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Scorpion envenomation causing neuromuscular toxicity (United States, Mexico, Central America, and Southern Africa)

Author
Frank LoVecchio, DO, MPH, FACEP
Section Editors
Daniel F Danzl, MD
Stephen J Traub, MD
Michele M Burns, MD, MPH
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

This topic will discuss the clinical manifestations, diagnosis, and management of envenomation by scorpions whose stings cause neuromuscular toxicity (eg, Centruroides species [indigenous to the southwestern United States, Mexico, and Central America] and Parabuthus species [inhabiting Western and Southern Africa]).

The clinical manifestations, diagnosis, and treatment of scorpion envenomations in other parts of the world that cause autonomic storm, myocardial depression, and pulmonary edema are discussed separately.

ENTOMOLOGY

Scorpions, which are grouped in the phylum Arthropoda, have a lobster-like body shape with seven sets of paired appendages: the chelicerae, the pedipalps (claws), four sets of legs, and the pectines (a pair of comb-like structures on the ventral surface) (figure 1). The segmented tail curves upward dorsally, ending in a terminal bulbous segment called the telson, which contains paired venom glands and the stinger. In the United States, a subaculear tooth on a small, slender scorpion is specific to Centruroides exilicauda (sculpturatus), also known as the bark scorpion (picture 1 and picture 2 and picture 3) [1,2].

Envenomation occurs through stinging, not biting. Scorpions clutch prey in their pedipalps (claws) and thrust the tail overhead to sting. Although envenomations are sometimes reported as bites, true scorpion bites have not been documented and would be inconsequential if they did occur. Scorpions can sting multiple times, although the first sting depletes or nearly depletes the telson of venom.

A characteristic physical property of scorpions is that they fluoresce when illuminated by ultraviolet light, as from a black light or a medical Wood's lamp (picture 4) [3]. This property is used in collecting scorpions for breeding or venom harvesting and in providing pest control. The fluorescent pigment in scorpion cuticle is most likely riboflavin.

                   

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Literature review current through: Dec 2016. | This topic last updated: Wed Dec 14 00:00:00 GMT 2016.
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References
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  1. Curry, SC, Vance, MV, Ryan, PJ, et al. Envenomation by the scorpion Centruroides sculpturatus. J Toxicol Clin Toxicol 1983-1984; 21:417.
  2. Russell FE. Venomous arthropods. Vet Hum Toxicol 1991; 33:505.
  3. Krifi MN, el Ayeb M, Ben Lasfar Z, et al. Improvement and standardization of antivenoms sera. Arch Inst Pasteur Tunis 1992; 69:253.
  4. Hutt MJ, Houghton PJ. A survey from the literature of plants used to treat scorpion stings. J Ethnopharmacol 1998; 60:97.
  5. LoVecchio F, McBride C. Scorpion envenomations in young children in central Arizona. J Toxicol Clin Toxicol 2003; 41:937.
  6. Gambhir IS, Singh DS, Pattnaik DN. Stroke in a young woman. Postgrad Med J 1998; 74:555.
  7. LoVecchio F, Welch S, Klemens J, et al. Incidence of immediate and delayed hypersensitivity to Centruroides antivenom. Ann Emerg Med 1999; 34:615.
  8. Stipetic ME, Lugo A, Brown B, et al. A prospective analysis of 558 common striped scorpion (Centruroides vittatus) envenomations in Texas during 1997 (meeting abstract). J Toxicol Clin Toxicol 1998; 36:461.
  9. Larsen N. Parabuthus granulatus (Granulated thick-tailed scorpion). Biodiversity Explore: The web of life in Southern Africa. http://www.biodiversityexplorer.org/arachnids/scorpions/buthidae/parabuthus_granulatus.htm (Accessed on November 03, 2016).
  10. Műller GJ, Modler H, Wium CA, Veale DJH. Scorpion sting in southern Africa: diagnosis and management. CME 2012:30 http://www.cmej.org.za/index.php/cmej/article/view/2545/2580 (Accessed on November 03, 2016).
  11. Parabuthus transvaalicus (Transvaal thick-tailed scorpion). Biodiversity Explorer: The web of life in southern Africa. http://www.biodiversityexplorer.org/arachnids/scorpions/buthidae/parabuthus_transvaalicus.htm (Accessed on November 03, 2016).
  12. Isbister GK, Bawaskar HS. Scorpion envenomation. N Engl J Med 2014; 371:457.
  13. Chippaux JP. Emerging options for the management of scorpion stings. Drug Des Devel Ther 2012; 6:165.
  14. Debont T, Swerts A, Van der Walt JJ, et al. Comparison and characterization of the venoms of three Parabuthus scorpion species occurring in southern Africa. Toxicon 1998; 36:341.
  15. Vatanpour H, Rowan EG, Harvey AL. Effects of scorpion (Buthus tamulus) venom on neuromuscular transmission in vitro. Toxicon 1993; 31:1373.
  16. Garcia ML, Hanner M, Kaczorowski GJ. Scorpion toxins: tools for studying K+ channels. Toxicon 1998; 36:1641.
  17. Inceoglu B, Lango J, Jing J, et al. One scorpion, two venoms: prevenom of Parabuthus transvaalicus acts as an alternative type of venom with distinct mechanism of action. Proc Natl Acad Sci U S A 2003; 100:922.
  18. Arie-Saadia G, Sofer S, Zlotkin E, Shainberg A. Effect of Leiurus quinquestriatus hebreus venom on calcium and deoxyglucose uptake in cultured cardiac cells. Toxicon 1996; 34:435.
  19. Quintero-Hernández V, Jiménez-Vargas JM, Gurrola GB, et al. Scorpion venom components that affect ion-channels function. Toxicon 2013; 76:328.
  20. Sofer S. Scorpion envenomation. Intensive Care Med 1995; 21:626.
  21. Boyer L, Heubner K, McNally J, Buchanan P. Death from Centruroides scorpion sting allergy. J Toxicol Clin Toxicol 2001; 39:561.
  22. Dehesa-Dávila M, Possani LD. Scorpionism and serotherapy in Mexico. Toxicon 1994; 32:1015.
  23. Klauber LM. Rattlesnakes: Their Habits, Life Histories, and Influence on Mankind, University of California Press, Berkeley 1997. Vol 1, p.838.
  24. Müller GJ. Scorpionism in South Africa. A report of 42 serious scorpion envenomations. S Afr Med J 1993; 83:405.
  25. Bergman NJ. Clinical description of Parabuthus transvaalicus scorpionism in Zimbabwe. Toxicon 1997; 35:759.
  26. Amaral CF, Rezende NA. Both cardiogenic and non-cardiogenic factors are involved in the pathogenesis of pulmonary oedema after scorpion envenoming. Toxicon 1997; 35:997.
  27. Bergman NJ. Scorpion sting in Zimbabwe. S Afr Med J 1997; 87:163.
  28. Clark RF, Selden BS, Kunkel DB, Frost MD. Abnormal eye movements encountered following severe envenomations by Centruroides sculpturatus. Neurology 1991; 41:604.
  29. Berg RA, Tarantino MD. Envenomation by the scorpion Centruroides exilicauda (C sculpturatus): severe and unusual manifestations. Pediatrics 1991; 87:930.
  30. Annobil SH. Scorpion stings in children in the Asir Province of Saudi Arabia. J Wilderness Med 1993; 4:241.
  31. Kolecki P. Inadvertent methamphetamine poisoning in pediatric patients. Pediatr Emerg Care 1998; 14:385.
  32. Approval letter - Anascorp. US Food and Drug Administration. http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/FractionatedPlasmaProducts/ucm266726.htm (Accessed on August 04, 2011).
  33. Boyer LV, Theodorou AA, Berg RA, et al. Antivenom for critically ill children with neurotoxicity from scorpion stings. N Engl J Med 2009; 360:2090.
  34. Ramsey JM, Salgado L, Cruz-Celis A, et al. Domestic scorpion control with pyrethroid insecticides in Mexico. Med Vet Entomol 2002; 16:356.