UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Scorpion stings in the United States and Mexico

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

Scorpion envenomation is a significant problem in the southwestern United States and throughout Mexico. In the United States, Centruroides exilicauda (sculpturatus) stings are associated with major neurologic toxicity, especially in young children. In Mexico, multiple toxic species exist, and annual mortality due to scorpion envenomation is ten times higher than that due to snakebite [1]. An estimated 5000 deaths occur annually from scorpion stings worldwide [2,3].

Supportive care is the key component of management. Antivenom therapy with equine derived Fab fragments reduces the duration of symptoms. Centruroides antivenom is available in Mexico; in the United States, its use is restricted to that of an approved investigational drug [4].

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) [5,6].

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) [7]. 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.

                                

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Dec 11 00:00:00 GMT+00:00 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Klauber LM. Rattlesnakes: Their Habits, Life Histories, and Influence on Mankind, University of California Press, Berkeley 1997. Vol 1, p.838.
  2. LoVecchio F, McBride C. Scorpion envenomations in young children in central Arizona. J Toxicol Clin Toxicol 2003; 41:937.
  3. Gambhir IS, Singh DS, Pattnaik DN. Stroke in a young woman. Postgrad Med J 1998; 74:555.
  4. 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.
  5. Curry, SC, Vance, MV, Ryan, PJ, et al. Envenomation by the scorpion Centruroides sculpturatus. J Toxicol Clin Toxicol 1983-1984; 21:417.
  6. Russell FE. Venomous arthropods. Vet Hum Toxicol 1991; 33:505.
  7. Krifi MN, el Ayeb M, Ben Lasfar Z, et al. Improvement and standardization of antivenoms sera. Arch Inst Pasteur Tunis 1992; 69:253.
  8. Hutt MJ, Houghton PJ. A survey from the literature of plants used to treat scorpion stings. J Ethnopharmacol 1998; 60:97.
  9. LoVecchio F, Welch S, Klemens J, et al. Incidence of immediate and delayed hypersensitivity to Centruroides antivenom. Ann Emerg Med 1999; 34:615.
  10. 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.
  11. Sofer S. Scorpion envenomation. Intensive Care Med 1995; 21:626.
  12. Vatanpour H, Rowan EG, Harvey AL. Effects of scorpion (Buthus tamulus) venom on neuromuscular transmission in vitro. Toxicon 1993; 31:1373.
  13. Garcia ML, Hanner M, Kaczorowski GJ. Scorpion toxins: tools for studying K+ channels. Toxicon 1998; 36:1641.
  14. 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.
  15. Boyer L, Heubner K, McNally J, Buchanan P. Death from Centruroides scorpion sting allergy. J Toxicol Clin Toxicol 2001; 39:561.
  16. Dehesa-Dávila M, Possani LD. Scorpionism and serotherapy in Mexico. Toxicon 1994; 32:1015.
  17. Clark RF, Selden BS, Kunkel DB, Frost MD. Abnormal eye movements encountered following severe envenomations by Centruroides sculpturatus. Neurology 1991; 41:604.
  18. Berg RA, Tarantino MD. Envenomation by the scorpion Centruroides exilicauda (C sculpturatus): severe and unusual manifestations. Pediatrics 1991; 87:930.
  19. Annobil SH. Scorpion stings in children in the Asir Province of Saudi Arabia. J Wilderness Med 1993; 4:241.
  20. 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.
  21. Kolecki P. Inadvertent methamphetamine poisoning in pediatric patients. Pediatr Emerg Care 1998; 14:385.
  22. Approval letter - Anascorp. US Food and Drug Administration. http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/FractionatedPlasmaProducts/ucm266726.htm (Accessed on August 04, 2011).
  23. Ramsey JM, Salgado L, Cruz-Celis A, et al. Domestic scorpion control with pyrethroid insecticides in Mexico. Med Vet Entomol 2002; 16:356.