A comparative study of severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus

From January 1984 to May 1994, 17 of 239 children under 15 years old stung by Tityus serrulatus (15.1%) or Tityus bahiensis (84.9%) presented severe envenoming. Of these 17 patients (1-11 years old; median=2 yr) 14 were stung by T.serrulatus and three by T.bahiensis. All of them received scorpion antivenom i.v. at times ranging from 45 min. to 5 h after the accident (median=2h). On admission, the main clinical manifestations and laboratory and electrocardiographic changes were: vomiting (17), diaphoresis (15), tachycardia (14), prostration (10), tachypnea (8), arterial hypertension (7), arterial hypotension (5), tremors (5), hypothermia (4), hyperglycemia (17), leukocytosis (16/16), hypokalemia (13/17), increased CK-MB enzyme activity (>6% of the total CK, 11/12), hyperamylasemia (11/14), sinusal tachycardia (16/17) and a myocardial infarction-like pattern (11/17). Six patients stung by T.serrulatus had depressed left ventricular systolic function assessed by means of echocardiography. Of these, five presented pulmonary edema and four had shock. A child aged two-years old presented severe respiratory failure and died 65 h after being stung by T.serrulatus. Severe envenomations caused by T.serrulatus were 26.2 times more frequent than those caused by T.bahiensis (p<0.001).

Programa de controle de surto de escorpião Tityus serrulatus, Lutz e Mello 1922, no município de Aparecida, SP (Scorpiones, Buthidae)

Os autores propuseram para o município de Aparecida, vale do Rio Paraíba, SP, região endêmica do Tityus serrulatus, um programa de controle do escorpionismo. Foram estudados a presença de focos do escorpião no campo e na cidade, as alterações ambientais periféricas à zona urbana e os novos ambientes de procriação e dispersão destes artrópodes. Além disso, foram avaliados os problemas básicos de infra-estrutura, tais como o acondicionamento e a coleta do lixo urbano público e domiciliar, o saneamento básico (esgotos e galerias pluviais) e a situação dos terrenos baldios e as construções da zona urbana. Após estudo epidemiológico, foram propostas medidas educativas, que constaram da confecção e distribuição de folhetos, de mutirões de limpeza, de visitas domiciliares e do engajamento de professores e alunos da rede de ensino pública e privada na campanha. Nos locais onde existiam focos de alto risco, em especial nas pré-escolas, foi proposto o emprego do controle químico. Dentro das normas sanitárias vigentes para a zona urbana, foi proposto ainda, o uso de predadores naturais no combate. Os autores concluem que as ações devem ser integradas e continuadas de forma ininterrupta por vários anos e propõem ação conjunta com a campanha da dengue. A instituição de uma semana por ano dedicada ao estudo do escorpionismo nas escolas dos municípios onde ocorre o problema seria uma medida educativa que viria contribuir sobremaneira para a prevenção dos acidentes e controle do escorpionismo.

Envenenamento por Tityus stigmurus (Scorpiones; Buthidae) no Estado da Bahia, Brasil

A presente investigação é um estudo descritivo dos aspectos clínicos dos acidentes causados pelo escorpião Tityus stigmurus no Estado da Bahia, Brasil. Foram analisados 237 casos confirmados, tratados pelo Centro de Informações Antiveneno da Bahia (CIAVE), no período de 1982-1995. O envenenamento por T. stigmurus caracterizou-se por manifestações locais: dor (94,4%), dormência (30%), edema (17,8%), eritema (17,8%) e parestesia (15,6%) e gerais: cefaléia (14%), vômitos (4,4%) e sudorese (3,3%). A maioria dos envenenamentos (94%) foi leve e todos evoluíram para cura. A ausência de letalidade, com o restabelecimento dos pacientes, inclusive casos graves, sugere a eficácia do tratamento com o antiveneno específico, apesar do veneno desta espécie não estar presente no pool de produção nacional do soro. Há necessidade de revisão dos critérios regionais nos esquemas atuais de soroterapia. Os dados apontam para a semelhança da gravidade do envenenamento por T. serrulatus, com exceção da ocorrência de óbitos e complicações sistêmicas.

Primeiro registro de escorpionismo causado por Tityus adrianoi Lourenço (Scorpiones: Buthidae)

Apresentamos três casos de escorpionismo causados por Tityus adrianoi Lourenço ocorridos em Belo Horizonte e Curvelo, Minas Gerais, Brasil. O atendimento aos pacientes ocorreu no mesmo dia do acidente e em todos os casos foi relatada apenas dor local, que variou de leve a intensa, sem complicações posteriores. Os três acidentes foram classificados como leves.

Scorpionism due to Tityus neoespartanus (Scorpiones, Buthidae) in Margarita Island, northeastern Venezuela

The first two cases of scorpion envenoming caused by Tityus neoespartanus (Buthidae) are described. The accidents took place within human environments (one inside a home and the other inside a school), in the village of La Sierra, Margarita Island, State of Nueva Esparta, northeastern Venezuela. Both cases were moderately severe and developed pancreatic involvement and electrocardiographic abnormalities. This report allows inclusion of Margarita Island among the endemic areas of scorpionism in Venezuela.

Escorpionismo por Tityus pusillus Pocock, 1893 (Scorpiones; Buthidae) no Estado de Pernambuco

Apresentamos neste trabalho os primeiros relatos de acidente escorpiônico causado pela espécie Tityus pusillus (Buthidae). Os acidentes ocorreram no ambiente doméstico, na área rural situada nas cidades de Paudalho e São Lourenço da Mata, Pernambuco, Brasil. Os dois casos descritos, uma criança e uma mulher grávida, foram classificados como leve e moderado, respectivamente. Os sintomas clínicos apresentados foram distúrbios locais (dor e parestesia) e distúrbios sistêmicos (calafrios, tontura, cefaléia e vômito). Esses registros permitem incluir Tityus pusillus como uma espécie de importância médica no Brasil.

Tityus stigmurus (Thorell, 1876) (Scorpiones; Buthidae): response to chemical control and understanding of scorpionism among the population

In this study, the events following application of the insecticideDemand 2.5 concentrated solution (CS) in the field, to control Tityus stigmurus, were investigated. Data on attitudes and practices relating to scorpionism were collected using a questionnaire. During the months of May to July 2005, 69 premises were monitored on different days following insecticide treatment, focusing on scorpion frequency and mortality. According to the results, 42% of the premises showed scorpion incidence, with an average of three specimens per house. The highest incidence was recorded during the first week following the treatment. Only 7% of the specimens were found dead. Most (72%) of the population showed knowledge about prevention and control measures. Despite this, 100% of the premises presented breeding sites, mainly in debris (79.7%). These results indicate that the scorpion control method used by health agents during this investigation was not efficient, and the results suggest that the method may have had a dispersive effect on these animals.

Pediatric epidemiological aspects of scorpionism and report on fatal cases from Tityus stigmurus stings (Scorpiones: Buthidae) in State of Pernambuco, Brazil

Introduction Envenomation by scorpion stings is a major public health problem in numerous tropical countries because of its frequent incidence and potential severity. Approximately 1,900 species of scorpions are known in the world, and at least 130 of these have been described in Brazil. Methods This work reports on 3 child deaths caused by Tityus stigmurus stings and characterizes epidemiological and clinical surveys on pediatric cases of scorpionism recorded in the Centro de Assistência Toxicológica de Pernambuco (Ceatox-PE). Results Scorpion stings accounted for more than 60% of all cases recorded for venomous animals. The children were from 37 cities of the Pernambuco state and accounted for 28.8% of the victims treated for scorpion stings, with the highest incidence in the metropolitan area of Recife. Stings occurred throughout the year and slightly increased during the rainy season. Independent of the elapsed time for a prognosis, most cases showed mild symptoms. Three moderate cases that resulted in death featured cardiogenic shock and/or pulmonary edema or severe neurological symptoms. For the first time, death attributed to T. stigmurus was confirmed by the presence of the scorpion. Conclusions These results suggest that scorpionism in Pernambuco is a public health problem that needs to be monitored carefully throughout the year by the government.

Soldadura por uma das extremidades de dois cromossômios homólogos do tityus

In this paper the author describes a very interesting case of union of two homologous chromosomes of the scorpion Tityus bahiensis just by the opposite extremities. The two normal pairs of chromosomes behave as ordinarily, the members of each pair showing at times a slight disturbance in their regular parallelism. The complex chromosome, on the contrary, behaves itself as if it were devoid of kinetochores, that is, it does not orient like normal chromosomes nor reveal any kind of active movement. The fusion of the chromosomes has resulted from terminal breakage at the opposite ends, the correspondig fragments having been found unpaired in a cell in which two pairs of chromosomes were present. Consequently, the compound chromosome, like the normal ones, is provided with a kinetochore at each one of the free ends. Being thus a centric chromosome its behavior, or more exactly, its kinetic inactivity may be compared with that of the monovalents found elsewhere in meioses. It is due o the failure of a partner. The fusion of two homologous chromosomes has transformed them into a new chromosomal unit in whose corresponding parts the ability of pairing was entirely abolished. This result is in full contradiction with the theory of a point-to point attraction between homologous chromosomes attributed to particular power of the genes, since, if genes really exist, being placed in their original loci, they would promote the union side by side of the members of the compound chromosome. If an attraction loci-to-loci should prevail the compound chromosome would be bent as in Fig. 8, C or form a ring similar to the loops observed in the inverted segment of sailvary chromosomes of Drosophila, as represented in the Fig. 8, D and this, in accordance with the order of the loci resulting from an union of corresponding or opposite ends of the fused chromosomes, as indicated in the Fig, 8 A and B. The evidence in hand points to a fusion by non homologous extremities. The expected rings, however, have never been found in metaphase plates. From this fact the author concludes that there is no point-to-point attraction between chromosomes, a conclusion in full agreement with the behavior of Hemipteran chromosomes which, in spite of geing composed of two equivalent halves do not bend in order to adjust the corresponding loci. (Cf. the papers on Hemiptera published by the author in this volume).

Uma raça cromossômica natural de Tityus bahiensis (Scorpiones-Buthidae)

A natural chromosomal race of Tityus babiensis (Scorpiones Buthidae) is described in the present paper. Five males and seven females received from St. Joaquim, State of S. Paulo, gave the following interesting results: All the spermatogonia of the five males were provided with 9 chromosomes of different sizes. All primary spermatocytes showed at metaphase one independent bivalent of normal shape and a complex group formed by 7 chromosomes which have exchanged parts. Some of the chromosomes associated in the complex group, to Judge by their behavior, were composed of fragments of three different chromosomes, being thus paired with three other members of the compound group. The manner in which all the 7 components of the group have paired with each other showed to be very constant. They gave always origin to a double-cross configuration, the longst branch of which being formed by a long chromosome paired with two components of the group and with a third chromosome that did not belong to the group. The chromosomes of the independent bivalent separate regularly, going to different poles. From the 7 elements of the compound group, 4 go to one pole and 3 to the opposite one. Consequently, secondary spermatocytes with 4 and 5 chromosomes are produced. The females, so far as it can be inferred from the study of the follicular cells of the ovariuterus, have 10 chromosomes. These females are, therefore, considered as being monogametic, that is, as producing eggs with 5 chromosomes. A sex-determining mechanism arose in this manner, the spermatozoa with 5 chromosomes giving origin to females and those with 4 to males. The fact that the sex chromosome is one of the elements taking part in the formation of the group, seems highly interesting to the author. Tetraploid cysts have been occasionally found in the testis. In one individual the chromosomes of the tetraploid primary spermatocytes behaved as expected, forming a group of 14 elements, and two independent pairs or a tetravalent group In another individual, the chromosomes of the tetraploid cells have formed two independent groups of 7, and two independent pairs, as if both chromosomal sets were by their turn entirely independent frcm one another. This fact is certainly not devoid of special interest. The males as well as the females studied in this paper differed in nothing from the typical members of the species. The unique differential character of the new race is found in the umber and behavior of its chromosomes. It is highly remarkable that the occurrences which have transformed the 6 chromosomes normally present in the species into a new set of 9 elements, 7 of which have been profoun- dly altered in their structure, do not show any influence on the morphology of the organism. This fact, together with those found in the salivary-chromosomes races of Drosophila and Sciara. compromises strongly the genetical concept of position effects.

Effect of toxin-g from Tityus serrulatus scorpion venom on gastric emptying in rats

The effect of toxin-g from Tityus serrulatus scorpion venom on the gastric emptying of liquids was studied in 176 young adult male Wistar rats (2-3 months of age) divided into subgroups of 8 animals each. Toxin-g was injected iv at doses of 25, 37.5, 50 or 100 µg/kg and the effect on gastric emptying was assessed 30 min and 8 h later. A time-course study was also performed by injecting 50 µg of toxin-g /kg and measuring the effect on gastric emptying at times 0.25, 0.5, 1, 2, 4, 8, 24 and 48 h post-venom. Each envenomed animal was paired with its saline control and all received a saline test meal solution containing phenol red (60 µg/ml) as a marker. Ten minutes after administering the test meal by gavage the animals were sacrificed and gastric retention was determined by measuring the residual marker concentration of the test meal. A significant delay in gastric emptying, at 30 min and 8 h post-venom, was observed only after 50 and 100 µg of toxin-g /kg compared to control values. The responses to these two doses were significantly different after 8 h post-venom. Toxin-g (50 µg/kg) significantly delayed the gastric emptying of liquids at all times studied, with a peak response at 4 h after toxin administration compared to control values. These results indicate that the iv injection of toxin-g may induce a rapid, intense and sustained inhibition of gastric emptying 0.25 to 48 h after envenomation.

Inhibition of gastric emptying and intestinal transit in anesthetized rats by a Tityus serrulatus scorpion toxin

The effects of a fraction (T1) of Tityus serrulatus scorpion venom prepared by gel filtration on gastric emptying and small intestinal transit were investigated in male Wistar rats. Fasted animals were anesthetized with urethane, submitted to tracheal intubation and right jugular vein cannulation. Scorpion toxin (250 µg/kg) or saline was injected iv and 1 h later a bolus of saline (1.0 ml/100 g) labeled with 99m technetium-phytate (10 MBq) was administered by gavage. After 15 min, animals were sacrificed and the radioactivity remaining in the stomach was determined. Intestinal transit was evaluated by instillation of a technetium-labeled saline bolus (1.0 ml) through a cannula previously implanted in the duodenum. After 60 min, the progression of the marker throughout 7 consecutive gut segments was estimated by the geometric center method. Gastric retention of the liquid test meal in rats injected with scorpion toxin (median: 88%; range: 52-95%) was significantly higher (P<0.02) than in controls (54%; 21-76%), an effect which was not modified by gastric secretion blockade with ranitidine. The progression of the isotope marker throughout the small intestine was significantly slower (P<0.05) in rats treated with toxin (1.2; 1.0-2.5) than in control animals (2.3; 1.0-3.2). Inhibition of both gastric emptying and intestinal transit in rats injected with scorpion toxin suggests an increased resistance to aboral flow, which might be caused by abnormal neurotransmitter release or by the local effects of venom on smooth muscle cells.

Excitatory amino acid receptor blockade within the caudal pressor area and rostral ventrolateral medulla alters cardiovascular responses to nucleus raphe obscurus stimulation in rats

Pressor responses elicited by stimulation of the nucleus raphe obscurus (NRO) depend on the integrity of the rostral ventrolateral medulla (RVLM). Therefore, to test the participation of excitatory amino acid (EAA) receptors in the cardiovascular responses evoked by NRO stimulation (1 ms, 100 Hz, 40-70 µA, for 10 s), the EAA antagonist kynurenic acid (Kyn) was microinjected at different sites in the ventrolateral medullar surface (2.7 nmol/200 nl) of male Wistar rats (270-320 g, N = 39) and NRO stimulation was repeated. The effects of NRO stimulation were: hypertension (deltaMAP = +43 ± 1 mmHg, P<0.01), bradycardia (deltaHR = -30 ± 7 bpm, P<0.01) and apnea. Bilateral microinjection of Kyn into the RVLM, which did not change baseline parameters, almost abolished the bradycardia induced by NRO stimulation (deltaHR = -61 ± 3 before vs -2 ± 3 bpm after Kyn, P<0.01, N = 7). Unilateral microinjection of Kyn into the CVLM did not change baseline parameters or reduce the pressor response to NRO stimulation (deltaMAP = +46 ± 5 before vs +48 ± 5 mmHg after Kyn, N = 6). Kyn bilaterally microinjected into the caudal pressor area reduced blood pressure and heart rate and almost abolished the pressor response to NRO stimulation (deltaMAP = +46 ± 4 mmHg before vs +4 ± 2 mmHg after Kyn, P<0.01, N = 7). These results indicate that EAA receptors on the medullary ventrolateral surface play a role in the modulation of the cardiovascular responses induced by NRO stimulation, and also suggest that the RVLM participates in the modulation of heart rate responses and that the caudal pressor area modulates the pressor response following NRO stimulation.

Age effects on the pharmacokinetics of tityustoxin from Tityus serrulatus scorpion venom in rats

The pharmacokinetics of scorpion venom and its toxins has been investigated in experimental models using adult animals, although, severe scorpion accidents are associated more frequently with children. We compared the effect of age on the pharmacokinetics of tityustoxin, one of the most active principles of Tityus serrulatus venom, in young male/female rats (21-22 days old, N = 5-8) and in adult male rats (150-160 days old, N = 5-8). Tityustoxin (6 µg) labeled with 99mTechnetium was administered subcutaneously to young and adult rats. The plasma concentration vs time data were subjected to non-compartmental pharmacokinetic analysis to obtain estimates of various pharmacokinetic parameters such as total body clearance (CL/F), distribution volume (Vd/F), area under the curve (AUC), and mean residence time. The data were analyzed with and without considering body weight. The data without correction for body weight showed a higher Cmax (62.30 ± 7.07 vs 12.71 ± 2.11 ng/ml, P < 0.05) and AUC (296.49 ± 21.09 vs 55.96 ± 5.41 ng h-1 ml-1, P < 0.05) and lower Tmax (0.64 ± 0.19 vs 2.44 ± 0.49 h, P < 0.05) in young rats. Furthermore, Vd/F (0.15 vs 0.42 l/kg) and CL/F (0.02 ± 0.001 vs 0.11 ± 0.01 l h-1 kg-1, P < 0.05) were lower in young rats. However, when the data were reanalyzed taking body weight into consideration, the Cmax (40.43 ± 3.25 vs 78.21 ± 11.23 ng kg-1 ml-1, P < 0.05) and AUC (182.27 ± 11.74 vs 344.62 ± 32.11 ng h-1 ml-1, P < 0.05) were lower in young rats. The clearance (0.03 ± 0.002 vs 0.02 ± 0.002 l h-1 kg-1, P < 0.05) and Vd/F (0.210 vs 0.067 l/kg) were higher in young rats. The raw data (not adjusted for body weight) strongly suggest that age plays a pivotal role in the disposition of tityustoxin. Furthermore, our results also indicate that the differences in the severity of symptoms observed in children and adults after scorpion envenomation can be explained in part by differences in the pharmacokinetics of the toxin.