SCORPION ENVENOMATION - FATAL CASES

CUPO, P.(1)

(1)Departamento de Puericultura e Pediatria - Faculdade de Medicina de Ribeirão Preto – USP.

Scorpion envenomation represents an important and serious public health problem in Brazil and also in others parts of the world. It may cause severe hemodynamic and cardiorespiratory alterations, particularly in children, being the cardiac failure and pulmonary edema the causes of death. Cardiac damage has been attributed to sympathetic hyperstimulation caused by the venom, by direct action on the myocardium or through hemodynamic effects, to local action of the toxin in the heart and, as side effect, to increased levels of cytokines. Evidence of cardiac injury includes in addition to clinical manifestations, electro and echocardiographic changes, increased levels of creatinokinase, lactatodesydrogenase, and its fractions CKMB and LD1. Recently it was also described an increased levels of troponin I, the gold standard for the diagnosis of myocardial injury, which support the cardiac origin of pulmonary edema. Unfortunately the epidemiological data of scorpion poisoning as well anathomopathological data of fatal cases are scarce, limited mainly to short communications of isolated cases. During 1982-1998, 7880 victims of scorpion bites were managed at the Emergency Unity of Clinical Hospital of Faculty of Medicine of Ribeirão Preto. Most of the accidents were caused by T. serrulatus and were classified as mild in 7639 (97%) patients, moderate in 105 (1.3%), and severe in 136 (1.7%), occurring 7 deaths (0.09%). Most of the severe and moderate poisoning (91% and 84%) occurred in children under 15 years, as well as the deaths (5 under 7 years and 2 under 12). The pulmonary edema/shock developed in the first 10 h and most of the patients died within the 24 h of the bite. Anathomopathological data of 6 patients revealed lung with increased size, diffuse alveolar edema, areas with hemorrhage, and inflammatory infiltrate. The coronary arteries were pervious in all the patients and the cardiac chambers were increased in 4. Microscopy was carried out in 5 patients and showed vacuolar degeneration of cardiac fibers, focal areas with myocitolysis and necrosis, interstitial edema with inflammatory infiltrate.

CORRESPONDENCE TO:

Palmira Cupo, Rua Adolfo Serra, 889, Ribeirão Preto, SP, CEP: 14025-520, Brasil, Email: pcupo@fmrp.usp.br