Serum Levels of Toxin in Scorpion Envenomed Pediatric Patients in the Hospital del Niño Morelense.
Osnaya N1; Negrete G2; Acosta l2; Medina T1; León G1; Possani L3; Bon C4; Calderon-Aranda E2.
1Hospital Del Niño Morelense Cuernavaca, Morelos, México; 2Sección de Toxicología Ambiental, Departamento de Farmacología y Toxicología, CINVESTAV IPN MÉXICO; 3Departamento de Reconocimiento Molecular y Bioestructura, Instituto de Biotecnología, UNAM. México; 4Unité Des Venins, Institute Pasteur. Paris, Francia
Scorpion envenoming is a problem that affects some regions of the Mexican Republic. In Mexico, about 200,000 people have been reported with scorpion envenoming, resulting in around 700 to 800 deaths. In 1996, the Morelos State reported 29,830 cases and 8 deaths, (report of the Health Department Number II). Centruroides limpidus limpidus is the species that is found in the Morelos State and is considered one of the more toxic species to humans. The treatment of scorpion envenoming is to give urgent support, treating symptoms and administering antivenom. The clinical manifestations of central and peripheric neurotoxicity, cardiotoxicity, and metabolic disorders shown by patients are directly related to the amount of venom, and the toxin concentration that the scorpion delivers to the victim. It is therefore important to correlate the toxin levels with the clinical manifestations. We decided to perform a study in the Hospital del Niño Morelense in Cuernavaca, Morelos to find the correlation between the serum levels of scorpion toxin with clinical manifestation severity, patient weight, and the number of doses of scorpion antivenom administered. The study was conducted from November 1997 to June 1998 in the emergency unit of the Hospital del Niño Morelense. We included 71scopion-envenomed patients without having been previously treated. At the beginning, we collected a 2 ml-blood sample that was centrifuged for determination of toxin level by ELISA. We divided the patients into 3 groups based on mild, moderate, and severe clinical manifestations. We observed a higher percentage of males gender (66%), with the median age being 71.1 months. Toxin levels correlated with the severity of the manifestations were statistically significant. Toxin levels were detected within the 2-hour period after sting. There was no correlation between weight and number of doses of antivenom with toxin levels. Time between the sting and initial consultation was 1 hour. We concluded that the severity of clinical manifestations is related to the toxin levels in patient serum independently of weight and age. The toxin levels were detected within the first two hours post-sting. After this time, we did not detect scorpion toxin independently of clinical manifestations. We wish to emphasize the importance of scorpion antivenom administration as soon as possible in patients with moderate and severe manifestations to avoid complications or even death. It is important to establish health education programs in all endemic regions.
Publication in this collection
08 Oct 2002
Date of issue