title: Clinical consequences of Tityus bahiensis and Tityus serrulatus scorpion stings in the region of Campinas, southeastern Brazil.
abstract: Scorpion stings account for most envenomations by venomous animals in Brazil. A retrospective study (1994-2011) of the clinical consequences of Tityus scorpion stings in 1327 patients treated at a university hospital in Campinas, southeastern Brazil, is reported. The clinical classification, based on outcome, was: dry sting (no envenoming), class I (only local manifestations), class II (systemic manifestations), class III (life-threatening manifestations, such as shock and/or cardiac failure requiring inotropic/vasopressor agents, and/or respiratory failure), and fatal. The median patient age was 27 years (interquartile interval = 15-42 years). Scorpions were brought for identification in 47.2% of cases (Tityus bahiensis 27.7%; Tityus serrulatus 19.5%). Sting severity was classified and each accounted for the following percentage of cases: dry stings - 3.4%, class I - 79.6%, class II - 15.1%, class III - 1.8% and fatal - 0.1%. Pain was the primary local manifestation (95.5%). Systemic manifestations such as vomiting, agitation, sweating, dyspnea, bradycardia, tachycardia, tachypnea, somnolence/lethargy, cutaneous paleness, hypothermia and hypotension were detected in class II or class III + fatal groups, but were significantly more frequent in the latter group. Class III and fatal cases occurred only in children <15 years old, with scorpions being identified in 13/25 cases (T. serrulatus, n = 12; T. bahiensis, n = 1). Laboratory blood abnormalities (hyperglycemia, hypokalemia, leukocytosis, elevations in serum total CK, CK-MB and troponin T, bicarbonate consumption and an increase in base deficit and blood lactate), electrocardiographic changes (ST segment) and echocardiographic alterations (ventricular ejected fraction <54%) were frequently detected in class III patients. Seventeen patients developed pulmonary edema, 16 had cardiac failure and seven had cardiogenic shock. These results indicate that most scorpion stings involved only local manifestations, mainly pain; the greatest severity was associated with stings by T. serrulatus and in children <15 years old.
authors.affiliation: Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil; Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil. Electronic address: bucaret@fcm.unicamp.br.
authors.forename: Fábio
authors.initials: F
authors.lastname: Bucaretchi
authors.affiliation: Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Luciane C R
authors.initials: LC
authors.lastname: Fernandes
authors.affiliation: Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Carla B
authors.initials: CB
authors.lastname: Fernandes
authors.affiliation: Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Maíra M
authors.initials: MM
authors.lastname: Branco
authors.affiliation: Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Camila C
authors.initials: CC
authors.lastname: Prado
authors.affiliation: Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil; Department of Clinical Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Ronan J
authors.initials: RJ
authors.lastname: Vieira
authors.affiliation: Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil; Department of Clinical Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: De Capitani
authors.affiliation: Campinas Poison Control Center, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil; Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil. Electronic address: hyslop@fcm.unicamp.br.
authors.forename: Stephen
authors.initials: S
authors.lastname: Hyslop
mesh_terms: D000293:Adolescent; D000328:Adult; D000997:Antivenins / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D065008:Scorpion Stings / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D000997:Antivenins
keywords: Heart failure; Pulmonary edema; Scorpion sting; Severity; Tityus bahiensis; Tityus serrulatus