[PDF] Scorpionism in South Africa Victims of scorpion sting particularly

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derbite.Toxiam1969;6:299-300. 25.

Med]1990;77:92-95.

ScorpionisminSouthAfrica

issue). 29.

37-46.

30.VisserJ.Dangeroussnakesandsnakebite.JohnVisser,P 0Box

916,Durbanville,7550.

cases.

Med]AlISc1961;11:44-49.

VecHumToxicol1980;22:suppl2,39-41.

33.
envenomation.AnnEmergMed1987;16:188-191.

Areportof42seriousscorpionenvenomations

G.].MULLER

mentofscorpionismarediscussed.

Mostenvenomationsoccurredinthesummer

months,peakinginJanuaryandFebruary.An immediatelocalburningpainwasthemostpro minentsymptom.Systemicsymptomsandsigns developedwithin4hoursofthestinginmost hyperaesthesia,musclepainandcramps.Other andsialorrhoeawithvaryingdegreesoflossof temperaturewereoftenraisedandthetendon impaired.Inaconsiderablenumberofpatients andsignsofsystemicenvenomationshould receiveantivenom.

Parabuthusgranulatus(Hemprich&Ehren

tantvenomousspeciesinthewesternCape.The antivenomisproducedfromthevenomofthe

1899.Astrongcasecanthereforebemadeforthe

inclusionofP.granulatusvenomintheproduc tionofapolyvalentantivenom.

SAfrMedJ1993;83:405-411.

Parowvallei,CP

Accepted17Dec1992.

seriousscorpionenvenomationsarenotas commoninSouthAfricaasincenainregionsof

TormAfrica,theMiddleEast,Indiaandorm

entity species envenomation,4 ofwhichhadafataloutcome,arepre sented andtheclinicalprofileandmanagementofscor pionism isdiscussed.

Methods

1991/92wereincluded

intheseries.Inordertodeter mine sibleforseriousenvenomations inourregion,panicular catedinincidents.

Scorpionstingcausingsystemic

symptomsandsigns is

Results

adults and19inchildren.Twenty-sevenpatientswere graphicaldistribution ofthescorpionstingsisshownin

Fig.1.

Allbut1oftheenvenomationsoccurredinthe

springandsummer monthsfromOctobertoMarch,

Seventy-five

percentofthestingstookplaceinthe theveld,

27%ofthevictimswerestunginsidethehome.

Asting

markwasvisibleinonlyhalfofthe38patients thesethe surroundinginflammatotyreactionwasmild site ofthesting,28werestungonthefootandlower leg,7 onthehandandforearmand3ontheback.

IIWESTERNCAPEI/

AVAHFiHYJiSDOfUll

.000

FIG.1.

within4hours ofthestinginmostpatients,onsetin4 adultpatientswasdelayedfrom4to12hours. arterial bloodgasvaluesfor11ofthe12patientsare showninTableIT. mrnHgto2001130mrnHg. hyperactive tendonreflexes,wasamarkedprolongation oftherelaxationphaseoftheanklereflex. inanaveragedoseof10ml;22patientsreceived hours,1after48hoursand1onday5.Noneofthe venomisusedinthetreatmentoflatrodectism. 4 Itwas

PROMINENTSYMPTOMSANDSIGNSOFSCORPIONISM

DOCUMENTEDINTHISCASESERIES

SYMPTOMS

Severepainatstingsite·(96%)(79%)

Paraesthesia(74%)_(11%)

Generalfeelingofweakness(61%)_(26%)

Trembling-152%).(5%)

HY....I

(43%)•(5%)

Increasedsalivation(30%)(63%)

AnXiety(26%)(68%)

Visualdisturbances-

(26%).(5%)

Difficultyinbreathing----------------

_(22%)(42%)

Increasedsweating-----------------

_(22%)(0%)

Nausea,vomiting,diarrhoea-----------

_(9%)10%) SIGNS

Dysphagia,dysarthria(70%)(47%)

Tremors,involuntarymovements(57%)(32%)

Stingmarkevident(57%)(32%)

Raisedbloodpressure(48%)(32%)

Hyperactivestretchreflexes(48%).(5%)

Decreasedmotorpower(43%)_(26%)

Raisedtemperature(43%)(32%)

Incoordination,ataxia(39%)(42%)

Hyperactivity,restlessness(39%)(84%)

Increasedsalivation(35%)(68%)

Increasedsweating(26%).(5%)

Ptosis(26%)_(16%)

Respiratorydepression·126%)(53%)

Tachycardia_122%)(42%)

Absentgagreflex------------------

_(9%)_(21%) I III III!I!I!I!I!I!I , III I, !IItII I IIII!tII III

0 510152023

0 5101519

NumberofpatientsNumberofpatients

FIG.2.

cacy function (TableI).Noinstancesofanallergicresponse to mildform ofsystemicinvolvement.The4childrenwho antivenom.

Onechilddiedenroutetohospital1Y2hours

tions ofaspiration. completely,wereasfollows:7patients hadamoderately elevatedwhitecell countrangingfrom11to24X10'/1 (the patients,4 outof6hadraisedcreatinekinaselevels,and radiograph. granulatus and1asP.capensis(Hemprich&Ehrenberg, has

Discussion

belong totheButhidaefamily.TheButhidaeareeasily distinguishablefrom theScorpionidaebytheirthicktails 140
shallow burrowsorscrapesatthebaseofshrubs,under depicts arerestrictedtoNamaqualandandthenonhern

Africa."·

Scorpionvenomisinjectedbymeansofastinger

asthevesicle,containstwovenomglands, eachwitha also low-molecular-weightorganicmolecules andmanydif ferentsmallbasicproteins(M r <8000),whicharethe alleffectisa tendencyoftheneurontofiresponta from theadrenalmedullaY3-I'Thesemechanismsmay muscleeffects ofscorpionvenom.IISymptomsandsigns insevereenvenomations. 3

Hypenensionmayalsobe

11

Tremorsandinvoluntarymovementsseeninscor

phase ofneurotransminerdepletion,someotherunex plainedcentral mechanismsmaywellbeinvolved.

Thespectrumanddegreeofsymptomsandsignsof

including thescorpionspeciesinvolved,thebodymass the wellasdifficultiesineliciting cenainsignsinachildpre sentingwithextremerestlessness. canbedescribedasfollows: time paraesthesiainthehandsandfeetwithin1 - 4hoursof

Generalisedhyperaesthesia,muscle

painandcrampsare

FIG.3.

FIG.4.

ParabuthusinsouthernAfrica.

reflected indifficultyinwalking,isacommonsymptom. stantialnumberhavedifficultybreathing.

FIG.5.

southernAfrica. stimulation.

Themechanismresponsibleforthebulbar

explored.

Thebloodpressureandtemperarureareoften

raised isnotclear. ataxica]]yinagaitsimilar tothatseeninalcoholincoxi cation. numberofpatients. ficult torestrain.Heorshemayassumeanunnarural effects ofanoverdoseofneuroleptics,tricyclicanti explain.

Someauthorshavesuggestedthattheincrease

in

TABLEI.

quotesdbs_dbs26.pdfusesText_32

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