title: Acute cerebellar dysfunction with neuromuscular manifestations after scorpionism presumably caused by Tityus obscurus in Santarém, Pará / Brazil.
abstract: Scorpionism is a public health problem in many tropical countries, especially in North Africa, South India, Latin America and the Middle East. In Brazil, patients with severe scorpion envenoming have mainly cardiovascular events, including acute heart failure, acute respiratory distress syndrome and shock, death is rare. We described 58 accidents presumably caused by Tityus obscurus in Brazilian Amazonia. Patients reported a sensation of "electric shocks" which could last hours. The vast majority of patients presented a clinical picture compatible with acute cerebellar dysfunction, beginning minutes and lasting up to 2 days after the accident. They presented cerebellar ataxia, dysdiadochokinesia, dysmetry, dysarthria, dyslalia, nausea and vomiting. Besides, some patients presented myoclonus and fasciculation which can also be attributed to cerebellar dysfunction or maybe the result of direct action on skeletal muscle. Two patients had evidence of intense rhabdomyolysis and acute kidney injury. The clinical picture in this scorpion envenoming is mainly characterized by an acute dysfunction of cerebellar activities and abnormal neuromuscular manifestations and in some cases muscle injury which are not described in any other region of the world. This work presents clinical, epidemiologic, laboratory and treatment aspects of this unmatched scorpion envenoming in the state of Pará, northern Brazil.
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil. Electronic address: pasesa2@hotmail.com.
authors.forename: Pasesa P Q
authors.initials: PP
authors.lastname: Torrez
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Mariana M M
authors.initials: MM
authors.lastname: Quiroga
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Paulo A M
authors.initials: PA
authors.lastname: Abati
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Melissa
authors.initials: M
authors.lastname: Mascheretti
authors.affiliation: 9th Regional Center of Health, Department of Pará, Brazil.
authors.forename: Walter Silva
authors.initials: WS
authors.lastname: Costa
authors.affiliation: Hospital Municipal de São Jose dos Campos, São Paulo, SP, Brazil.
authors.forename: Luciana P
authors.initials: LP
authors.lastname: Campos
authors.affiliation: Advanced Tropical Medicine Center, Santarém, Pará of the Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil; Department of Infectious and Parasitic Diseases, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Francisco O S
authors.initials: FO
authors.lastname: França
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002526:Cerebellar Diseases / Q000209:etiology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005207:Fasciculation / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008297:Male; D009207:Myoclonus / Q000209:etiology / Q000473:pathology*; D065008:Scorpion Stings / Q000150:complications* / Q000453:epidemiology*
keywords: Amazonia; Cerebellum; Envenomation; Scorpion sting; Tityus