title: Clinical and Epidemiological Aspects of Scorpionism in the World: A Systematic Review.
abstract: OBJECTIVE
  Scorpion stings are registered worldwide, but the incidence and the features of the envenomations vary depending on the region. The aim of this review was to summarize the epidemiological, clinical, diagnostic, and therapeutic data worldwide regarding humans stung by scorpions.
  
  
  METHODS
  A systematic review of the literature was conducted through the online databases of the Virtual Health Library (VHL), which hosts Medline and the Latin American and Caribbean Center on Health Sciences Informational (LILACS) database. We selected articles published between January 1, 2002 and July 31, 2014.
  
  
  RESULTS
  Scorpion envenomation reports were found throughout the world, mainly in subtropical and tropical regions. The clinical manifestations were sympathetically and parasympathetically mediated, depending on the species of scorpion. Some of the most common severe complications of scorpionism included respiratory distress syndrome, pulmonary edema, cardiac dysfunction, impaired hemostasis, pancreatitis, and multiple organ failure. Scorpion envenomation could be classified as mild, moderate, and severe, and the therapeutic approach was based on the case severity. The treatment comprised 3 components: symptomatic measures, vital functions support, and injection of antivenom. Moreover, the time that elapsed between the sting and administration of the appropriate medical care was extremely important to the patient's prognosis.
  
  
  CONCLUSIONS
  The large number of scorpion stings worldwide is concerning and reaffirms the need for new prevention measures and policies to reduce the incidence, prevalence, morbidity, and mortality rates from these poisonous arachnids.
authors.affiliation: Laboratory of Scientific Writing, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Drs Santos, Neto, C Júnior, Lopes, A Júnior, Bezerra, Luna, J Júnior, and Lima); Faculty of Medicine of ABC, Santo André, São Paulo, Brazil (Drs Santos and Silva).
authors.forename: Maria S V
authors.initials: MS
authors.lastname: Santos
authors.affiliation: Faculty of Medicine of ABC, Santo André, São Paulo, Brazil (Drs Santos and Silva).
authors.forename: Cláudio G L
authors.initials: CG
authors.lastname: Silva
authors.affiliation: Laboratory of Scientific Writing, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Drs Santos, Neto, C Júnior, Lopes, A Júnior, Bezerra, Luna, J Júnior, and Lima); Federal Institute of Education, Science and Technology-Campus Juazeiro do Norte, Ceará, Brazil (Dr Neto and Mr Cordeiro).
authors.forename: Basílio Silva
authors.initials: BS
authors.lastname: Neto
authors.affiliation: Laboratory of Scientific Writing, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Drs Santos, Neto, C Júnior, Lopes, A Júnior, Bezerra, Luna, J Júnior, and Lima).
authors.forename: Cícero R P
authors.initials: CR
authors.lastname: Grangeiro Júnior
authors.affiliation: Laboratory of Scientific Writing, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Drs Santos, Neto, C Júnior, Lopes, A Júnior, Bezerra, Luna, J Júnior, and Lima).
authors.forename: Victor H G
authors.initials: VH
authors.lastname: Lopes
authors.affiliation: Laboratory of Scientific Writing, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Drs Santos, Neto, C Júnior, Lopes, A Júnior, Bezerra, Luna, J Júnior, and Lima); Science Without Borders fellowship at University of Liverpool, Liverpool, United Kingdom (Dr A Júnior).
authors.forename: Antônio G
authors.initials: AG
authors.lastname: Teixeira Júnior
authors.affiliation: Laboratory of Scientific Writing, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Drs Santos, Neto, C Júnior, Lopes, A Júnior, Bezerra, Luna, J Júnior, and Lima).
authors.forename: Deryk A
authors.initials: DA
authors.lastname: Bezerra
authors.affiliation: Laboratory of Scientific Writing, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Drs Santos, Neto, C Júnior, Lopes, A Júnior, Bezerra, Luna, J Júnior, and Lima).
authors.forename: João V C P
authors.initials: JV
authors.lastname: Luna
authors.affiliation: Federal Institute of Education, Science and Technology-Campus Juazeiro do Norte, Ceará, Brazil (Dr Neto and Mr Cordeiro).
authors.forename: Josué B
authors.initials: JB
authors.lastname: Cordeiro
authors.affiliation: Laboratory of Scientific Writing, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Drs Santos, Neto, C Júnior, Lopes, A Júnior, Bezerra, Luna, J Júnior, and Lima).
authors.forename: Jucier Gonçalves
authors.initials: JG
authors.lastname: Júnior
authors.affiliation: Laboratory of Scientific Writing, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Drs Santos, Neto, C Júnior, Lopes, A Júnior, Bezerra, Luna, J Júnior, and Lima); Laboratory of Microbiology and Parasitology, Faculty of Medicine, Federal University of Cariri, Barbalha, Ceará, Brazil (Dr Lima). Electronic address: marcos.lima@ufca.edu.br.
authors.forename: Marcos A P
authors.initials: MA
authors.lastname: Lima
mesh_terms: D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D006801:Humans; D065008:Scorpion Stings / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D012605:Scorpions; D014329:Tropical Climate
chemical_list: D000997:Antivenins
keywords: clinical aspects; epidemiology; scorpion envenomation; scorpionism; scorpions