Scorpion Stings Presenting to an Emergency Department in Singapore With Special Reference to Isometrus Maculatus.
ABSTRACT OBJECTIVE.-: We describe the epidemiology and clinical features of scorpion stings presenting to an emergency department in Singapore, including that of the venomous species Isometrus maculatus. A management approach to scorpion stings is proposed. METHODS.-: A retrospective study was done for patients from 2004 to 2009. Cases were identified by searching through emergency department records with ICD code E905, inpatient records, and the hospital toxicology service records. Identification of species was assisted by the Venom and Toxin research program at the National University of Singapore. RESULTS.-: A total of 13 cases of scorpion stings were identified. Eleven stings occurred locally, and the remaining 2 stings occurred in neighboring countries. The most common presenting symptoms were pain (92%), numbness (31%), and weakness (23%) confined to the region of the sting. The most common clinical signs recorded were redness (77%), tenderness (77%), and swelling (46%). Only 2 patients had significant alterations of vital signs: 1 had hypertension and the other had hypotension from anaphylaxis. Three patients experienced complications (abscess formation, anaphylaxis, cellulitis) requiring inpatient management. There were no fatalities, and all patients made a good recovery. Three cases were identified to be stings from I maculatus. These cases occurred locally, and mainly had clinical features of pain, redness, and mild regional numbness. CONCLUSIONS.-: Scorpion stings are uncommon presentations to the emergency department. Most stings cause local reactions that can be managed with supportive treatment. Stings by I maculatus were observed to cause mild, self-limiting effects.
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ABSTRACT: There is little information on scorpion stings in Australia. The aim of this study is to describe the circumstances and clinical effects of stings by Australian scorpions. Cases of scorpion stings were collected prospectively from calls and presentations to Australian poison information centres and emergency departments from February 2000 to April 2002. Only definite scorpion stings where the scorpion was immediately collected and expertly identified were included. There were 95 patients, 33 males and 62 females, with a mean age of 32 (SD 19.5; range 1-71) and 23 children (age<15 years). Three families of scorpions caused all stings: Buthidae (79), Bothruiridae (11, all Cercophonius spp.) and Urodacidae (five, all Urodacus spp.). The majority of stings (76%) were by one genus of scorpion Lychas spp. Seventy one percent of stings occurred between 6pm and 8am and 82 (86%) occurred indoors. Sixty percent of stings occurred on distal limbs. The median duration of effects was 6 h (interquartile range (IQR): 1-24 h). Immediate localised pain occurred in all cases and was severe in 76 cases (80%). Other local effects included red mark/redness (66%), tenderness (35%), numbness (12%) and paraesthesia (11%). Minor systemic effects (nausea, headache and malaise) occurred in 11% of cases. There were no deaths or major systemic envenoming. Less severe effects were observed for the larger Urodacus species, compared to Lychas spp. Scorpion stings in Australia do not appear to cause severe or life-threatening effects, even in children. This differs from other parts of the world, where severe envenoming is reported. The major clinical effect is severe pain, consistent with other scorpion stings. Most stings occurred indoors and at night.Toxicon 06/2003; 41(7):877-83. DOI:10.1016/S0041-0101(03)00065-5 · 2.58 Impact Factor
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ABSTRACT: Scorpion venoms are composed of a number of peptides, many of which show neurotoxicity. In addition to these neurotoxins, several antimicrobial peptides have also been isolated from the venoms. The scorpion Isometrus maculatus, belonging to the Buthidae family, is found in many tropical regions including Japan, but little attention has been paid to its biological activity and chemical composition. In this study, we isolated a novel insect toxin, Im-1, by bioassay-guided fractionation of the venom of I. maculatus. Rapid and reversible paralysis was observed after injection of Im-1 into crickets. Im-1 consists of 56 amino acids, and is predicted to form an amphipathic alpha-helix. Since Im-1 shares sequence similarity to an antimicrobial peptide, parabutoporin, we evaluated its effects on several bacterial strains and found that it showed an antimicrobial activity profile similar to parabutoporin. This suggests that Im-1 and parabutoporin exert their antimicrobial effects through similar mechanisms.Bioscience Biotechnology and Biochemistry 02/2010; 74(2):364-9. DOI:10.1271/bbb.90723 · 1.21 Impact Factor
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ABSTRACT: Envenomation by Mesobuthus tamulus scorpion sting can result in serious cardiovascular effects. Scorpion antivenom is a specific treatment for scorpion sting. Evidence for the benefit of scorpion antivenom and its efficacy compared with that of commonly used vasodilators, such as prazosin, is scarce. We assessed the efficacy of prazosin combined with scorpion antivenom, compared with prazosin alone, in individuals with autonomic storm caused by scorpion sting. Prospective, open label randomised controlled trial. General hospital inpatients (Bawaskar Hospital and Research Centre Mahad Dist-Raigad Maharashtra, India). Seventy patients with grade 2 scorpion envenomation, older than six months, with no cardiorespiratory or central nervous system abnormalities. Scorpion antivenom plus prazosin (n=35) or prazosin alone (n=35) assigned by block randomisation. Treatment was not masked. Analysis was by intention to treat. The primary end point was the proportion of patients achieving resolution of the clinical syndrome (sweating, salivation, cool extremities, priapism, hypertension or hypotension, tachycardia) 10 hours after administration of study drugs. Secondary end points were time required for complete resolution of clinical syndrome, prevention of deterioration to higher grade, doses of prazosin required overall and within 10 hours, and adverse events. The study protocol was approved by the independent ethics committee of Mumbai. Mean (SD) recovery times in hours for the prazosin plus scorpion antivenom group compared with the prazosin alone groups were: sweating 3 (1.1) v 6.6 (2.6); salivation 1.9 (0.9) v 3 (1.9); priapism 4.7 (1.5) v 9.4 (1.5). Mean (SD) doses of prazosin in the groups were 2 (2.3) and 4 (3.5), respectively. 32 patients (91.4%, 95% confidence interval 76.9% to 97.8%) in the prazosin plus antivenom group showed complete resolution of the clinical syndrome within 10 hours of administration of treatment compared with eight patients in the prazosin group (22.9%, 11.8% to 39.3%). Patients from the antivenom plus prazosin group recovered earlier (mean 8 hours, 95% CI 6.5 to 9.5) than those in the control group (17.7 hours, 15.4 to 19.9; mean difference -9.7 hours, -6.9 to -12.4). The number of patients whose condition deteriorated to a higher grade was similar in both groups (antivenom plus prazosin four of 35, prazosin alone five of 35). Hypotension was reported in fewer patients in the antivenom plus prazosin group (12 of 35, 34.3%) than in the prazosin group (19 of 35, 54.3%), but the difference was not statistically significant. No difference was noted in change in blood pressure and pulse rate over time between two groups. Recovery from scorpion sting is hastened by simultaneous administration of scorpion antivenom plus prazosin compared with prazosin alone. CTRI/2010/091/000584 (Clinical Trials Registry India).BMJ (online) 01/2011; 342:c7136. DOI:10.1136/bmj.c7136 · 16.38 Impact Factor