Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
PLoS Negl Trop Dis. 2023 Apr 5;17(4):e0011219. doi: 10.1371/journal.pntd.0011219. eCollection 2023 Apr.
Scorpion envenomation is associated with several complications. One of the most serious complications is the cardiac involvement in the form of myocarditis that remains the main reason for mortalities associated with scorpion envenomation. The present review aims to elucidate clinical and paraclinical findings associated with scorpion-related myocarditis, and to explore different management strategies and subsequent outcomes.
We searched PubMed, Web of Science, Scopus, and Google Scholar for articles related to keywords of myocarditis associated with scorpion envenomation up to May 1, 2022. Each article was carefully reviewed by two independent researchers. In case of disagreement for inclusion, we sought a third researcher opinion.
A total of 703 cases from 30 case reports and 34 case series were included in our review. Myocarditis associated with scorpion envenomation was usually reported in children presenting with cardiopulmonary symptoms including pulmonary edema (60.7%) and shock or hypotension (45.8%). The most common ECG findings are sinus tachycardia (82%) followed by ST-T changes (64.6%). The management typically included inotropes (especially dobutamine), prazosin, diuretics, nitroglycerine and digoxin, when indicated. Mechanical ventilation was required in 36.7% of the patients. Mortality in confirmed scorpion-related myocarditis cases is estimated at 7.3%. Almost all survived cases showed rapid recovery and improvement in the left ventricular function.
Even though myocarditis associated with scorpion envenomation is rare, it remains a serious and in some of cases a fatal consequence of scorpion sting. In case of relative presentations, particularly in envenomed children, diagnosis of myocarditis should be considered. Early screening using serial cardiac markers and echocardiography can guide the treatment. Prompt treatment that focuses on cardiogenic shock and pulmonary edema usually results in a favorable outcome.
蝎子螫伤可引起多种并发症。其中最严重的并发症之一是心肌受累，表现为心肌炎，这仍然是蝎子螫伤相关死亡的主要原因。本综述旨在阐明与蝎子相关心肌炎相关的临床和辅助检查结果，并探讨不同的治疗策略及后续结果。
我们在 PubMed、Web of Science、Scopus 和 Google Scholar 上搜索了截至 2022 年 5 月 1 日与与蝎子螫伤相关心肌炎相关的关键词的文章。两位独立研究人员仔细审查了每一篇文章。如果对纳入存在分歧，我们会寻求第三位研究人员的意见。
本综述共纳入了 30 篇病例报告和 34 篇病例系列研究中的 703 例病例。与蝎子螫伤相关的心肌炎通常发生在有心肺症状的儿童中，包括肺水肿（60.7%）和休克或低血压（45.8%）。最常见的心电图发现是窦性心动过速（82%），其次是 ST-T 改变（64.6%）。治疗方法通常包括正性肌力药（特别是多巴酚丁胺）、特拉唑嗪、利尿剂、硝酸甘油和地高辛，如果有指征的话。需要机械通气的患者占 36.7%。确诊为与蝎子相关的心肌炎病例的死亡率估计为 7.3%。几乎所有存活的患者都表现出左心室功能的快速恢复和改善。
尽管与蝎子螫伤相关的心肌炎很少见，但它仍然是蝎子螫伤的一种严重且在某些情况下是致命的后果。在出现相关症状，特别是在被蝎子螫伤的儿童中，应考虑心肌炎的诊断。使用连续的心脏标志物和超声心动图进行早期筛查可以指导治疗。侧重于心源性休克和肺水肿的及时治疗通常会产生良好的结果。
