Borges Adolfo, Rojas-Runjaic Fernando J M, Diez Nardy, Faks José G, Op den Camp Huub J M, De Sousa Leonardo
Laboratory of Molecular Biology of Toxins and Receptors, Biomembranes Section, Institute of Experimental Medicine, Central University of Venezuela, Caracas, Venezuela.
Wilderness Environ Med. 2010 Dec;21(4):282-90. doi: 10.1016/j.wem.2010.06.008. Epub 2010 Jun 11.
Scorpion envenomation is a common public health problem in Venezuela. We report an envenoming case by Tityus breweri, endemic to the Guayana Shield, southeast Venezuela, and the outcome of its treatment with antivenom anti-Tityus discrepans. Toxin composition and antigenic reactivity of T breweri venom were also explored. T breweri distribution range was re-evaluated.
Clinical signs and symptoms in an adult male were recorded after envenoming and treatment with antivenom. Toxin composition and antigenicity of T breweri venom were investigated by polyacrylamide gel electrophoresis, immunoblotting, and mass spectrometry. T breweri distribution range was reassessed by mapping new records of the species.
The moderately severe case (a 21-year-old man) presented autonomic manifestations, including cardiopulmonary and gastrointestinal effects. Full recovery was achieved after anti-T discrepans antivenom administration. T breweri venom contains toxins in the 6-8 kd range that affect voltage-sensitive sodium channels. Based on new records, T breweri distribution area reaches 12 155 km.(2) Inclusion of southeast Venezuela as an endemic area of scorpionism prompted the examination of clinical, immunological, and phylogenetic evidence for suggesting a partitioning of the Venezuelan Tityus fauna into toxinological provinces.
The severity of the case reinforces categorization of the Guayana Shield region as a macroendemic area of scorpionism in Venezuela and allows classification of T breweri as a species of medical importance, with toxins immunologically related to central-eastern Venezuelan Tityus. Partitioning of the territory incorporating multiple criteria may help health authorities establish and implement preventive and therapeutic measures for scorpion envenoming in this region.
蝎蜇伤是委内瑞拉常见的公共卫生问题。我们报告了一例由委内瑞拉东南部圭亚那地盾特有的布鲁氏肥尾蝎（Tityus breweri）蜇伤的病例，以及使用抗 discrepans 肥尾蝎抗蛇毒血清治疗的结果。同时还探讨了布鲁氏肥尾蝎毒液的毒素组成和抗原反应性，并重新评估了其分布范围。
记录了一名成年男性被蜇伤并使用抗蛇毒血清治疗后的临床症状和体征。通过聚丙烯酰胺凝胶电泳、免疫印迹和质谱法研究了布鲁氏肥尾蝎毒液的毒素组成和抗原性。通过绘制该物种的新记录图重新评估了布鲁氏肥尾蝎的分布范围。
该例中度严重病例（一名21岁男性）出现了自主神经症状，包括心肺和胃肠道症状。给予抗 discrepans 肥尾蝎抗蛇毒血清后完全康复。布鲁氏肥尾蝎毒液含有影响电压门控钠通道的6 - 8kd范围内的毒素。根据新记录，布鲁氏肥尾蝎的分布面积达12155平方千米。将委内瑞拉东南部纳入蝎蜇伤流行地区促使对临床、免疫学和系统发育证据进行研究，以建议将委内瑞拉的肥尾蝎属动物划分为不同的毒素学省份。
该病例的严重程度进一步证明了圭亚那地盾地区作为委内瑞拉蝎蜇伤大流行地区的分类，并使布鲁氏肥尾蝎被归类为具有医学重要性的物种，其毒素与委内瑞拉中东部的肥尾蝎在免疫学上相关。纳入多个标准对该地区进行划分可能有助于卫生当局制定和实施该地区蝎蜇伤的预防和治疗措施。
