Disfunción autonómica debido a accidente escorpiónico: reporte de caso

Abstract

El escorpionismo se caracteriza por presentar un espectro clínico variable que puede incluir desde la presencia de dolor urente localizado en el sitio de picadura hasta el compromiso de pares craneales, colapso cardiovascular y muerte. Se presenta el caso de un paciente varón de 17 años de edad, sin antecedentes de importancia, quien sufrió escorpionismo; inicialmente presentó dolor generalizado, fasciculaciones musculares, diaforesis, signos de inflamación en el sitio de picadura. Al examen físico se encontró bradicardia sinusal e hipertensión persistente, exantema maculopapular, prolongación en el tiempo de llenado capilar y edema periorbitario. Los exámenes de laboratorio mostraron leucocitosis neutrofílica. Tanto el compromiso simpático como parasimpático persistieron hasta 96 horas luego del ingreso. Aproximadamente en el 85% de los casos las manifestaciones clínicas son leves; mientras que en el 15% restante pueden haber alteraciones cardiacas, pulmonares, neurológicas –a nivel central y periférico- que provoquen una disfunción autonómica, e incluso llegar a la muerte. La familia Buthidae es la principal implicada en este tipo de accidentes.

Case Report: Fatal Scorpion Envenomation in a Shuar Child by Tityus cisandinus from Amazonian Ecuador: A Call for Specific Antivenom Availability in the Amazon Basin

“…The case presented attests to the severity of scorpion envenomation in Amazonian Ecuador for the pediatric population, a situation shared by neighboring areas in Colombia and Peru, 6,11 and confirms the involvement of T. cisandinus in the Ecuadorean case. Notably, hyperglycemia, thrombocytosis, and high leukocytic count at the expense of neutrophilia, as recorded in this case, are established poor prognostic factors with severe scorpion envenomation worldwide, which statistically correlate with multiorgan failure, including lung injury.…”

“…7,25,26 Notably, in an envenomation case from southern Colombia treated with anti-Centruroides antibodies, autonomic manifestations did not subside upon antivenom administration up to 96 hours after immunotherapy. 11 In this context, further support for the use of paraspecific antivenoms to treat the envenomation syndrome produced by Tityus species endemic to Ecuador is needed to validate their neutralizing ability and determine the antivenom doses to be administered depending on the case severity.…”

Amazonian scorpions and scorpionism: integrating toxinological, clinical, and phylogenetic data to combat a human health crisis in the world’s most diverse rainfores

“…in Huila, southern Colombia (Imeri area of endemism), which is a manifestation not usually observed after stings by Tityus spp. in those countries, and is reminiscent of similar effects in the case of T. obscurus [ 15 , 16 ] ( Table 2 ).…”

“…However, a similar pathology occurs in other regions of the Amazon Basin as well. Specifically, severe cases and fatalities have been reported from French Guiana, Venezuela, Guyana, Colombia, Ecuador, and Peru [9][10][11][12][13][14][15][16].…”

“…About 65% of Amazonia lies within Brazil, but only four areas of endemism are almost entirely (Rondônia) or entirely (Tapajós, Xingu, and Belém) Brazilian. Less than 50% of the Napo and Imeri areas are in Brazil, and the scorpion envenomation problem is increasing in sections of these areas in Colombia, Ecuador and Peru [ 14 , 16 ] (see also https://web.ins.gob.pe/index.php/es/prensa/noticia/instituto-nacional-de-salud-traslado-suero-antiescorpionico-para-nino-de-comunidad).…”