Borges Adolfo, Morales Melva, Loor Wilmer, Delgado Miguel
Laboratory of Biotechnology, Faculty of Natural Sciences, University of Guayaquil, Guayaquil, Ecuador; Laboratory of Molecular Biology of Toxins and Receptors, Institute of Experimental Medicine, Central University of Venezuela, Caracas 1051, Venezuela; Secretaría Nacional de Educación Superior, Ciencia, Tecnología e Innovación de Ecuador, Ecuador.
Division of Surveillance of Public Health of Manabí Province, Ministry of Public Health, Portoviejo, Manabí, Ecuador.
Toxicon. 2015 Oct;105:56-61. doi: 10.1016/j.toxicon.2015.08.019. Epub 2015 Sep 4.
The presence in rural areas of western Ecuador of scorpions in the genus Tityus capable of producing pediatric mortality is hereby evidenced. The medical significance of scorpions in Ecuador has been underestimated partly because of the clinically unimportant stings delivered by Centruroides margaritatus and Teuthraustes atramentarius, which have venom with low toxicity to vertebrates. Five intra-domiciliary cases of scorpion envenoming in victims aged between 1.9 and 16 years old, including one fatality, are reported from rural settings in forest areas of Chone (n = 2) and Flavio Alfaro (n = 3) counties, northern Manabí province, western Ecuador. Three cases were graded as Class II (moderate) and two in Class III (severe) envenoming. Manifestations showed characteristic autonomic nervous system hyper-stimulation and the fatality (a 1.9-year-old boy from Flavio Alfaro) was due to cardio-respiratory failure. Marked leukocytosis in four of the cases (21,800-31,800 cells/mm(3)), with notable neutrophilia (58-82%), suggests induction of a venom-mediated systemic inflammatory response-like syndrome. Specimens responsible for cases in Flavio Alfaro County, including the fatality, were classified as Tityus asthenes Pocock, accountable for severe scorpionism in Colombia. These findings demand implementation of control and therapeutic measures in affected areas in Ecuador, including evaluation of available scorpion antivenoms.
有证据表明，在厄瓜多尔西部农村地区存在能够导致儿童死亡的蒂修斯属蝎子。厄瓜多尔蝎子的医学重要性一直被低估，部分原因是玛格丽塔斯正钳蝎和黑腹拟蝎蜇伤在临床上并不严重，它们的毒液对脊椎动物毒性较低。本文报告了来自厄瓜多尔西部马纳比省北部乔内县（n = 2）和弗拉维奥·阿尔法罗县（n = 3）森林地区农村的5例家庭内蝎子蜇伤病例，受害者年龄在1.9岁至16岁之间，其中1例死亡。3例被分级为II级（中度）蜇伤，2例为III级（重度）蜇伤。临床表现显示出典型的自主神经系统过度刺激症状，死亡病例（一名来自弗拉维奥·阿尔法罗县的1.9岁男孩）死于心肺衰竭。4例病例出现明显的白细胞增多（21,800 - 31,800个细胞/mm³），伴有显著的中性粒细胞增多（58 - 82%），提示诱导了一种毒液介导的全身炎症反应样综合征。包括死亡病例在内，弗拉维奥·阿尔法罗县病例的标本被鉴定为阿氏蒂修斯蝎，这种蝎子在哥伦比亚会导致严重的蝎蜇中毒。这些发现要求在厄瓜多尔受影响地区实施控制和治疗措施，包括评估现有的蝎子抗蛇毒血清。
