Scorpion Envenomation Among Children: Clinical Manifestations and Outcome (Analysis of 685 Cases)

Abstract

Our objective was to characterize both epidemiologically and clinically manifestations after severe scorpion envenomation and to define simple factors indicative of poor prognosis in children. We performed a retrospective study over 13 years (1990–2002) in the medical intensive care unit (ICU) of a university hospital (Sfax-Tunisia). The diagnosis of scorpion envenomation was based on a history of scorpion sting. The medical records of 685 children aged less than 16 years who were admitted for a scorpion sting were analyzed. There were 558 patients (81.5%) in the grade III group (with cardiogenic shock and/or pulmonary edema or severe neurological manifestation [coma and/or convulsion]) and 127 patients (18.5%) in the grade II group (with systemic manifestations). In this study, 434 patients (63.4%) had a pulmonary edema, and 80 patients had a cardiogenic shock; neurological manifestations were observed in 580 patients (84.7%), 555 patients (81%) developed systemic inflammatory response syndrome (SIRS), and 552 patients (80.6%) developed multi-organ failure. By the end of the stay in the ICU, evolution was marked by the death in 61 patients (8.9%). A multivariate analysis found the following factors to be correlated with a poor outcome: coma with Glasgow coma score ≤ 8/15 (odds ratio [OR] = 1.3), pulmonary edema (OR = 2.3), and cardiogenic shock (OR = 1.7). In addition, a significant association was found between the development of SIRS and heart failure. Moreover, a temperature > 39°C was associated with the presence of pulmonary edema, with a sensitivity at 20.6%, a specificity at 94.4%, and a positive predictive value at 91.7%. Finally, blood sugar levels above 15 mmol/L were significantly associated with a heart failure. In children admitted for severe scorpion envenomation, coma with Glasgow coma score ≤ 8/15, pulmonary edema, and cardiogenic shock were associated with a poor outcome. The presence of SIRS, a temperature > 39°C, and blood sugar levels above 15 mmol/L were associated with heart failure.

Symptom patterns in adult patients stung by scorpions with emphasis on coagulopathy and hemoglubinuria

“…First, in this study the symptoms in none of the patients were accompanied by neurological complications, from which no patients were suffering during the hospitalization. This is in contrast to previous studies conducted in Iran and other countries, which repeatedly reported neurological symptoms in scorpion-sting patients during hospitalization and considered such symptoms to be the major signs (6,(12)(13)(14). All patients in this study were past age 11, while in Pipelzadeh and colleagues study, the majority of cases were children aged less than 12 years.…”

NT-proBNP in Myocarditis after a Scorpion Sting Envenomation

“…The severity of the envenomation is related to the age of the victim, the size of the scorpion, the season of the sting and time which had elapsed between the sting and the hospitalization [8,9]. A severe scorpion sting envenomation occurs in children with a 3.9-10% fatality, which is irrespective of the intensive care management, in Israel, Turkey and India [10][11][12][13]. No clinically useful demographic or epidemiological data to guide the decision making regarding the need for the intensive care unit admission for the paediatric victims of scorpion sting, was noted by Bosnak et al, in Turkey [12].…”

Çocuklarda akrep zehirlenmeleri ve yönetimi

“…Hastaları sınıflandırmak adına kimi çalışma-cılar "pediatric mortalite risk skoru (PRISM)" kullanırken bir kısmı da evreleme yöntemi (evre 1; lokal bulgular, evre 2; sistemik bulgular, evre 3; kardiyojenik şok ve/veya pulmoner ödem veya koma yada konvülziyon gibi ağır nöro-lojik bulgular) kullanmıştır (7,8). Laboratuvar imkanları-nın artması ile troponin, BNP, ardından N-terminal-pro BNP kullanılarak sistemik bulgular anlaşılmaya çalışılmış, EKO imkanlarının artması ile kalp yetmezlikleri, hipoaktif alanlar erken fark edilmeye başlanmıştır (35)(36)(37)(38)(39) Genel kanı sadece lokal bulguları olan hastaların yoğun bakım ihtiyacı olmadığı yönündedir.…”

“…Laboratuvar imkanları-nın artması ile troponin, BNP, ardından N-terminal-pro BNP kullanılarak sistemik bulgular anlaşılmaya çalışılmış, EKO imkanlarının artması ile kalp yetmezlikleri, hipoaktif alanlar erken fark edilmeye başlanmıştır (35)(36)(37)(38)(39) Genel kanı sadece lokal bulguları olan hastaların yoğun bakım ihtiyacı olmadığı yönündedir. Ancak çocuklarda hastaların basamakları tahmin edilemeyen sürelerde atlayabildikleri görülmüştür (7). Bu yüzden biz tüm çocuk hastaların hiçbir şikayeti olmasa bile en az 24 saat yakın-dan izlenmesinin uygun olacağı kanaatindeyiz.…”

“…Vakaların 5'ünde kalp yetmezliği ve 2'sinde akciğer ödemi gelişti. Laboratuvar sonuçları; hemoglobin 11,8±1 g/dl (9,6-13,1), lökosit 10,5±3,1 bin/mm3 (6,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)6), trombosit 284±42 bin/mm3 (214-459), kan şekeri 135±50 mg/dL (60-105), kreatin kinaz miyokard izoenzimi (CK-MB) 40±22 U/L (<25), troponin 1,76±2,3 ng/mL (<0,04), B-tipi natriüretik peptid (BNP) 83±102 pg/ml (0-100) olarak saptandı. Ekokardiyografi (EKO) yapılabılan 7 hastadan 2'sinde (%6,6) EKO normal, 5 hastada da anormal (sol ventrikül disfonksiyonu, ejeksiyon fraksiyonu %40) olarak değerlendirildi.…”