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Species of scorpions of medical importance in Brazil. Upper left. Tityus serrulatus (yellow scorpion). Upper right. Tityus stigmurus. Lower left. Tityus bahiensis (brown scorpion). Lower right. Tityus obscurus. Photographs: Denise Cândido.
Source publication
Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a significant public health problem globally. Only scorpions of the Tityus genus are of medical importance in Brazil, and Tityus serrulatus is responsible for the most serious envenomations and deaths. The toxic effects of scorpion envenomation are d...
Context in source publication
Context 1
... Brazil, medically important scorpions belong to Tityus genus; the major envenoming-related species are T. serrulatus and T. bahiensis in the Southeast, T. stigmurus in the Northeast, and T. obscurus (paraensis) in the North (Figure 1) (5) . Most stings involve mild envenoming, while more serious envenoming is caused by T. serrulatus (3) (4) (5) ...
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Citations
... Crianças entre zero a 9 anos correspondem a cerca de 10 a 13% dos casos leves, mas representam um terço de todas as vítimas fatais de escorpionismo.¹ O veneno do escorpião é uma mistura complexa de proteínas neurotóxicas, proteases, hipontensinas, hialuronidases, sais, carboidratos e mucopolissacarídeos. 2,3 As toxinas agem na liberação de catecolaminas com manifestações simpáticas e parassimpáticas. 3 A combinação entre excitação simpática e liberação de fatores inflamatórios, citocinas e catecolaminas no plasma causa a maioria dos efeitos sistêmicos graves, incluindo insuficiência cardíaca, edema pulmonar e choque cardiogênico. ...
... O veneno do escorpião é uma mistura complexa de proteínas neurotóxicas, proteases, hipontensinas, hialuronidases, sais, carboidratos e mucopolissacarídeos. 2,3 As toxinas agem na liberação de catecolaminas com manifestações simpáticas e parassimpáticas. 3 A combinação entre excitação simpática e liberação de fatores inflamatórios, citocinas e catecolaminas no plasma causa a maioria dos efeitos sistêmicos graves, incluindo insuficiência cardíaca, edema pulmonar e choque cardiogênico. 2,3 Os mecanismos envolvidos na disfunção cardíaca e edema pulmonar após envenenamento escorpiônico são complexos, mas parecem resultar de uma combinação de miocardite induzida por catecolaminas, ação de citocinas e fatores inflamatórios e do efeito direto da toxina sobre o miocárdio. ...
... 3 A combinação entre excitação simpática e liberação de fatores inflamatórios, citocinas e catecolaminas no plasma causa a maioria dos efeitos sistêmicos graves, incluindo insuficiência cardíaca, edema pulmonar e choque cardiogênico. 2,3 Os mecanismos envolvidos na disfunção cardíaca e edema pulmonar após envenenamento escorpiônico são complexos, mas parecem resultar de uma combinação de miocardite induzida por catecolaminas, ação de citocinas e fatores inflamatórios e do efeito direto da toxina sobre o miocárdio. 2,3 O envenenamento causa sintomas locais e sistêmicos. ...
O escorpionismo lidera o ranking de ocorrências de acidentes com animais peçonhentos no Brasil, sendo as crianças o grupo de maior vulnerabilidade às complicações do acidente. Este é o relato de caso de um paciente de 6 anos que evoluiu com choque cardiogênico após acidente escorpiônico grave. Na abordagem diagnóstica e terapêutica do paciente, a utilização do ultrassom point-of-care otimizou o tempo de administração de medicamentos, auxiliou nos procedimentos invasivos necessários e promoveu avaliação imediata após terapias instituídas, em cada fase da abordagem. O intuito deste relato é demonstrar a importância dessa ferramenta na avaliação clínica do paciente com sinais de escorpionismo grave no setor de emergência.
... Four studies (Borges et al., 2015;De Sousa et al., 2007;Román et al., 2018) have reported the use of metoclopramide as an antiemetic agent. If profuse vomiting does not cease after scorpion antivenom, antiemetics can be used (Cupo, 2015). ...
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 < 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.
... Among the various scorpion species found in Brazil, those belonging to the Tityus genus are of medical importance. The Tityus serrulatus scorpion is responsible for the most severe cases of envenomation and fatalities [5,6], especially in areas of human population densities [7]. This scorpion's venom is a complex mixture of various molecules, including low molecular weight peptides such as neurotoxins and high molecular weight proteins such as enzymes [6,8]. ...
... In addition to local symptoms, systemic manifestations can also occur. Tachycardia, diaphoresis, profuse sweating, psychomotor agitation, tremors, nausea, vomiting, sialorrhea, arterial hypertension, or hypotension are some systemic symptoms observed after T. serrulatus envenoming [3,5,6]. In severe systemic manifestations, other clinical manifestations may occur, including acute pulmonary edema, cardiovascular collapse, cardiac arrhythmia, congestive heart failure, and shock. ...
Tityus serrulatus scorpion is responsible for a significant number of envenomings in Brazil, ranging from mild to severe, and in some cases, leading to fatalities. While supportive care is the primary treatment modality, moderate and severe cases require antivenom administration despite potential limitations and adverse effects. The remarkable proliferation of T. serrulatus scorpions, attributed to their biology and asexual reproduction, contributes to a high incidence of envenomation. T. serrulatus scorpion venom predominantly consists of short proteins acting as neurotoxins (α and β), that primarily target ion channels. Nevertheless, high molecular weight compounds, including metalloproteases, serine proteases, phospholipases, and hyaluronidases, are also present in the venom. These compounds play a crucial role in envenomation, influencing the severity of symptoms and the spread of venom. This review endeavors to comprehensively understand the T. serrulatus scorpion venom by elucidating the primary high molecular weight compounds and exploring their potential contributions to envenomation. Understanding these compounds' mechanisms of action can aid in developing more effective treatments and prevention strategies, ultimately mitigating the impact of scorpion envenomation on public health in Brazil.
... The Tityus serrulatus sting is responsible for most cases of severe and fatal progression (3,4,9) . The toxins released in the sting can cause serious cardiovascular and respiratory effects due to the action of the venom on brainstem and spinal cord structures that act in neurovegetative control (3,9) , and massive autonomic response (4,9) . ...
... The Tityus serrulatus sting is responsible for most cases of severe and fatal progression (3,4,9) . The toxins released in the sting can cause serious cardiovascular and respiratory effects due to the action of the venom on brainstem and spinal cord structures that act in neurovegetative control (3,9) , and massive autonomic response (4,9) . The venom, or part of it, can cross the blood-brain barrier, mainly in young individuals, in whom it is not completely formed, reaching the central nervous system. ...
... The Tityus serrulatus sting is responsible for most cases of severe and fatal progression (3,4,9) . The toxins released in the sting can cause serious cardiovascular and respiratory effects due to the action of the venom on brainstem and spinal cord structures that act in neurovegetative control (3,9) , and massive autonomic response (4,9) . The venom, or part of it, can cross the blood-brain barrier, mainly in young individuals, in whom it is not completely formed, reaching the central nervous system. ...
Objective
To characterize scorpion accidents at the Information and Toxicological Assistance Center (CIATox) in Campinas, to analyze risk factors related to the moderate and severe classification, and to determine the age group at greatest risk for this classification.
Method
Cross-sectional and retrospective study, with patients assisted in person at CIATox, who had a scorpion accident, from January 2015 to December 2019. Descriptive and inferential analysis was conducted. For the age variable, a ROC curve was constructed to determine cutoff points in relation to the severity classification. Poisson regression models were adjusted considering severity classification as the dependent variable.
Results
A total of 754 cases with a mean age of 36.05 years, mostly female and non-occupational accidents that occurred in the urban area, was analyzed. The most frequent scorpion was the Tityus serrulatus. The risk factors found for greater severity were age group up to 22 years and previous care in other health services.
Conclusion
The age range up to 22 years old should be used as a predictive factor of severity in the clinical evaluation of patients stung by scorpions to carry out adequate management of cases.
DESCRIPTORS
Scorpion Stings; Risk Factors; Nursing
... A picada do Tityus serrulatus é responsável pela maioria dos casos de evolução grave e fatal (3,4,9) . As toxinas liberadas na picada podem causar graves efeitos cardiovasculares e respiratórios devido à ação do veneno em estruturas do tronco cerebral e da medula espinal que atuam no controle neurovegetativo (3,9) , e maciça resposta autonômica (4,9) . ...
... A picada do Tityus serrulatus é responsável pela maioria dos casos de evolução grave e fatal (3,4,9) . As toxinas liberadas na picada podem causar graves efeitos cardiovasculares e respiratórios devido à ação do veneno em estruturas do tronco cerebral e da medula espinal que atuam no controle neurovegetativo (3,9) , e maciça resposta autonômica (4,9) . O veneno ou parte dele pode atravessar a barreira hematencefálica, principalmente em indivíduos jovens, em que ela não está completamente formada, alcançando o sistema nervoso central. ...
... A picada do Tityus serrulatus é responsável pela maioria dos casos de evolução grave e fatal (3,4,9) . As toxinas liberadas na picada podem causar graves efeitos cardiovasculares e respiratórios devido à ação do veneno em estruturas do tronco cerebral e da medula espinal que atuam no controle neurovegetativo (3,9) , e maciça resposta autonômica (4,9) . O veneno ou parte dele pode atravessar a barreira hematencefálica, principalmente em indivíduos jovens, em que ela não está completamente formada, alcançando o sistema nervoso central. ...
Objective
To characterize scorpion accidents at the Information and Toxicological Assistance Center (CIATox) in Campinas, to analyze risk factors related to the moderate and severe classification, and to determine the age group at greatest risk for this classification.
Method
Cross-sectional and retrospective study, with patients assisted in person at CIATox, who had a scorpion accident, from January 2015 to December 2019. Descriptive and inferential analysis was conducted. For the age variable, a ROC curve was constructed to determine cutoff points in relation to the severity classification. Poisson regression models were adjusted considering severity classification as the dependent variable.
Results
A total of 754 cases with a mean age of 36.05 years, mostly female and non-occupational accidents that occurred in the urban area, was analyzed. The most frequent scorpion was the Tityus serrulatus. The risk factors found for greater severity were age group up to 22 years and previous care in other health services.
Conclusion
The age range up to 22 years old should be used as a predictive factor of severity in the clinical evaluation of patients stung by scorpions to carry out adequate management of cases.
DESCRIPTORS
Scorpion Stings; Risk Factors; Nursing
... Hyperglycemia can also result in modi cations to electrocardiograms [19]. Pulmonary edema and cardiac dysfunction are closely correlated with high glucose levels [25]. ...
Back ground
Scorpion envenomation is a common health problem all over the world. Recent experimental studies on animals were held to prove the correlation between interleukin 1 β (IL-1β), lipid peroxidation and nitric oxide (NO) production in the development of cardiac and pancreatic abnormalities after scorpion venom exposure. The aim of this study is to assess the correlation of lipid peroxidation and IL-1β release and the development of cardiac and pancreatic complications associated with scorpion envenomation in humans which will subsequently evaluate their role in prediction of cardiac or pancreatic complications and help the physicians when to determine to use antioxidants and (IL-1β) receptor blockers in treatment in addition to scorpion antivenom.
Methods
In this study, 88 subjects were recruited from El-Minia university hospital. All the patients admitted with scorpion envenomtion diagnosis were enrolled over a period of 12 months; from the 1st of Jan 2021 till the 30th of Jan 2022. After exclusion of 7 patients, the remaining subjects were divided into four groups of subjects according to their cardiac function into two groups: group A with normal cardiac function contained: 30 normal subjects, group B contained 51 subjects who had abnormal cardiac functions. The patients were considered to have abnormal cardiac function if they had at least one or more abnormal cardiac investigations (cardiac troponin I (c TN-I), electrocardiogram (ECG), and/or, trans thoracic echocardiography (TTE)).The same patients were divided into another two groups: group C with normal pancreatic function contained: 36 normal subjects, group D contained 45 subjects who had abnormal pancreatic function. Pancreatic function was considered abnormal if one or both of serum amylase & random blood sugar results weren’t normal.
Results
Our results showed the following: Regarding cardiac abnormality, there were significant statistical differences with both levels of IL-1β and MDA. Regarding pancreatic abnormality, there were insignificant statistical differences with both levels of IL-1β and MDA. Cutoff values were calculated to help health care providers to assess when to introduce such treatments in addition to antivenom to help to counteract these complications and decline the mortality rates.
Conclusion
It was concluded that IL-1β and MDA have significant correlations in development of cardiac and pancreatic functions abnormalities; the treatments that modify their release or counteract their action may be beneficial.
Trial registration
The research was approved by the ethical committee board of the faculty of medicine, Minia University, with approval number 206: December/2021. Patients or their first degree relatives (according to the conscious level) were informed by all procedures included in the study and were asked to sign informed consent if they agreed to participate in.
... The species Tityus serrulatus (Brazilian yellow scorpion), is considered the most dangerous in South America (Reckziegel;Pinto Jr, 2014), being responsible for the majority of the accidents related to venomous animals (Cupo, 2015). ...
The effects of Tityus serrulatus venom was accessed on the cell cycle and genetic material of the Lactuca sativa L. and compared with the damages to human leukocytes, in order to evaluate the genotoxic and mutagenic potential of toxins on cell types very different. The occurrence of cell cycle alterations and DNA fragmentation was evaluated in Lactuca sativa. Incubations of venom with human leukocytes were also held with subsequent evaluation of cell proliferation index, micronucleus and fragmented DNA. The T. serrulatus venom showed cytogenotoxic, reducing mitotic index and induced alterations in the cell cycle and micronuclei formation. The occurrence of cell death was evidenced by the detection of condensed nuclei, positive TUNEL signals, and presence of DNA fragmentation on lettuce cells. The scorpion venom induced DNA fragmentation and micronuclei in leukocytes. Further, the role of peptides and proteases from this venom in inducing the observed damage was discussed.
... Scorpion venoms are abundant in neurotoxins that commonly induce adrenergic excess. The most clinically important toxins are α-toxins that inhibit the inactivation of neuronal Na + channels [9], the reason behind pulmonary edema and hemorrhages (mostly fatal) in various human case reports [9,10,119,120] and animal studies [121][122][123]. Almost all these dangerous stings are by scorpions belonging to the family Buthidae -genera Androctonus, Buthus, Tityus, and Mesobuthus, and rarely, the family Caraboctonidae -genus Hadruroides. ...
Abstract Venomous animals and their venom have always been of human interest because, despite species differences, coevolution has made them capable of targeting key physiological components of our bodies. Respiratory failure from lung injury is one of the serious consequences of envenomation, and the underlying mechanisms are rarely discussed. This review aims to demonstrate how toxins affect the pulmonary system through various biological pathways. Herein, we propose the common underlying cellular mechanisms of toxin-induced lung injury: interference with normal cell function and integrity, disruption of normal vascular function, and provocation of excessive inflammation. Viperid snakebites are the leading cause of envenomation-induced lung injury, followed by other terrestrial venomous animals such as scorpions, spiders, and centipedes. Marine species, particularly jellyfish, can also inflict such injury. Common pulmonary manifestations include pulmonary edema, pulmonary hemorrhage, and exudative infiltration. Severe envenomation can result in acute respiratory distress syndrome. Pulmonary involvement suggests severe envenomation, thus recognizing these mechanisms and manifestations can aid physicians in providing appropriate treatment.
... (11) La temperatura y la humedad son factores importantes que contribuyen a la variación de presentación de picaduras de alacranes. (12) La familia Buthidae contiene 972 especies descritas en 80 géneros, (13) siendo la única familia con especies consideradas potencialmente peligrosas para el hombre, por los componentes activos de sus venenos. ...
... (15) Se debate el mecanismo de cardiotoxicidad con edema pulmonar agudo después de la picadura de escorpión, pero probablemente refleja una interacción compleja de múltiples efectos del veneno, incluida la vasoconstricción coronaria, microcirculatoria cardíaca y sistémica mediada por catecolaminas; taquicardia y arritmias inducidas por catecolaminas; y depresión de la contractilidad miocárdica causada por los efectos directos del veneno y la respuesta proinflamatoria al envenenamiento. (12,18) www.revcmpinar.sld.cu ...
Introducción: las picaduras de escorpión son comunes en diversas partes del mundo y son un verdadero problema de salud pública.
Objetivo: describir las especies de alacranes, características del veneno, fisiopatología, manifestaciones clínicas, clasificación de la gravedad, diagnóstico y su manejo en la unidad de
cuidados intensivos. Métodos: se realizó una búsqueda de información en el periodo febrero-marzo de 2023 en las
bases de datos SciELO, Scopus, PubMed/MedLine, el buscador Google Académico, así como en los servicios ClinicalKeys. De los documentos resultantes se seleccionaron aquellos redactados
en los últimos 10 años, en idioma español o inglés.
Desarrollo: aproximadamente existen 2584 especies de alacranes. La especie Tityus (Tityus) sorataensis fue descrita para Bolivia. Los venenos de escorpión se han estudiado durante más
de un siglo. Las principales manifestaciones clínicas: placas de urticaria, hinchazón, eritema, equimosis y celulitis con edema. Las manifestaciones sistémicas van de uno a dos días después
del envenenamiento y pueden desarrollar signos sistémicos: fiebre, palidez, fatiga, edema
generalizado. El diagnóstico se basa en una historia de una picadura de escorpión y signos característicos de envenenamiento. El tratamiento puede ser empírico, aplicar medidas generales, manejo del dolor y si está presente algunas complicaciones como edema pulmonar,choque cardiogénico es necesario su manejo en una sala de cuidados intensivos
... Cases of scorpionism have significantly increased due to the high frequency of their occurrence and their severity, representing an emerging public health problem in Brazil, being more common in dry, humid, coastal, and urban areas (Cupo, 2015;Fontenele et al., 2015;Shibakura et al., 2020). In 2020, 238,433 accidents involving venomous animals were reported in Brazil. ...
... It can be concluded that the severity of systemic effects caused by different scorpion species depends on the composition of the venom and the physical characteristics of the affected individuals. In general, children under the age of twelve and, less commonly, the elderly with associated comorbidities present the worst symptoms, with most deaths occurring in these age groups (Reckziegel & Pinto, 2014;Cupo, 2015). ...
Scorpion sting accidents have a significant impact in Brazil, leading to increased hospitalizations and healthcare costs, especially in regions with high scorpion populations. The present study aimed to perform an epidemiological analysis of these accidents in Southeastern Brazil. It is an epidemiological, ecological, and mixed-design study. The methodological strategy involved the analysis of epidemiological bulletins provided by the Sistema de Informação de Agravos de Notificação (Sinan) from 2011 to 2022. The data revealed that 613,385 cases of accidental scorpion bites were reported. Minas Gerais had the highest number of cases (50.44%). Males, Caucasians, between 20 and 59 years old, with a low level of education, are the most affected. Victims sought medical attention within 3 hours of the bite, and 27.34% were on the fingers. About 89.7% of the cases were classified as mild, 95.33% were cured, and 0.78% died from the reported disease. The results highlight the urgent need for targeted prevention strategies, improved medical management, and community awareness campaigns to reduce the impact of scorpion stings in the southeastern region of Brazil.
