Scorpion sting envenomation presenting with pulmonary edema in adults: A report of seven cases from Nepal (original) (raw)
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Scorpion sting is a common problem in villages of underdeveloped countries like India. It may present with mild local pain to severe systemic symptoms related to respiratory, neurologic and cardiovascular systems. The life-threatening complications like myocarditis and pulmonary edema are known with red scorpion in India. This condition requires urgent attention and ICU care from few hours to days. Delay in recognition and the hypoxemia increase the morbidity and mortality. Illiteracy, ignorance, poverty, traditional faith healers trying treatment in remote areas, lack of transport in difficult terrains and the non availability of ventilation facility in nearby hospital, add to delay in appropriate treatment.
International Journal of Cardiology, 2013
Scorpion envenomation is common in tropical and subtropical regions. Cardio-respiratory manifestations, mainly cardiogenic shock and pulmonary edema, are the leading causes of death after scorpion envenomation. The mechanism of pulmonary edema remains unclear and contradictory conclusions were published. However, most publications confirm that pulmonary edema has been attributed to acute left ventricular failure. Cardiac failure can result from massive release of catecholamines, myocardial damage induced by the venom or myocardial ischemia. Factors usually associated with the diagnosis of pulmonary edema were young age, tachypnea, agitation, sweating, or the presence of high plasma protein concentrations. Treatment of scorpion envenomation has two components: antivenom administration and supportive care. The latter mainly targets hemodynamic impairment and cardiogenic pulmonary edema. In Latin America, and India, the use of Prazosin is recommended for treatment of pulmonary edema because pulmonary edema is associated with arterial hypertension. However, in North Africa, scorpion leads to cardiac failure with systolic dysfunction with normal vascular resistance and dobutamine was recommended. Dobutamine infusion should be used as soon as we have enough evidence suggesting the presence of pulmonary edema, since it has been demonstrated that scorpion envenomation can result in pulmonary edema secondary to acute left ventricular failure. In severe cases, mechanical ventilation can be required.
Acute myocarditis and pulmonary edema due to scorpion sting
Global Cardiology Science and Practice, 2016
Objective: To present a case of a serious manifestation of scorpion sting, which was not reported before in Qatar, review the literature, and compare with previously reported similar cases. Case presentation and intervention: A young male patient was admitted to CCU with a clinical picture of acute toxic myocarditis and cardiogenic shock with abnormal ECG and elevated cardiac markers after a scorpion sting to his right big toe. Thorough investigations, including echocardiography, cardiac MRI and right heart catheterization, supported the diagnosis. Coronary angiography was normal. Patient was managed conservatively with supportive measures, mechanical ventilation, IV fluids, inotropic agents, steroids, antibiotics and Prazocin. Over 9 days of hospital course, patient gradually improved, was successfully extubated, and was discharged in a stable condition. Conclusion: Toxic myocarditis (with myocardial damage), pulmonary edema and cardiogenic shock are reported manifestations of scorpion venom intoxication.
Journal of Evidence Based Medicine and Healthcare, 2016
INTRODUCTION Scorpion sting envenomation are real threats in children of tropical and subtropical zones of world including India. It may be life threatening in children, if left untreated. The annual number of scorpion stings exceeds 1.2 million with 2.3 billion population at risk. The incidence of scorpion sting is very high in some parts of India; Warangal is one among them. METHODS & MATERIALS This is an Observational Cross-Sectional Study of 115 cases of scorpion sting, admitted to MGM Hospital Warangal, under Kakatiya Medical College from 1st Jan 2014 to December 2014 were included in the study. RESULTS In this present study, incidence of scorpion sting was 2.45 %. More than half cases were seen in 1-6 years of age. 63% of scorpion stings are in summer and late winter. 85% of cases were from rural areas. 84% of scorpion stings were indoor, may be due to poor housing condition. Most common symptom was pain, followed by sweating, paraesthesia, vomiting. Most common physical signs noted were cold extremities followed by hypotension, priapism hypertension, tachycardia, and bradycardia. Most common complication observed was peripheral circulatory failure followed by myocarditis, pulmonary oedema, congestive heart failure. CONCLUSION One child developed hemiplegia, severity of symptoms, signs, complications and outcome did not depend on the age, sex, site of sting, interval between sting and admission. Presence of, vomiting, tachypnoea, shortness of breath, ECG abnormalities, priapism, creps in the lungs, prolonged CRT, had more chances of progressing to complications like myocarditis, pulmonary oedema. The serum levels of sodium, potassium, blood glucose, total leucocyte count did not have any effect on complications and outcome of the children. Two deaths occurred due to massive pulmonary oedema and myocarditis. Case Fatality rate was 1.7%.
Scorpion Sting-induced Pulmonary Edema
Chest, 1990
We report two cases of pulmonary edema due to scorpion sting. Radionuclide ventriculography (MUGA scan) showed localized cardiac dysfunction. The cardiac injury induced by the scorpion venom persisted for a prolonged period.
Scorpion Bite Induced Myocardial Ischaemia and Pulmonary Edema
Journal of Case Reports, 2020
Background: Scorpion stings are common in India. Most of them are limited to moderate to severe pain at site of bite only, but good number of patients present with life threatening complications in the form of involvement of cardiac, respiratory and nervous system. Here we are reporting a case of myocarditis and pulmonary edema following sting of scorpion. Case Report: A 25 year old male presented with scorpion bite induced myocardial ischaemia, congestive cardiac failure and pulmonary edema. The cardiovascular manifestations in scorpion bite are the result of effect of venom on the sympathetic nervous system, adrenal secretion of catecholamines and the direct toxic effect of the venom on myocardium itself. Conclusion: Severe scorpion bites can present as myocardial ischaemia, congestive cardiac failure and pulmonary edema. Aggressive management with ventilator support, diuretics, parenteral steroids, antihistaminics and ionotropic agents can result in rapid clinical resolution.
A Study Of ECG abnormalities associated with scorpion sting in a tertiary care centre, Kadapa
Background: Scorpion stings, though not a big problem in many developed countries, it is a major public health problem in underdeveloped and in some developing countries all over the world. In India, many people are stung by the red scorpion (Mesobuthus tamulus) with recorded fatalities in both adults and children. Scorpion sting is considered as a life threatening medical emergency of villagers in India. Numerous envenomations go unreported. Hence, true incidence is frequently unavailable. Among the eighty six scorpion species in India, Mesobuthus tamulus and Palamneus swammwe-dami are of medical importance. Aims and Objectives: To study the clinical spectrum and electrocardiographic changes in scorpion sting envenomation. Materials and Methods : 53 patients of scorpion sting envenomation who were admitted in Goverment medical college and hospital ,kadapa, were included in the study. The clinical spectrum, symptoms, signs, electrocardiogram, CK-MB were collected and analysed Result: 53 patients were included in the study out of which 30 were male and 23 were female. There was no significant difference in clinical presentation with respect to age group and gender. Hand was the commonest site of sting. Local pain was the most common symptom followed by local swelling, paaresthesias and redness. Tenderness at the sting site was the most common sign followed by tachycardia. Pulmonary edema was present in 3 patients.18 patients had grade 3 envenomation and all those 18 patients had significant ECG changes and serum CK-MB was elevated in all these 18 patients .Sinus tachycardia was the most common ECG abnormality. Conclusion: In this study eighteen out of 53 cases had ECG changes. Three of the patients presented with pulmonary edema. There was no mortality due to scorpion sting in the study period. There was significant correlation between the time delay and severity of envenomation. This indicates a need for immediate medical care following scorpion sting Following this study it is seen that patients were stung by the scorpions due to their lack of knowledge about scorpions and due to their carelessness, like putting their hands in to scorpion homes. Follow up studies are required to assess the long term complications of scorpion stings.
Clinical Features and Complications of Scorpion Sting: A Descriptive Study
Background: Scor pion sting is a common pr oblem in r ur al par ts of India. It is uncommon for patients with scor pion sting to present with life threatening complications. This study aimed to describe the clinical manifestations and complications of scorpion sting. Methods: A descr iptive study of clinical featur es and complications of patients diagnosed with scor pion sting and admitted in two hospitals attached to Jagadguru Jayadeva Murugarajendra (J.J.M) Medical College in Davangere, a state at the southern India. Results: A total of 52% of scorpion sting cases were patients between the age group of 15 to 30 years. Pain at the sting site (100%) and tachycardia (78%) were the most common presenting signs and symptoms respectively. Pulmonary oedema (24%) and myocarditis (18%) were the two most serious complications. Most of the cases (94%) recovered completely without any sequale. Mortality (4%) was secondary to severe pulmonary oedema and myocarditis. Conclusion : Cardiovascular complications were most common causes of death from scorpion sting. Early treatment may prove to be necessary for complete recovery.