Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil; Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil.
Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil.
Toxicon. 2020 Nov;187:245-254. doi: 10.1016/j.toxicon.2020.09.012. Epub 2020 Sep 28.
Scorpion envenomations are a major public health problem in Brazil, and most medically important cases are attributable to the Tityus genus. The objective of this study is to describe the clinical and epidemiological aspects of a series of 151 cases of confirmed scorpion stings, which were treated at the hospitals of two cities in the Western Brazilian Amazon, between June 2014 and December 2019. This study shows that the genus Tityus was the most prevalent. Tityus (Atreus) metuendus (Pocock, 1897) was responsible for the greatest number of cases (68.2%), followed by Tityus (Archaeotityus) silvestris (Pocock, 1897) (14.6%). Most of the envenomations involved males (53.6%), and analysis showed a slight predominance in the group from 40 to 49 years (22.5%). The most affected body regions were feet (49.0%) and hands (31.8%). The time elapsed between the accident and medical care was ≤6 h in 92.1% of cases. Regarding clinical severity, classes I (80.8%) and II (15.9%) predominated. However, there were five (3.3%) class III cases; four for T. metuendus and one for T. silvestris. The most frequent local and systemic manifestations were, respectively, pain (84.1%), paresthesia (34.4%) and mild edema (25.8%), and nausea (9.3%) and myoclonia (8.6%). The clinical manifestations were similar among the patients stung by the different species of scorpions. There were no differences between the manifestations of envenomation caused by T. metuendus, T. silvestris and T. raquelae. For victims of T. apiacas, a higher frequency of piloerection and myoclonia was observed, and was described by the affected patients as a 'sensation of receiving an electric shock' throughout the body. No deaths were registered. The species of greatest epidemiological importance in Manaus is T. metuendus, a species that leads to clinical pictures that do not differ substantially from those observed in other Brazilian regions. T. apiacas causes neurological manifestations that differed from other Tityus species. Our findings suggest that the available antivenoms have little effectiveness when used in the treatment of envenomations by some Amazonian scorpions.
巴西的蝎子螫伤是一个主要的公共卫生问题，大多数医学上重要的病例归因于 Tityus 属。本研究的目的是描述 2014 年 6 月至 2019 年 12 月在巴西西部亚马逊地区两个城市医院治疗的 151 例确诊蝎子螫伤的临床和流行病学特征。这项研究表明，Tityus 属最为普遍。Tityus (Atreus) metuendus (Pocock, 1897) 导致的病例最多（68.2%），其次是 Tityus (Archaeotityus) silvestris (Pocock, 1897)（14.6%）。大多数螫伤发生在男性（53.6%），分析显示 40-49 岁年龄组略有优势（22.5%）。受影响最严重的身体部位是脚（49.0%）和手（31.8%）。在 92.1%的病例中，事故发生与医疗救治之间的时间间隔≤6 小时。关于临床严重程度，I 级（80.8%）和 II 级（15.9%）占主导地位。然而，有 5 例（3.3%）为 III 级病例；其中 4 例为 T. metuendus，1 例为 T. silvestris。最常见的局部和全身表现分别为疼痛（84.1%）、感觉异常（34.4%）和轻度水肿（25.8%），恶心（9.3%）和肌阵挛（8.6%）。不同种属蝎子螫伤患者的临床表现相似。T. metuendus、T. silvestris 和 T. raquelae 引起的螫伤表现无差异。对于 T. apiacas 的受害者，观察到毛发竖立和肌阵挛的频率更高，受影响的患者将这种感觉描述为全身“触电”的感觉。没有死亡记录。在马瑙斯，具有最大流行病学重要性的物种是 T. metuendus，它导致的临床症状与巴西其他地区观察到的症状没有实质性差异。T. apiacas 引起的神经表现与其他 Tityus 物种不同。我们的研究结果表明，当用于治疗一些亚马逊地区的蝎子螫伤时，现有的抗蛇毒血清的效果很小。
