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Envenomation by scorpion in dog: case report

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Abstract

A case admitted at the Small Animals Clinics Service, Veterinary Hospital, FMVZ - UNESP, in May, 1999 is described. A Brazilian Terrier dog, 3 years and 3 months old, weighing 1.7 kg was brought after 2 hours and a half from contact with a scorpion (Tityus bahiensis). The dog showed vocalization inserted with drowsiness. Physical examination showed slightly hyperemic mucous, pain, agressiveness, tachypnea, tachycardia, and discrete erythema on the right forelimb palmar face. An anesthetic block was performed around the stung area using 2% lidocaine hydrochloride without vasoconstrictor (10mL). The animal was asymptomatic, after 24 h treatment.
Received: December 10, 2001 J. Venom. Anim. Toxins incl. Trop. Dis.
Accepted: June 5, 2002 V.10, n.1, p.98-105, 2004.
Published online: February 14, 2004 Case report - ISSN 1678-9199.
ENVENOMATION BY SCORPION IN DOG – CASE REPORT
CARDOSO M. J. L.1, SAKATE M.2 , CIAMPOLINI P.2, MOUTINHO F. Q.2,
CHERUBINI A. L.3
1 Department of Animal Reproduction and Veterinary Radiology - College of Veterinary Medicine and
Animal Science (FMVZ), Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil; 2
Department of Veterinary Clinics, FMVZ, UNESP, Botucatu, São Paulo, Brazil; 3 Center for the Study
of Venoms and Venomous Animals (CEVAP), UNESP, Botucatu, São Paulo, Brazil.
ABSTRACT. A case admitted at the Small Animals Clinics Service, Veterinary Hospital,
FMVZ - UNESP, in May, 1999 is described. A Brazilian Terrier dog, 3 years and 3 months
old, weighing 1.7 kg was brought after 2 hours and a half from contact with a scorpion (Tityus
bahiensis). The dog showed vocalization inserted with drowsiness. Physical examination
showed slightly hyperemic mucous, pain, agressiveness, tachypnea, tachycardia, and discrete
erythema on the right forelimb palmar face. An anesthetic block was performed around the
stung area using 2% lidocaine hydrochloride without vasoconstrictor (10mL). The animal was
asymptomatic, after 24 h treatment.
KEYWORDS: scorpion, dog, envenomation, poisoning, Tityus bahiensis.
CORRESPONDENCE TO:
M. J. L. CARDOSO - R. Dr. Yves Ribeiro, 38, Vila Maria Alice, 86360-000, Bandeirantes,
Paraná, Brasil. E-mail: maurolahm@hotmail.com.br
M. J. L. Cardoso et al. ENVENOMATION BY SCORPION IN DOG – CASE REPORT. J. Venom. Anim. Toxins incl.
Trop. Dis., 2004, 10, 1, p.99.
INTRODUCTION
Despite the significant number of cases involving scorpionisms in humans, in certain regions,
their descriptions are rare in Brazilian pet animals or international literature. The scorpion
cases in Brazil and in other parts of the world are extremely important not only due to its high
incidence in specific regions but also due to its likelihood to induce severe or lethal cases,
especially in children (1,3,14,15,16).
Scorpions belong to Arachnida class, Scorpionidae order. There are more than 650 species
around the world; in Brazil, three scorpion species of the Tityus (T) genders are responsible
for severe accidents in humans and they are: T. serrulatus, T. bahiensis and T. stigmurus
(3,7). T. serrulatus is found in the southeast region, Parana state, south of Goias and Bahia
states; T. bahiensis occurs in the south and southeast regions, south of Minas Gerais state and
north of Argentina; T. stigmurus is predominant in the northeast regions, mainly in
Pernambuco and Paraiba states.
Scorpions are nocturnal creatures and the places where they stay are wood, piles of bricks,
slits, walls or basements, and they are also hidden in clothes and shoes.
Scorpions are not aggressive to humans or animals, they only sting when touched or
threatened and they are virtually blind; they feel their preys through soil vibrations in short
distance. In the last tail segment there are glands that secrete venom (4). T. bahiensis or black-
scorpion is 6 to 7 cm of length, and it has dark brownish with stained paws and tongues.
Most of physiopharmacological effects induced by scorpion toxin are due to actions in
specific sodium channel places, followed by depolarization of excitable cells membrane in the
organism. Consequently, there are massive catecholamines and acetylcholines released by
post ganglial nerve ends of sympathetic and parasympathetic systems and adrenal medullar
zone. This way, this substance (scorpion toxin), acting in different organism sites, is
responsible for many signs observed in scorpion cases (8).
Death due to scorpion accidents occurs by cardiocirculatory failure and it also could be by
pulmonary edema. It’s known that lethal dosage in dogs is 0.1 to 0.5 mg/kg. Clinical picture
presented will depend upon acethylcholine, adrenaline or noradrenaline effects prevalence.
Clinical occurrence is divided in local and systemic.
M. J. L. Cardoso et al. ENVENOMATION BY SCORPION IN DOG - CASE REPORT. J. Venom. Anim. Toxins incl.
Trop. Dis., 2004, 10, 1, p.100.
Local signs: local pain is present in almost every case and the intensity varies according to the
amount of venom inoculated and animal’s individual sensitiveness. The stung place is in most
cases difficult to be found because it is characterized by a discrete edema and hyperemia,
followed or not by sudoresis and local piloerection or in the whole limb. In severe cases, pain
may be unbearable, present as burning, sting or prick spreading on the whole limb and
becomes intense when palpation is performed. Pain may remain for several hours followed by
hyperesthesia or paresthesia, local or radiated which may remain for some days (11).
Systemic signs: dogs may show agitation, shivering, sudoresis, visual alterations, erythema
and priapism and may also show drowsiness and coma (19).
Severe hemorrhagic pancreatitis is one of the most severe consequences of scorpion accidents
in men, which shows sialism, nausea, vomiting, diarrhea and abdominal pain (18). Some
scorpion species may stimulate pancreatitis in dogs (2,17,20,22).
The respiratory alterations described are tachypnea and dyspnea with or without pulmonary
edema. They are attributed, at least experimentally, to toxin reflex effect on parasympathetic
system (21). Physical examination showed pulmonary rales and wheezes (19). Cardiovascular
physical findings are alternated tachycardia and bradycardia, arrhythmias, congestive cardiac
failure, severe edema and shock (1,5,13,18). In humans, there are suggestive myocarditis
alterations on echocardiogram and electrocardiogram (10) and /or myocardium acute infarct
(1,9,12,14,15). Cardiac alterations are reverted most of the time within the first week after the
accident (12).
Central nervous system alterations in scorpion accidents are various; most of them do not
show a clear physiopathology. In men, high adrenaline concentration in the brain, released by
the toxin, may cause shivers, seizure and anxiety. In animals, high dosages of adrenaline may
cause lethargy, spasticity and convulsion (21). Hypoxia provoked by cardiovascular
complications is responsible for the appearance of neurological signs (6). Shivers, muscle
contractions, agitation, myoclonies, hemiplegies, convulsions and coma are physical findings
observed in severe cases of scorpion accidents.
The clinical picture of scorpion accident is rich in signs derived from neurotransmitter
released in almost all tissues. In relation to diagnosis, therapeutic orientation and prognosis,
the scorpion accidents may be classified as mild, moderate and severe accidents. Besides
M. J. L. Cardoso et al. ENVENOMATION BY SCORPION IN DOG - CASE REPORT. J. Venom. Anim. Toxins incl.
Trop. Dis., 2004, 10, 1, p.101.
clinical manifestations, the factor “time” is also an auxiliary element to establish criteria of
the poisoning severity. In mild cases, only local manifestations and some systemic signs are
shown. In severe cases, there are local and systemic manifestations, involving almost all
organs.
The main findings on complementary examinations are hyperglycaemia, hyperamylasaemia,
hypokalaemia and leucocytosis with neuthrophilia, increase in Creatine Kinase (CK) and
Lactate dehydrogenase (LDH). In the presence of cardio-respiratory failure there may occur
acid-base disturbances. Besides, in some dogs, glycosuria, ketonuria, proteinuria and
myoglobinuria are present. The most frequent findings in electrocardiogram are: sinusal
tachycardia, migratory pacemaker, ventricular extra systoles and ST segment depression (10).
The main findings in echocardiography are left ventricular diffuse hypokinesia and
interventricular septum, ejection fraction decrease, light to moderate degree of mitral
regurgitation (1,6,14,15). Cardiomegaly and pulmonary edema in breast radiological
examination may be found.
Patients involved in scorpion accidents should remain in observation for 4 to 6 hours after the
stung even in mild cases. Severe cases, or with cardiopulmonary alterations, need an intensive
care. Therapy is aimed to combat poisoning signs, to maintain vital functions and to neutralize
the circulating venom.
CASE REPORT
A Brazilian Terrier dog, 3 years and 3 months old, 1.7kg weight, was admitted at the Service
of Small Animals Clinics, Veterinary Hospital - UNESP - Botucatu. The dog did not show
morbid antecedents, it was immunized against canine distemper, leptospirosis, hepatitis and
rabies.
The dog was brought to the Veterinary Hospital around 2 hours and 30 minutes after contact
with T. bahiensis scorpion species; adequately identified by the Center for the Study of
Venoms and Venomous Animals (CEVAP) - UNESP-Botucatu. The dog showed
vocalization
M. J. L. Cardoso et al. ENVENOMATION BY SCORPION IN DOG - CASE REPORT. J. Venom. Anim. Toxins incl.
Trop. Dis., 2004, 10, 1, p.102.
interpolated with drowsiness periods. Physical examination: normal temperature, hydrated,
slightly hyperemic mucous, increased sensitiveness on right fore limb palmar face (MAD),
aggressiveness, tachypnea (54 movements/minute) and tachycardia (184 beats/minute).
Besides, at the place of stung there was a subtle erythema. The animal underwent blood
collection for hemogram, serum biochemical profile and blood gas analysis. Chest
radiographic and electrocardiogram exams were performed. Complementary exams were
within normal patterns for the species. Before conclusive diagnosis, intravenous fluid therapy
was started with Ringer solution (50 mL/kg/h for 24 hours), and also an anesthetic block
around the stung spot with 2% lidocaine hydrochloride without vasoconstrictor (10mL).
Around 2 hours after anesthetic block the animal was calm and slept peacefully. After 24
hours the animal was asymptomatic.
DISCUSSION
Clinical picture was typically consistent with the issues discussed long before about
scorpions. Anamnesis characterized as a severe picture evolution, pain and erythema localized
was important to clear morbid picture.
General physical examination showed pain, aggressiveness, erythema, tachypnea and
tachycardia, besides vocalization interpolated by drowsiness periods. These findings are
totally consistent with mild scorpion accidents described by some authors (6,21).
Conclusive diagnosis was possible by the scorpion species identification, captured by the
dog's owner and identified by CEVAP as T. bahiensis, one of the three species responsible for
severe scorpion accidents in Brazil (6).
Complementary exams showed normal standards for the species, finding which was
consistent with those classically referred to mild scorpion accidents (1,6,14,15).
Anesthetic block around the stung using 2% lidocaine hydrochloride without vasoconstrictor
was used. When pain is intense, oral or parenteral potent analgesic “painkillers” are
recommended (12), which was not to this case.
M. J. L. Cardoso et al. ENVENOMATION BY SCORPION IN DOG - CASE REPORT. J. Venom. Anim. Toxins incl.
Trop. Dis., 2004, 10, 1, p.103.
Specific serotherapy is indicated in severe and mild cases. Anti-scorpion serum should be
done intravenously as fast as possible as neutralizing aim for circulating toxin. The Hospital
in Ribeirão Preto uses 2-4 ampoules in mild accidents and 5-10 in severe cases (6). Some
patients may show hypersensitiveness reactions after the use of anti-scorpion serum (7).
Clinical veterinarians should be alert and suspect scorpion accidents in dogs, especially those
living in places where scorpions are expected to be. Scorpion accidents are an emergency,
despite the low number of fatal accidents. Prognosis is hopeful when treatment is early
started. The biggest problem for emergency care is the lack of veterinary anti-scorpion serum,
despite symptomatic treatment is as important as serotherapy. There is a lack of data in
literature about scorpion accidents, making the veterinary work difficult. This report aimed to
bring clinical data from scorpion accident in dogs, to contribute for further knowledge on the
subject.
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... Elaborate study about envenomation and therapeutic management in humans has been done in India (Bawaskar, 1982). Scorpion envenomation although well studied and reported in humans (Bawaskar, 1982;Bahloul et al., 2004), reports are lacking in livestock animals (Cardoso et al., 2004;Gajalakshmi et al., 1978). ...
... humans are numerous and based on the species and venom composition; the treatment protocols have been standardized to enhance the recovery rate (Bawaskar and Bawaskar, 2012). Cardoso et al. (2004) In conclusion, scorpion envenomation in buffaloes can be diagnosed based on circumstantial evidence and can be successfully treated symptomatically with prompt attention for uneventful recovery. ...
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Nine children, hospitalized for severe respiratory failure following scorpion envenomation, were a part of a group of 61 youngsters and infants admitted to the Pediatric Intensive Care Unit of the Soroka Medical Center, Beer-Sheva during the years 1983-87 because of scorpion venom intoxication. Four out of the nine had cardiogenic shock, three had severe systemic hypertension and one had severe airway obstruction. All nine patients had central nervous system manifestations, including lethargy, confusion and agitation (three cases), and markedly reduced level of consciousness (six cases). Hemodynamic studies performed in two patients showed 'high pressure' (cardiogenic) pulmonary edema. Seven patients recovered completely, one died and another one was left severely handicapped. Hydralazine i.v. showed a remarkable effect on the systemic blood pressure and central nervous system disturbances in addition to mechanical ventilation. Based on our own experience and previous clinical and experimental studies, the possible pathogenetic mechanisms underlying the respiratory and central nervous system dysfunction following scorpion sting are discussed.
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Acute hemorrhagic pancreatitis has been produced in dogs by two separate intraarterial injections (20 and 10 micrograms/kg) of venom from the scorpion Buthus quinquestriatus. Morphological changes related to the development of the disease were detectable by electron and light microscopy at 1 and 3 hr, respectively, following the injection of venom. Six hours following venom injection, widespread areas of hemorrhage and fat necrosis were observed on the surface of the pancreas and adjacent mesenteries. By 24 hr, areas of fat necrosis more than 1 cm in diameter were present on the surface of the pancreas. No free protease was found in pure pancreatic juice collected at 3, 6, 24, and 96 hr after the injection of Buthus quinquestriatus venom. Amylase concentrations in serum increased to a maximum sevenfold above the basal level at 6-8 hr after injection. Since acute hemorrhagic pancreatitis occurred both with and without pancreatic duct cannulation, it is likely that the pathological process is independent of any venom effect on papillary sphincter tone. The morphological characteristics of the experimental disease appear similar to those observed at autopsy in acute hemorrhagic pancreatitis in humans.
Article
The hemodynamic effects of scorpion venom (Leiurus quinquestriatus) and the mechanism of heart failure were investigated in two groups of anesthetized spontaneously breathing dogs. The effects of different adrenergic and cholinergic blocking agents on the venom-induced hemodynamic changes were also evaluated. In one group the venom was given before autonomic nervous system blocking agents and in a second group propranolol, atropine, phentolamine and hexamethonium alone or in different combinations were given before the venom. Complete autonomic nervous system blockade was induced in two animals to evaluate a possible direct myocardial effect of venom.The venom, a powerful arrhythmogenic agent stimulating the autonomic sympathetic nervous system and adrenals, induced dramatic hemodynamic increases in left ventricular systolic and diastolic pressures, pulmonary and systemic arterial pressures and left ventricular contractility. The hemodynamic data show clearly for the first time that pulmonary edema in severe scorpion envenomation is cardiac in origin, thus emphasizing the importance of the abnormal left ventricular hemodynamics. Heart failure is most probably the result of the interaction of several mechanisms that include a catecholamine-induced decrease in left ventricular compliance and increased impedance to left ventricular emptying and cardiac arrhythmias, all of which may impede left ventricular filling. The combination of propranolol and phentolamine was the most effective blocking agent in reversing the venom-induced hemodynamic changes. However, atropine was effective only when the venom-induced cholinergic effects dominated the clinical picture.