identical to known toxins from scorpions. The venom was also analyzed using a proteomic technique. The presence of a total of 16 different venom peptides was confirmed by LC–MS/MS analysis. The discovery of a wide range of new and new-type venom peptides highlights the unique diversity of the venom peptides from A. bicolor. These data also provide a series of novel templates for the development of therapeutic drugs for treating ion channel-associated diseases and infections caused by antibiotic-resistant pathogens, and offer molecular probes for the exploration of structures and functions of various ion channels.

Epidemiological and Clinical Characteristics and Outcomes of Scorpion Envenomation in Hospitalized Children in Adiyaman, Turkey.

Epidemiological and Clinical Characteristics and Outcomes of Scorpion Envenomation in Hospitalized Children in Adiyaman, Turkey.

Suppressed Insulin Secretion, Elevated Mediators of Inflammation, Hyper-Insulinemia-Insulin Resistance: Insulin Administration Reverses Cardiovascular, Metabolic Changes, Pulmonary Edema and All Other Clinical Manifestations in Scorpion Envenoming Syndrome

Death due to poisonous scorpion stings is common in many tropical and sub-tropical countries. Scorpion envenoming syndrome causes stimulation of neuro-endocrine axis resulting in autonomic storm, intense stimulation of sympathetic nervous system, massive release of catecholamines, angiotensin II, suppressed insulin secretion, glucagon, glucocorticoids, increased free fatty acid levels, hyperglycemia, hyper-insulinemia, insulin resistance, acute myocarditis, initial hypertension, hypotension, arrhythmias, conduction defects, ischemia, infarction, acute pancreatitis, CNS damage, motor aphasia, hemiplegia, mydriasis, hyperhidrosis, acute respiratory distress syndrome, disseminated intravascular coagulation, multi system organ failure, shock and death. The scorpion envenoming syndrome also causes stimulation of immuno-pathological axis, systemic and local inflammation, increase in production of proinflammatory cytokines IL-1α, IL-1β, IL-4, IL-6, IL-10, IL-12, TNF-α, IFN-γ and NO and contribute to immunological imbalance, hyperglycemia, hyper-insulinemia, insulin resistance, multi-system organ failure, shock and death. Elevated levels of TNF-α cause impaired glucose tolerance and induce insulin resistance for endogenously secreted insulin. Insulin administration reversed metabolic, respiratory changes, cardiogenic and non-cardiogenic pulmonary edema, electrocardiographic, cardiovascular changes and many other manifestations in our experimental animals and in our scorpion sting victims with scorpion envenoming syndrome. Treatment: Continuous infusion of regular crystalline insulin at the rate of 0.3 U/g glucose and glucose at the rate of 0.1g/kg body weight/h, for 48–72 h, with supplementation of potassium as needed, maintenance of fluid, electrolytes, acidbase balance.

Acute Pancreatitis in Scorpion Envenoming Syndrome: Insulin-Glucose Administration Reverses Haemodynamic Changes, Pulmonary Edema and Other Clinical Manifestations Due to Scorpion (Mesobuthus tamulus Concanesis, Pocock [Buthidaefamily]) Stings

Death due to poisonous scorpion (Buthidae family) stings is a common event in the developing countries. Scorpion envenoming syndrome results in autonomic storm, release of catecholamines, angiotensin II, glucagon, glucocorticoids, either suppressed insulin secretion or hyperinsulinemia; hyperglycemia, lipolysis – sudden increase in free fatty acids (FFA), acute myocarditis, disseminated intravascular coagulation, cardiovascular disturbances, pulmonary oedema, acute pancreatitis, and many clinical manifestations. Under these altered hormonal mileu, insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming in the experimental animals and in scorpion sting victims. Insulin has a primary metabolic role in preventing, counter-acting and reversing the metabolic, cardiovascular, haemodynamic, and neurological manifestations and pulmonary oedema induced by scorpion envenoming and reversing all the deleterious effects of FFA by inhibiting the catecholamine induced lipolysis, and increase intra-cellular K+, facilitating glucose transport to the myocardium and glucose metabolism through different pathways. Profuse sweating, excessive salivation and abdominal pain are the triad of symptoms of ominous significance in scorpion sting victims with acute pancreatitis. Laryngeal spasm and respiratory failure are more common with acute pancreatitis. Continuous infusion of regular crystalline insulin should be given at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48–72 hours, with supplementation of potassium as needed and maintenance of fluid, electrolytes and acid-base balance.

Hypertension, Autonomic Storm, Increased Counter Regulatory Hormones and Suppressed Insulin in Acute Myocarditis in Scorpion Envenoming Syndrome

Death due to scorpion envenoming syndrome is a common event in many of the tropical and non-tropical counties. Initial transient hypertension is commonly observed in scorpion sting victims. Scorpion envenoming causes autonomic storm resulting in initial transient hypertension followed by hypotension, cold clammy skin, hypothermia, cardiovascular disturbances, acute myocarditis, sarcolemmal defects, pulmonary oedema, acute pancreatitis, disseminated intravascular coagulation (DIC), Adult respiratory distress syndrome (ARDS), and many other clinical manifestations. All these manifestations could be due to sudden increase in catecholamines, angiotensin II, glucagon, Cortisol and either due to suppressed insulin secretion or insulin resistance and death. The sudden increase of metabolic A in counter-regulatory hormones along with either suppressed insulin secretion/or insulin resistance results in glycogenolysis in liver, cardiac and skeletal muscles causing hyperglycemia and a sudden increase in free fatty acid levels. Free Fatty Acids increase the susceptibility of the ventricles to the disorganized electrical behavior, inhibit cardiac sarcolemmal Na+-K+ ATPase activity, increase the tendency to intravascular thrombus, increase myocardial oxygen consumption, interfere with tropomyosin-troponin activation of Actin-Myosin coupling, show detergent effects on cell membranes and they could alter the stabilization of lysosomal membranes and probably become toxic to the myocardium. Based on our animal experiments in which insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming and treating the poisonous scorpion sting victims with insulin, we consider that insulin has a primary metabolic role in preventing, counter-acting and reversing all the deleterious effects of FFA by inhibiting the catecholamine induced by lipolysis, and increasing intra-cellular K+, facilitating glucose transport to the myocardium and glucose metabolism through different pathways. Administration of insulin-glucose infusion to scorpion sting victims appears to be the physiological basis for the control of the metabolic response when that has become a determinant to survival. Treatment using continuous infusion of regular crystalline insulin should be given at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48 - 72 hours, with supplementation of potassium as needed and maintenance of fluid, electrolytes and acid-base balance.

Laryngeal Spasm in Scorpion Envenoming Syndrome

Death due to scorpion envenoming syndrome is a common event all over the world in tropical and sub-tropical countries. Scorpion envenoming syndrome results in a severe autonomic storm with a massive release of catecholamines, increased levels of angiotensin II, glucagon, cortisol, thyroid hormones, either hypoinsulinemia or hyperinsulinemia, hyperglycemia and increased free fatty acid levels. Under these conditions, scorpion envenoming syndrome with laryngeal spasm, fasciculations, clonus and tetany like skeletal muscle contractions, myocardial damage, disseminated intravascular coagulation, cardiovascular disturbances, peripheral circulatory failure, cardiac pulmonary oedema, adult respiratory distress syndrome, and many other clinical manifestations cause multi-systemorgan-failure and death. Under these altered conditions, scorpion envenoming essentially results in a syndrome of fuel – energy deficits and an inability to use the existing metabolic substrates by vital organs causing MSOF and death. Based on our animal experiments in which insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming and treating the poisonous scorpion sting victims with insulin, we consider that insulin has a primary metabolic role in preventing and reversing laryngeal spasm, fasciculations, clonus and tetany like contractions, the cardiovascular, neurological manifestations and pulmonary oedema. Administration of insulinglucose infusion to scorpion sting victims is the physiological basis for the control of the metabolic response when that has become a determinant to survival. Continuous infusion of regular crystalline insulin at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48–72 hours, potassium supplementation and maintenance of fluid, electrolytes and acid–base balance.

Cardiac Sarcolemmal Defects in Acute Myocarditis Due to Scorpion Envenoming Syndrome

Death due to scorpion envenoming syndrome is a common event in tropical and subtropical countries. Severe scorpion envenoming causes autonomic storm, massive release of catecholamines, counter-regulatory hormones, suppressed insulin/hyperinsulinemia, acute myocarditis, hyperglycemia, increased free fatty Acid levels, acute pancreatitis, disseminated intra-vascular coagulation, acute pulmonary oedema and death. Severe scorpion envenoming causes cardiac sarcolemmal defects displayed by alterations in Na+ - K+ ATPase, Mg++ ATPase and Ca2+ ATPase activities, inhibition of erythrocyte Na+ - K+ ATPase activities, hyperkalemia and may result in death. Based on our animal experiments in which insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming and treating the poisonous scorpion sting victims with insulin, we consider that insulin has a primary metabolic role in preventing and reversing acute myocarditis, the cardiovascular, haemodynamic, and neurological manifestations and pulmonary oedema induced by scorpion envenoming. Administration of insulin-glucose infusion to scorpion sting victims appears to be the physiological basis for the control of the metabolic response when that has become a determinant to survival. Continuous infusion of regular crystalline insulin should be given at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48 - 72 hours, with supplementation of potassium as needed and maintenance of fluid, electrolytes and acid-base balance. The observation of cardiac sarcolemmal defects and physiological basis of various patho-physiological mechanisms involved in the genesis of scorpion envenoming syndrome and its reversal (in the experimental animals and scorpion sting victims) by administration of insulin are reviewed.

Epidemiological, Clinical Characteristics and Outcomes of Scorpion Sting in Southeastern Region of Turkey

Scorpion sting resulting in envenomation is a life-threatening emergency and causes serious health problems in tropical and subtropical regions. The aim of this study was to present the epidemiologic and clinical features of 123 cases presenting with symptoms of scorpion poisoning, a cause of preventable mortality and morbidity. This study retrospectively analyzed the epidemiologic and demographic features of a total of 123 patients who presented to Diyarbakır State Hospital Emergency Service with scorpion sting between January 2008 and December 2009. Among 123 patients who presented to Diyarbakır State Hospital Emergency Service with scorpion sting between January 2008 and January 2009, 62.6% (n=77) were female and 37.4% (n=46) were male. The mean age of the patients was 33.5±17.3 years (2-80), and 27 (22%) patients were younger than 18 years. The place of residence was rural region in 98 (79.7%) patients and the city center in 25 (20.3%). The majority of victims were stung by scorpions while they were at active work (42.3%) or asleep (19.5%) in bed. Eleven (8.95%) patients were stung by a scorpion while putting on their own clothes. This simple descriptive study will hopefully help healthcare providers take measures to prevent scorpion stings, which should take into consideration local epidemiological features.

Diabody Mixture Providing Full Protection against Experimental Scorpion Envenoming with Crude Androctonus australis Venom

Androctonus australis is primarily involved in envenomations in North Africa, notably in Tunisia and Algeria, and constitutes a significant public health problem in this region. The toxicity of the venom is mainly due to various neurotoxins that belong to two distinct structural and immunological groups, group I (the AahI and AahIII toxins) and group II (AahII). Here, we report the use of a diabody mixture in which the molar ratio matches the characteristics of toxins and polymorphism of the venom. The mixture consists of the Db9C2 diabody (anti-group I) and the Db4C1op diabody (anti-AahII), the latter being modified to facilitate in vitro production and purification. The effectiveness of the antivenom was tested in vivo under conditions simulating scorpion envenomation. The intraperitoneal injection of 30 μg of the diabody mixture protected almost all the mice exposed to 3 LD(50) s.c. of venom. We also show that the presence of both diabodies is necessary for the animals to survive. Our results are the first demonstration of the strong protective power of small quantities of antivenom used in the context of severe envenomation with crude venom.

Dose-dependent effect of carbamazepine on weanling rats submitted to subcutaneous injection of tityustoxin

The scorpion envenoming syndrome is a serious public health matter in Brazil. The most severe cases occur during childhood and elderly. Previous results from our laboratory suggest that the effects of scorpion toxins on the central nervous system play a major role on the lethality induced by scorpion envenoming. The aim of this work is to evaluate the therapeutic potential of carbamazepine (CBZ) injected i.p. 90 min before s.c. tityustoxin (TsTX) injection in weanling rats. Rats were divided into six experimental groups according to s.c. injection (saline or TsTX) and i.p. treatment (vehicle or CBZ 12, 50 and 100 mg/kg): Sal/Veh group (n=4); Sal/CBZ100 (n=4); TsTX/CBZ12 (n=6); TsTX/CBZ50 (n=8); TsTX/CBZ100 (n=8) and, at last, TsTX/Veh (n=8). The dose of TsTX was the same for all groups: 6.0mg/kg, twice the DL50 for weanling rats. Video images were recorded until death or for a maximum period of 240 min. Lungs were excised and weighed to evaluate edema. The results showed that CBZ (12, 50 and 100mg/kg) was able to increase the survival rate and latency-to-death of the rats. Only the group treated with 100mg/kg of CBZ had a decrease in the pulmonary edema. The known effect of CBZ reducing neuronal excitability most likely protected the neural substrates targeted by TsTX. Although treatment was performed before TsTX inoculation, the results are promising regarding CBZ as a therapeutic coadjuvant in the treatment of scorpion poisoning. The pharmacokinetics of CBZ can be very much improved by either changing the form of administration or encapsulating the drug in order to enhance solubility.

Carbamazepine protects the CNS of Wistar rats against the central effects of scorpion envenomation

The scorpion envenoming syndrome is a serious public health matter in Brazil. Previous results from our laboratory suggest that the effects of scorpion toxins on the central nervous system play a major role on the lethality induced by scorpion envenoming. The objective of this work is to evaluate carbamazepine (CBZ) as a potential therapeutic agent against tityustoxin (TsTX) envenomation. The choice of i.c.v. toxin injection assures that TsTX is readily available in the parenchyma, configuring a worst case scenario for protecting the CNS afflicted by envenomation. Adult Wistar rats were submitted to surgery for guide cannulae (lateral ventricle) and electrodes (EEG-parietal cortices and ECG-thoracic leads) implantation. Animals ( n = 25) were treated with i.p. injections of either vehicle or CBZ 90 min before injected i.c.v. with a fixed volume of either saline or TsTX: vehicle treated/TsTX injected (1.74 μg, i.c.v.; n = 4), CBZ treated (50 mg/kg, i.p.)/TsTX injected ( n = 12); CBZ treated/saline injected ( n = 5); and vehicle treated/saline injected ( n = 4). Video EEG/ECG was recorded until death or for a maximum period of 90 min. Lungs were excised and weighed to evaluate edema. The results showed that 10 out of 12 CBZ treated rats survived to TsTX i.c.v. microinjection. CBZ significantly decreased cardiac arrhythmias and pulmonary edema in rats injected with TsTX. Furthermore, CBZ also significantly increased the latency for the first cortical epileptiform discharge. The known effect of CBZ reducing neuronal excitability most likely protected the neural substrates targeted by TsTX. CBZ was efficient in attenuating envenoming symptoms after the i.c.v. inoculation of the TsTX in rats. Thus, CBZ can be proposed as a therapeutic coadjuvant in the treatment of scorpion poisoning.