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Articlemonteiroetal2019.Pdf See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/335640297 Perspectives and recommendations towards evidence-based health care for scorpion sting envenoming in the Brazilian Amazon: A comprehensive review Article in Toxicon · September 2019 DOI: 10.1016/j.toxicon.2019.09.003 CITATIONS READS 0 64 17 authors, including: Wuelton Marcelo Monteiro Nelson Ferreira Fé Fundação de Medicina Tropical Doutor Heitor Vieira Dourado Universidade do Estado do Amazonas 260 PUBLICATIONS 1,547 CITATIONS 41 PUBLICATIONS 360 CITATIONS SEE PROFILE SEE PROFILE Iran Mendonça da Silva Fernando Fonseca de Almeida e Val Universidade do Estado do Amazonas Fundação de Medicina Tropical Doutor Heitor Vieira Dourado 47 PUBLICATIONS 248 CITATIONS 29 PUBLICATIONS 90 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Effects of exercise on muscle and bone in pathogenic conditions View project PNG Snakebite Research Project View project All content following this page was uploaded by Wuelton Marcelo Monteiro on 06 September 2019. 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Toxicon xxx (xxxx) xxx-xxx Contents lists available at ScienceDirect Toxicon journal homepage: http://ees.elsevier.com Review Perspectives and recommendations towards evidence-based health care for scorpion sting envenoming in the Brazilian Amazon: A comprehensive review a b a b a a b Wuelton Marcelo Monteiro , ,∗, Jacimara Gomes , , Nelson Fé , Iran Mendonça da Silva , , Marcus Lacerdaa,c, Aristóteles Alencara,d, Altair Seabra de Fariasa,b, Fernando Vala, Vanderson de Souza Sampaioa,e, Gisely Cardoso de Meloa,b, Pedro Pardalf, Ageane Mota da Silvag, h a,d i Paulo Sergio Bernarde , Luiz Carlos de Lima Ferreira , José María Gutierrez , Jacqueline de Almeida Gonçalves Sachetta,b,j, Hui Wen Fank a Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil b Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Amazonas, Brazil c Fundação Oswaldo Cruz, Instituto Leônidas e Maria Deane, Manaus, Amazonas, Brazil d Universidade Federal do Amazonas, Manaus, Amazonas, Brazil e Fundação de Vigilancia em Saúde, Manaus, Amazonas, Brazil f Universidade Federal do Pará, Belém, Pará, Brazil g Instituto Federal do Acre, Cruzeiro do Sul, Acre, Brazil h Universidade Federal do Acre, Campus Floresta, Cruzeiro do Sul, Acre, Brazil i Instituto Clodomiro Picado, School of Microbiology, University of Costa Rica, San José, j Costa Rica Fundação Alfredo do Matta, Manaus, Amazonas, Brazil k Instituto Butantan, São Paulo, São Paulo, Brazil A R T I C L E I N F O A B S T R A C T Keywords Although underreported across the Amazon region, scorpion stings are very prevalent in some areas and can be potentially life-threatening, especially in children. The most vulnerable populations are those living in locations far Amazon Antivenom from the capitals, hence having limited access to the health system where the appropriate structure for the Arachnida treatment of severe cases is found. An abundant and diverse fauna of scorpions is found in the region, but few Public health studies have been conducted to decipher the clinical characteristics and therapeutic response of the available an- Scorpion Scorpion stings tivenoms in envenomings caused by the various species. Antivenom underdosage as well as delayed medical as- sistance are common among indigenous populations, resulting in poor outcome rates. An in depth understanding of the epidemiological, clinical and therapeutic aspects of scorpion sting envenomings in the Amazon is necessary to improve the outcome of these cases. 1. Introduction yearly. A total of 124,077 cases were reported in 2017, which represents an incidence of 59.7 cases/100,000 inhabitants (Ministério Approximately two billion people live in risk areas for scorpion en- da Saúde/ SVS, 2019). venoming with annual estimates reaching over a million cases world- Most medically important scorpion species in South America belong to wide (Chippaux and Goyffon, 2008). These occur predominantly in the buthid genus Tityus (Borges and Graham, 2016). This genus comprises countries with tropical and subtropical climates (Dabo et al., 2011), the most diverse group of scorpions in South America (Wil-son R. especially in the warmer season (Chowell et al., 2006; Hui Wen et al., Lourenço, 2002a, 2002b). In Brazil, the main species of med-ical interest 2015). Developing countries from Africa, the Middle East re-gion, belongs to the genus Tityus, which, in addition to their dis-tribution in Southern India, Mexico, Brazil and other Latin American coun-tries natural habitats, has a high adaptive capacity to colonize anthropic within the Amazon region present the highest prevalence of se-vere environments (Ministério da Saúde do Brasil- Fundação Nacional de Saúde cases. In Brazil, scorpion stings are an emerging and neglected pub-lic (FUNASA), 2001). In the Brazilian Amazon, tax-onomical and distribution health problem, with an increasing number of cases being reported information is available for four subgenera ∗ Corresponding author. Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, Amazonas, Brazil. E-mail address: [email protected] (W.M. Monteiro) https://doi.org/10.1016/j.toxicon.2019.09.003 Received 1 May 2019; Received in revised form 26 July 2019; Accepted 1 September 2019 Available online xxx 0041-0101/© 2019. W.M. Monteiro et al. Toxicon xxx (xxxx) xxx-xxx comprising 27 Tityus species (Limeira-de-Oliveira et al., 2006; Table 1 Lourenço, 2017, 1981a; 1979; Lourenço et al., 2005; W R Lourenço, Tityus scorpions recorded in the Brazilian Amazon. 2002c; Lourenço, 2008, 2006; 2005, 1997; 1988, 1986; 1984, 1981b; Incriminated Lourenço and Leguin, 2008; Lourenço and Pézier, 2002; Lourenço Study in human and Ramos, 2004; Lourenço and Silva, 2007; Mello-Leitão, 1945; Species Distribution Reference envenomings Pinto-da-Rocha and Lourenço, 2000) (Table 1). Outside the Amazon Tityus (Archaeotityus) subgenus region, T. bahiensis, T. serrulatus and probably T. costatus and T. Tityus bastosi Western Brazilian Lourenço Yes stigmurus are the major causative agents of scorpion stings, resulting Lourenço (1984) Amazon region, (1984) in high severity and lethality rates (Lourenço, 2015; Ministério da reaching Peru, Saúde do Brasil- Fundação Nacional de Saúde (FU-NASA), 2001). Equador and Colombia Tityus clathratus Roraima state. Guyana Lourenço No Koch, 1844 Shield and Venezuela. (1984) The clinical presentation of scorpion stings may vary from mild lo-cal Tityus maranhensis Caxias, state of Limeira- de- No symptomology as pain, paresthesia, mild edema, erythema, sweat-ing, Lourenço, Jesus- Maranhão. Oliveira et piloerection and burning sensation to severe systemic neurotoxicity, which Júnior & Oliveira, al. (2006) may lead to autonomous nervous system imbalance, further caus-ing 2006 Tityus Open areas of Mato Lourenço No uncoordinated neuromuscular activity, myocardial depression, respi-ratory mattogrossensis Grosso and other areas (1979) failure and multiorgan failure (Isbister and Bawaskar, 2014). Borelli, 1901 of Central Brazil. The effects caused by scorpion stings do not have a typical charac- Tityus silvestris From the French Lourenço Yes teristic that discriminates them from injuries caused by other Pocock, 1897 Guyana and Amapá (1986) arthropods and vice versa. Envenoming diagnosis may be very and Pará states to the Peruvian Amazon. inaccurate, especially in cases presenting no systemic signs. This fact Most of the area of can lead even to the un-necessary use of antivenom in the case of Amazonas. Tityus (Tityus) subgenus assistance to be carried out by an inattentive professional. Clinical manifestations related to local envenoming should be Tityus canopensis Tarumã Mirim, Lourenço No Lourenço and Manaus, state of and Pézier treated with parenteral analgesic agents and anesthetic nerve block to Pézier (2002) Amazonas. (2002) relief local pain. Supportive intensive care treatment for autonomic Tityus carvalhoi Pará. Barra do Mello- No distur-bances, acute pulmonary edema and cardiogenic shock often Mello-Leitão Tapirapés. Eastern Leitão includes the use of inotropes and vasodilators (Isbister and Bawaskar, (1945) Mato Grosso. (1945) 2014). On the other hand, the evidence for the effectiveness of Tityus gasci French Guiana. Lourenço No Lourenço, Amazon Basin in Brasil (1981a) antivenom treat-ment recommended for scorpion envenoming is 1981a,b and Peru. variable, and the fre-quency of antivenom use, as well as antivenom Tityus marajoensis Marajó Island, state of Lourenço No dosage, varies according to the species causing the sting, the Lourenço and Pará. and Silva availability of the product, and the clinical effects of envenoming. Silva (2007) (2007) Tityus nelsoni São Gabriel da Lourenço No An uncertain scenario regarding the epidemiology, main causative Lourenço (2005) Cachoeira, state of (2005) species, clinical presentations and proper access diagnosis and treatment Amazonas. access turns scorpion sting into a major public health problem in many Tityus raquelae Rio Preto da Eva, Lourenço No countries from Latin America since there is a shortage of studies on the Lourenço (1988) Itacoatiara and Tefé, (1988) state of Aamzonas. subject, especially in the Amazon region. Therefore, in order to syn-thetise Tityus strandi Amazonas and Pará Lourenço No the current knowledge regarding scorpion sting in the Amazon region,
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