Evaluation of Scorpion Envenomation by Tityus trivittatus in Adults: An Analysis of Variables Related to Severity of Clinical Presentation

Abstract

Introduction-In Argentina, the scorpion species Tityus trivittatus has been the species most commonly associated with serious injury and death. Methods-We performed a retrospective study of cases of T trivittatus envenomation that presented to the emergency department at an infectious disease hospital in Cordoba, Argentina, between December 2014 and February 2015. All cases were taxonomically confirmed using criteria established in the Argentine Ministry of Health national guidelines. The primary outcome was classification of clinical presentation (mild/moderate/severe). Classification of clinical presentation was performed in a post hoc fashion using the national guidelines and compared to the classification of clinical presentation given to patients at the time of diagnosis in the emergency department. Results-We included 450 individuals with T trivittatus envenomation. The median age of was 36 y (interquartile range 25À52), and 57% were female. In the emergency department, only 5 patients (<1%) were diagnosed as moderate cases and received antivenom; all other cases were diagnosed as mild. Conversely, in our post hoc classification of clinical presentations, 280 patients had mild presentations, 170 had moderate presentations, and no patients had severe presentations. In our cohort, there were no deaths, no inpatient hospital admissions, and no requirements for continuous cardiac monitoring. We found that age >50 y, (odds ratio [OR] 2.5, P<0.001), time from sting to presentation >120 min (OR 2.6, P=0.02), and pre-existing hypertension (OR=3.9, P<0.001) were all independently associated with worse post hoc classification severity. Conclusions-Our study exposed factors associated with moderate presentations of scorpion envenomation and proposes the option of conservative treatment for affected adults.

Clinical manifestations and management of Tityus species envenoming: A systematic review

“…Eight selected studies were retrospective studies (Amaral et al, 1994;Bucaretchi et al, 1995;Bucaretchi et al, 2014;De Rezende et al, 1996;Frassone et al, 2019;Freire-Maia et al, 1994;Lira-da-Silva et al, 2000;Román et al, 2018), six were case series (Borges et al, 2015;Cupo & Hering, 2002;De Sousa et al, 2007;Gomes et al, 2020;Magalhães et al, 1999;Pardal et al, 2014), two prospective and observational studies (Coelho et al, 2016;Torrez et al, 2015), one study with retrospective and prospective data (J. P. , a prospective and experimental study (Cupo et al, 2007), a casecontrol study (Fukuhara et al, 2003), a cross-sectional study (Mazzei de Dàvila et al, 2002), a descriptive study (Reyes-Lugo & Rodriguez-Acosta, 2001), and finally, two studies with uninformed designs (D'Suze et al, 2003;Hering et al, 1993). As for the place of completion, Brazil contributed with 15 studies (Amaral et al, 1994;Bucaretchi et al, 1995;Bucaretchi et al, 2014;Coelho et al, 2016;Cupo et al, 2007;Cupo & Hering, 2002;De Rezende et al, 1996;Freire-Maia et al, 1994;Fukuhara et al, 2003;Gomes et al, 2020;Hering et al, 1993;Lira-da-Silva et al, 2000;Magalhães et al, 1999;Pardal et al, 2014;Torrez et al, 2015), Venezuela with four works (D'Suze et al, 2003;De Sousa et al, 20...…”

“…trivittatus (Frassone et al, 2019), T. silvestres (Coelho et al, 2016), T. bahiensis and T. serrulatus (Bucaretchi et al, 2014) serrulatus (Bucaretchi et al, 1995). In addition, one study reported the genus, without mentioning the specie (Gomes et al, 2020).…”

“…The time elapsed between the accident and medical care ranged from 15 minutes to more than 6 hours. Symptoms and clinical manifestations were classified as mild, moderate and severe in 13 studies (Cupo et al, 2007;Cupo & Hering, 2002;D'Suze et al, 2003;De Sousa et al, 2007;Frassone et al, 2019;Freire-Maia et al, 1994;Fukuhara et al, 2003;Lira-da-Silva et al, 2000;Magalhães et al, 1999;Pardal et al, 2014;Reyes-Lugo & Rodriguez-Acosta, 2001;Torrez et al, 2015), or divided into classes I, II and III in 4 studies (Borges et al, 2015;Bucaretchi et al, 2014;Coelho et al, 2016;Gomes et al, 2020;Román et al, 2018). Another five studies reported symptoms, but did not classify in any category (Amaral et al, 1994;Bucaretchi et al, 1995;De Rezende et al, 1996;Hering et al, 1993;Mazzei de Dàvila et al, 2002) (Table 2).…”

“…Children-1% and rate in the total number of patient was Research, Society and Development, v. 13, n. 2, e1302345161, 2024 (CC BY 4.0) All cases of scorpion stings should be treated based on the relief of the signs and symptoms of envenomation, neutralization of circulation venom and supporting the vital functions (Marangoni et al, 1990). The treatments performed in the studies that make up this review include scorpion antivenoms (Amaral et al, 1994;Bucaretchi et al, 1995;Bucaretchi et al, 2014;Coelho et al, 2016;Cupo et al, 2007;Cupo & Hering, 2002;De Rezende et al, 1996;De Sousa et al, 2007;Frassone et al, 2019;Freire-Maia et al, 1994;Fukuhara et al, 2003;Gomes et al, 2020;Hering et al, 1993;Lira-da-Silva et al, 2000;Magalhães et al, 1999;Mazzei de Dàvila et al, 2002;Pardal et al, 2014;Reyes-Lugo & Rodriguez-Acosta, 2001;Torrez et al, 2015), corticosteroids (Borges et al, 2015;Cupo & Hering, 2002;Fukuhara et al, 2003;Gomes et al, 2020;Hering et al, 1993;Torrez et al, 2015), anesthetics (Coelho et al, 2016;Hering et al, 1993;Pardal et al, 2014;Román et al, 2018;Torrez et al, 2015), antiemetics agents (Borges et al, 2015;De Sousa et al, 2007;Frassone et al, 2019;Fukuhara et al, 2003;Gomes et al, 2020;…”