Clinical manifestations and management of Tityus species envenoming: A systematic review
DOI:
https://doi.org/10.33448/rsd-v13i2.45161Keywords:
Clinical manifestations; Scorpions; Scorpion stings; Systematic review.Abstract
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.
References
Abraham, W. T., Adams, K. F., Fonarow, G. C., Costanzo, M. R., Berkowitz, R. L., LeJemtel, T. H., & Group, A. S. (2005). In-hospital mortality in patients with acute decompensated heart failure requiring intravenous vasoactive medications: an analysis from the Acute Decompensated Heart Failure National Registry (ADHERE). Journal of the American College of Cardiology, 46(1), 57-64.
Abroug, F., ElAtrous, S., Nouria, S., Haguiga, H., Touzi, N., & Bouchoucha, S. (1999). Serotherapy in scorpion envenomation: a randomised controlled trial. The Lancet, 354(9182), 906-909.
Abroug, F., Ouanes-Besbes, L., Tilouche, N., & Elatrous, S. (2020). Scorpion envenomation: state of the art. Intensive Care Med, 46(3), 401-410. https://doi.org/10.1007/s00134-020-05924-8
Aksel, G., Güler, S., Doğan, N., & Çorbacioğlu, Ş. (2015). A randomized trial comparing intravenous paracetamol, topical lidocaine, and ice application for treatment of pain associated with scorpion stings. Human & Experimental Toxicology, 34(6), 662-667.
Amaral, C. F., Dias, M. B., Campolina, D., Proietti, F. A., & de Rezende, N. A. (1994). Children with adrenergic manifestations of envenomation after Tityus serrulatus scorpion sting are protected from early anaphylactic antivenom reactions. Toxicon, 32(2), 211-215. https://doi.org/10.1016/0041-0101(94)90110-4
Bahloul, M., Chaari, A., Ammar, R., Allala, R., Dammak, H., Turki, O., & Bouaziz, M. (2013). Severe scorpion envenomation among children: does hydrocortisone improve outcome? A case-control study. Transactions of the royal society of tropical medicine and hygiene, 107(6), 349-355.
Bawaskar, H., & Bawaskar, P. (1996). Severe envenoming by the Indian red scorpion Mesobuthus tamulus: the use of prazosin therapy. QJM: An International Journal of Medicine, 89(9), 701-704.
Borges, A., Morales, M., Loor, W., & Delgado, M. (2015). Scorpionism in Ecuador: First report of severe and fatal envenoming cases from northern Manabí by Tityus asthenes Pocock. Toxicon, 105, 56-61. https://doi.org/10.1016/j.toxicon.2015.08.019
Boubekeur, K., L’Hadj, M., & Selmane, S. (2020). Demographic and epidemiological characteristics of scorpion envenomation and daily forecasting of scorpion sting counts in Touggourt, Algeria. Epidemiology and health, 42.
Bucaretchi, F., Baracat, E. C., Nogueira, R. J., Chaves, A., Zambrone, F. A., Fonseca, M. R., & Tourinho, F. S. (1995). A comparative study of severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus. Rev Inst Med Trop Sao Paulo, 37(4), 331-336. https://doi.org/10.1590/s0036-46651995000400008
Bucaretchi, F., Fernandes, L. C., Fernandes, C. B., Branco, M. M., Prado, C. C., Vieira, R. J., & Hyslop, S. (2014). Clinical consequences of Tityus bahiensis and Tityus serrulatus scorpion stings in the region of Campinas, southeastern Brazil. Toxicon, 89, 17-25. https://doi.org/10.1016/j.toxicon.2014.06.022
Casewell, N. R., Wüster, W., Vonk, F. J., Harrison, R. A., & Fry, B. G. (2013). Complex cocktails: the evolutionary novelty of venoms. Trends in ecology & evolution, 28(4), 219-229.
Chippaux, J.-P., & Goyffon, M. (2008). Epidemiology of scorpionism: a global appraisal. Acta tropica, 107(2), 71-79.
Chippaux, J. P. (2012). Emerging options for the management of scorpion stings. Drug Des Devel Ther, 6, 165-173. https://doi.org/10.2147/dddt.s24754
Coelho, J. S., Ishikawa, E. A., Dos Santos, P. R., & Pardal, P. P. (2016). Scorpionism by Tityus silvestris in eastern Brazilian Amazon. J Venom Anim Toxins Incl Trop Dis, 22(1), 24. https://doi.org/10.1186/s40409-016-0079-2
Cupo, P. (2015). Clinical update on scorpion envenoming. Rev Soc Bras Med Trop, 48(6), 642-649. https://doi.org/10.1590/0037-8682-0237-2015
Cupo, P., Figueiredo, A. B., Filho, A. P., Pintya, A. O., Tavares Júnior, G. A., Caligaris, F., & Simões, M. V. (2007). Acute left ventricular dysfunction of severe scorpion envenomation is related to myocardial perfusion disturbance. Int J Cardiol, 116(1), 98-106. https://doi.org/10.1016/j.ijcard.2006.02.015
Cupo, P., & Hering, S. E. (2002). Cardiac troponin I release after severe scorpion envenoming by Tityus serrulatus. Toxicon, 40(6), 823-830. https://doi.org/10.1016/s0041-0101(02)00080-6
D'Suze, G., Moncada, S., González, C., Sevcik, C., Aguilar, V., & Alagón, A. (2003). Relationship between plasmatic levels of various cytokines, tumour necrosis factor, enzymes, glucose and venom concentration following Tityus scorpion sting. Toxicon, 41(3), 367-375. https://doi.org/10.1016/s0041-0101(02)00331-8
De Rezende, N. A., Chavéz-Olortegui, C., & Amaral, C. F. S. (1996). Is the severity of Tityus serrulatus scorpion envenoming related to plasma venom concentrations? Toxicon, 34(7), 820-823.
De Sousa, L., Boadas, J., Kiriakos, D., Borges, A., Boadas, J., Marcano, J., & De Los Ríos, M. (2007). Scorpionism due to Tityus neoespartanus (Scorpiones, Buthidae) in Margarita Island, northeastern Venezuela. Revista da Sociedade Brasileira de Medicina Tropical, 40(6), 681-685.
Elatrous, S., Nouira, S., Besbes-Ouanes, L., Boussarsar, M., Boukef, R., Marghli, S., & Abroug, F. (1999). Dobutamine in severe scorpion envenomation: effects on standard hemodynamics, right ventricular performance, and tissue oxygenation. Chest, 116(3), 748-753.
Francis, G. S., Siegel, R. M., Goldsmith, S. R., Olivari, M. T., Levine, T. B., & Cohn, J. N. (1985). Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure: activation of the neurohumoral axis. Annals of internal medicine, 103(1), 1-6.
Frassone, N. E., Ford, J. S., Villalon, D., Barnes, A., Debes, J. D., & Marianelli, L. G. (2019). Evaluation of Scorpion Envenomation by Tityus trivittatus in Adults: An Analysis of Variables Related to Severity of Clinical Presentation. Wilderness Environ Med, 30(3), 274-280. https://doi.org/10.1016/j.wem.2019.05.007
Freire-Maia, L., Campos, J., & Amaral, C. (1994). Approaches to the treatment of scorpion envenoming. Toxicon, 32(9), 1009-1014.
Fukuhara, Y. D., Reis, M. L., Dellalibera-Joviliano, R., Cunha, F. Q., & Donadi, E. A. (2003). Increased plasma levels of IL-1beta, IL-6, IL-8, IL-10 and TNF-alpha in patients moderately or severely envenomed by Tityus serrulatus scorpion sting. Toxicon, 41(1), 49-55. https://doi.org/10.1016/s0041-0101(02)00208-8
Gomes, J. V., Fé, N. F., Santos, H. L. R., Jung, B., Bisneto, P. F., Sachett, A., & de Oliveira Pardal, P. P. (2020). Clinical profile of confirmed scorpion stings in a referral center in Manaus, Western Brazilian Amazon. Toxicon, 187, 245-254.
Gómez, J. P., Quintana, J. C., Arbeláez, P., Fernández, J., Silva, J. F., Barona, J., & Otero, R. (2010). Picaduras por escorpión Tityus asthenes en Mutatá, Colombia: aspectos epidemiológicos, clínicos y toxinológicos. Biomédica, 30(1), 126-139.
Gómez, J. P., Quintana, J. C., Arbeláez, P., Fernández, J., Silva, J. F., Barona, J., & Otero, R. (2010). [Tityus asthenes scorpion stings: epidemiological, clinical and toxicological aspects]. Biomedica, 30(1), 126-139.
Hering, S. E., Jurca, M., Vichi, F. L., Azevedo-Marques, M. M., & Cupo, P. (1993). ‘Reversible cardiomyopathy’in patients with severe scorpion envenoming by Tityus serrulatus: evolution of enzymatic, electrocardiographic and echocardiographic alterations. Annals of tropical paediatrics, 13(2), 173-182.
Inceoglu, B., Lango, J., Jing, J., Chen, L., Doymaz, F., Pessah, I. N., & Hammock, B. D. (2003). One scorpion, two venoms: prevenom of Parabuthus transvaalicus acts as an alternative type of venom with distinct mechanism of action. Proceedings of the National Academy of Sciences, 100(3), 922-927.
Isbister, G. K., & Bawaskar, H. S. (2014). Scorpion envenomation. New England journal of medicine, 371(5), 457-463.
Kalapothakis, Y., Miranda, K., Pereira, A. H., Witt, A. S. A., Marani, C., Martins, A. P., & Kalapothakis, E. (2021). Novel components of Tityus serrulatus venom: A transcriptomic approach. Toxicon, 189, 91-104. https://doi.org/10.1016/j.toxicon.2020.11.001
Khattabi, A., Soulaymani-Bencheikh, R., Achour, S., Salmi, L. R., & Group, S. C. E. (2011). Classification of clinical consequences of scorpion stings: consensus development. Trans R Soc Trop Med Hyg, 105(7), 364-369. https://doi.org/10.1016/j.trstmh.2011.03.007
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of internal medicine, 151(4), W65. https://doi.org/10.7326/0003-4819-151-4-200908180-00136
Lira-da-Silva, R. M., Amorim, A. M., & Brazil, T. K. (2000). [Poisonous sting by Tityus stigmurus (Scorpiones; Buthidae) in the state of Bahia, Brazil]. Rev Soc Bras Med Trop, 33(3), 239-245. https://doi.org/10.1590/s0037-86822000000300001
Lourenço, W. (2008). Parthenogenesis in scorpions: some history-new data. Journal of Venomous Animals and Toxins including Tropical Diseases, 14, 19-44.
Magalhães, M. M., Pereira, M. E., Amaral, C. F., Rezende, N. A., Campolina, D., Bucaretchi, F., & Cunha-Melo, J. R. (1999). Serum levels of cytokines in patients envenomed by Tityus serrulatus scorpion sting. Toxicon, 37(8), 1155-1164. https://doi.org/10.1016/s0041-0101(98)00251-7
Malaque, C. M. S. A., de Bragança, A. C., Sanches, T. R., Volpini, R. A., Shimizu, M. H., Hiyane, M. I., & Andrade, L. (2015). The role of dexamethasone in scorpion venom-induced deregulation of sodium and water transport in rat lungs. Intensive Care Medicine Experimental, 3(1), 1-14.
Marangoni, S., Ghiso, J., Sampaio, S. V., Arantes, E. C., Giglio, J. R., Oliveira, B., & Frangione, B. (1990). The complete amino acid sequence of toxin TsTX-VI isolated from the venom of the scorpion Tityus serrulatus. Journal of protein chemistry, 9, 595-601.
Mazzei de Dàvila, C. A., Dàvila, D. F., Donis, J. H., de Bellabarba, G. A., Villarreal, V., & Barboza, J. S. (2002). Sympathetic nervous system activation, antivenin administration and cardiovascular manifestations of scorpion envenomation. Toxicon, 40(9), 1339-1346. https://doi.org/10.1016/s0041-0101(02)00145-9
Nascimento, D. G., Rates, B., Santos, D. M., Verano-Braga, T., Barbosa-Silva, A., Dutra, A. A., & Pimenta, A. M. (2006). Moving pieces in a taxonomic puzzle: venom 2D-LC/MS and data clustering analyses to infer phylogenetic relationships in some scorpions from the Buthidae family (Scorpiones). Toxicon, 47(6), 628-639.
Oliveira, F. N., Mortari, M. R., Carneiro, F. P., Guerrero-Vargas, J. A., Santos, D. M., Pimenta, A. M., & Schwartz, E. F. (2013). Another record of significant regional variation in toxicity of Tityus serrulatus venom in Brazil: a step towards understanding the possible role of sodium channel modulators. Toxicon, 73, 33-46. https://doi.org/10.1016/j.toxicon.2013.06.021
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., & Brennan, S. E. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj, 372.
Pardal, P. P., Ishikawa, E. A., Vieira, J. L., Coelho, J. S., Dórea, R. C., Abati, P. A., & Chalkidis, H. M. (2014). Clinical aspects of envenomation caused by Tityus obscurus (Gervais, 1843) in two distinct regions of Pará state, Brazilian Amazon basin: a prospective case series. J Venom Anim Toxins Incl Trop Dis, 20(1), 3. https://doi.org/10.1186/1678-9199-20-3
Reis, M. B., Rodrigues, F. L., Lautherbach, N., Kanashiro, A., Sorgi, C. A., Meirelles, A. F., & Ramos, S. G. (2020). Interleukin-1 receptor-induced PGE2 production controls acetylcholine-mediated cardiac dysfunction and mortality during scorpion envenomation. Nature communications, 11(1), 1-12.
Reyes-Lugo, M., & Rodriguez-Acosta, A. (2001). Scorpion envenoming by Tityus discrepans Pocock, 1897 in the northern coastal region of Venezuela. Revista Cientifica-Universidad del Zulia Facultad de Ciencias Veterinarias Division de Investigacion, 11(5), 412-417.
Rodrigo, C., & Gnanathasan, A. (2017). Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials. Systematic reviews, 6(1), 1-12.
Román, J. P., García, F., Medina, D., Vásquez, M., García, J., Graham, M. R., & Borges, A. (2018). Scorpion envenoming in Morona Santiago, Amazonian Ecuador: Molecular phylogenetics confirms involvement of the Tityus obscurus group. Acta tropica, 178, 1-9.
Santiago, J. J., Dávila, C. A., Davila, D. F., Donis, J. H., & Villaroel, V. (2010). Antiadrenergic rescue therapy with amiodarone in children with severe left ventricular dysfunction secondary to scorpion envenomation. Arquivos Brasileiros de Cardiologia, 94, 18-24.
Shaw, T., Rafferty, P., & Tait, G. (1987). Transient shock and myocardial impairment caused by phaeochromocytoma crisis. Heart, 57(2), 194-198.
Souza, C. M., Vieira, J. R., Souza, J. R., Sales, L. S., & Cunha, L. E. (2012). 169. Tityus serrulatus Scorpion Laboratory Breeding and Venom Collection for Antivenom Production and Research. Toxicon, 2(60), 182.
Torrez, P. P., Quiroga, M. M., Abati, P. A., Mascheretti, M., Costa, W. S., Campos, L. P., & França, F. O. (2015). Acute cerebellar dysfunction with neuromuscular manifestations after scorpionism presumably caused by Tityus obscurus in Santarém, Pará / Brazil. Toxicon, 96, 68-73. https://doi.org/10.1016/j.toxicon.2014.12.012
Zhang, X. G., Wang, X., Zhou, T. T., Wu, X. F., Peng, Y., Zhang, W. Q., & Zhao, J. (2016). Scorpion Venom Heat-Resistant Peptide Protects Transgenic Caenorhabditis elegans from β-Amyloid Toxicity. Front Pharmacol, 7, 227. https://doi.org/10.3389/fphar.2016.00227
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Ione Maria de Matos; Filipe Ferreira Santos; Fernanda Lima Marçal; Letícia Duarte Silva; Maisa Silva
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
