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Treatment of snake, insect, scorpion, and spider bites in the pediatric emergency department.

Most people seem to have a visceral fear of snakes, spiders, scorpions, and insects out of proportion to the actual danger they pose. The vast majority of bites and stings cause little more than local pain and never require medical attention. Nevertheless, physicians who work in the emergency department must be prepared to treat the few patients who present with anaphylactic reactions to Hymenoptera stings, as well as to recognize and treat those rare individuals who receive severe envenomation from poisonous snakes, spiders, or scorpions.

Anaphylaxis↗

Crystallization and preliminary X-ray analyses of insect neurotoxins with analgesic effect from the scorpion Buthus martensii Karsch.

Three insect neurotoxins from the scorpion Buthus martensii Karsch, named BmK I1, BmK I4 and BmK I6, have been purified and crystallized. BmK I1 and BmK I4 show strong toxicity to insects, while BmK I6 is relatively weaker. They all exhibit an evident analgesic effect on mice; this is a novel biological function for scorpion insect toxins. Their crystals diffract to at least 3.5 (BmK I1), 2.8 (BmK I4), 2.8 (BmK I6 crystal form I) and 2.2 A (of BmK I6 crystal form II) resolution on an ordinary X-ray source. Crystals of BmK I1 belong to space group P6, with unit-cell parameters a = b = 66.2, c = 176.7 A. BmK I4 crystallized in the tetragonal space group I4, with unit-cell parameters a = b = 134.5, c = 60.6 A. BmK I6 has been crystallized in two forms: form I belongs to space group C2, with unit-cell parameters a = 46.5, b = 85.2, c = 32.6 A, beta = 110.5 degrees; form II belongs to space group R3, with the hexagonal unit-cell parameters a = b = 44.5, c = 164.7 A.

Amino Acid Sequence↗

Crystallization and preliminary X-ray analysis of a depressant insect toxin from the scorpion Buthus martensii Karsch.

Depressant insect toxins are a distinct group of scorpion neurotoxins for which no three-dimensional structures are yet available. A depressant insect toxin named BmK dITAP3 from the scorpion Buthus martensii Karsch (BmK) has been purified and crystallized. Single crystals of dITAP3 grew in the presence of the detergent CYMAL-6 using the hanging-drop vapour-diffusion method with ammonium sulfate as precipitant. A set of diffraction data to 2.6 A resolution has been collected. Preliminary analysis of the diffraction data indicated that the crystal belonged to space group R3, with unit-cell parameters a = b = 73.29, c = 68.90 A, alpha = beta = 90, gamma = 120 degrees. Assuming two molecules in the asymmetric unit, the estimated solvent content is 53.4%.

Animals↗

Structure of an excitatory insect-specific toxin with an analgesic effect on mammals from the scorpion Buthus martensii Karsch.

BmK IT-AP is an excitatory insect-specific beta-toxin with analgesic effect from the Chinese scorpion Buthus martensii Karsch (BmK) and consists of 72 residues cross-linked by four disulfide bridges. The crystal structure of BmK IT-AP has been determined at a resolution of 2.6 A by molecular replacement. Compared with the mammal-selective alpha-toxins consisting of 64 residues from the scorpion BmK, the general fold of IT-AP features an additional one-and-a-half turn alpha-helix at the C-terminal residues 59-65 with a shifted disulfide bridge Cys38-Cys64. The extension and 'wiggling' of the C-terminal segment led to a reshaping of the bioactive surface, including the complete destruction of the active site RC comprising the reverse turn (8-12) and C-terminal residues 58-64, the disappearance of an active surface formed by two aromatic residues Trp38 and Tyr42 and the covering of the conserved aromatic cluster Tyr5, Tyr35 and Trp47, which are all critical for the structure and function of mammal-selective alpha-toxins. Bj-xtrIT, the only other excitatory insect-specific toxin whose three-dimensional structure has been determined, is distinct from BmK IT-AP. A functionally important five-residue alpha-helix (alpha0) formed by residues 17-21 in Bj-xtrIT is deleted in BmK IT-AP and helix alpha1 is immediately connected to Cys16 through two residues Leu17 and Phe18. Accordingly, the functional surface of this region in Bj-xtrIT has also been reshaped in IT-AP, which implies subtle differences between BmK IT-AP and Bj-xtrIT in binding to the receptor, although most other critical residues for structure and function adopt almost identical conformations. The crystal structure of IT-AP also forms a sound basis for further study of the structure-function determinants of the analgesic effect.

Amino Acid Sequence↗

Crystallization and preliminary diffraction data of neurotoxin Ts-gamma from the venom of the scorpion Tityus serrulatus.

Scorpion neurotoxin Ts-gamma was isolated from Tityus serrulatus venom and purified to apparent homogeneity by ion-exchange HPLC. Crystals of the toxin were grown using polyethylene glycol 6000 as precipitant and were found to belong to the monoclinic space group P21 with cell parameters a = 22.20, b = 36.90, c = 31.57 A, beta = 100.85 degrees. The crystals diffract beyond 1.73 A resolution at a synchrotron beamline, being notably stable during X-ray exposure. The structure has been solved by molecular replacement using the very high resolution structure of Sahara scorpion Androctonus australis Hector (PDB code 1AHO) as a search model.

Animals↗

A new scorpion venom toxin paralytic to insects that affects Na+ channel activation. Purification, structure, antigenicity and mode of action.

A new toxin, BotIT2, with a unique mode of action on the isolated giant axon of the cockroach Periplaneta americana and DUM (dorsal unpaired median) neurons, has been purified from the venom of the scorpion Buthus occitanus tunetanus. Its structural, antigenic and pharmacological properties are compared to those of three other groups of neurotoxins found in Buthidae scorpion venoms. Like excitatory, depressant and alpha-type insect-selective neurotoxins, BotIT2 is toxic to insects, but shows the following common and distinctive characteristics. (a) As alpha-type toxins, BotIT2 lack strict selectivity to insects; they have measurable but low toxicity to mice. (b) As depressant toxins and unlike alpha-type toxins, BotIT2 is able to displace iodinated AaHIT from its binding sites in insect neuronal membranes. This indicates that the binding site for BotIT2 is identical, contiguous or in allosteric interaction with that of AaHIT and depressant toxins. (c) The BotIT2 amino acid sequence shows strong similarity to depressant toxins. However, unexpectedly, despite this high sequence similarity, BotIT2 shares moderate cross-antigenic reactivity with depressant toxins. (d) Voltage and current-clamp studies show that BotIT2 induces limited depolarization concomitantly with the development of depolarizing after potential, repetitive activity and later plateau potentials terminated by bursts. Under voltage-clamp conditions, BotIT2 specifically acts on Na+ channels by decreasing the peak Na+ current and by simultaneously inducing a new current with very slow activation/deactivation kinetics. The voltage dependence of this slow current is not significantly different from that of the control current. These observations indicate that BotIT2 chiefly modifies the kinetics of axonal and DUM neuronal membrane Na(+)-channel activation.

Amino Acid Sequence↗

Modulation of acetylcholine release at mouse neuromuscular junctions by interaction of three homologous scorpion toxins with K+ channels.

1. The effects of three scorpion toxins, charybdotoxin (CTX), iberiotoxin (IbTX), and noxiustoxin (NTX) have been studied on acetylcholine release and on K+ channels by means of twitch tension and electrophysiological recording techniques using isolated skeletal muscle preparations and by a radioligand binding assay using 125I-labelled dendrotoxin I (DpI) and rat brain synaptosomal membranes. 2. On chick biventer cervicis preparations, CTX and IbTX (125 nM) augmented the twitch responses to indirect muscle stimulation. Further, the increase (about 70-80% of control twitch height) was fast in onset, reaching a maximum within 25-30 min. NTX at 125 nM produced a slower augmentation of the twitch responses to indirect muscle stimulation, with the maximum response being seen after 40-50 min. 3. On mouse triangularis sterni preparations, CTX (300 nM after 35-40 min) and IbTX (100 nM after 15 min) increased quantal content of the evoked endplate potentials (e.p.p.) by about two fold. However, NTX (300 nM) caused only a small increase in e.p.p. amplitude, which was followed by repetitive e.p.ps in response to single shock nerve stimulation after 40-50 min. 4. Extracellular recording of nerve terminal current waveforms in triangularis sterni preparations revealed that CTX and IbTX (3-100 nM), but not NTX (100 nM), blocked the Ca(2+)-activated K+ current, IK-Ca. However, there was no major change in the portion of the nerve terminal waveform associated with voltage-dependent K+ currents, IKv. 5. In the radioligand binding assay, NTX potently displaced labelled [125I]-DpI, whereas CTX produced only partial displacement. However, IbTX did not displace [125I]-DpI from its binding sites on rat brain synaptosomal membranes.6. We conclude that these three structurally homologous scorpion toxins act on different K+ channels and that this leads to different patterns of facilitation of acetylcholine release. IbTX acts selectively on high conductance Ca2+-activated K+ channels, leading to an increase in the amplitude of e.p.ps without any other changes. NTX acts on voltage-dependent K+ channels that are sensitive to dendrotoxin and causes repetitive e.p.ps. CTX shares amino acid residues that exist in the structures of IbTX and NTX;CTX acts on both Ca2+- and voltage-dependent K+ channels.

Acetylcholine↗

Haemodynamic patterns in patients with scorpion envenomation.

OBJECTIVE: To study cardiovascular haemodynamics following scorpion envenomation. SETTING: Intensive care unit of a university hospital. PATIENTS: Eight patients with Indian red scorpion (Mesobuthus tamulus) stings. INTERVENTION: Captopril (6.25 to 12.5 mg orally) every 30 minutes until pulmonary oedema resolved. MAIN OUTCOME MEASURES: Haemodynamic data obtained by pulmonary artery catheterisation. RESULTS: Two haemodynamic patterns were seen. There was a predominant vascular effect in one patient, with severe hypertension, tachycardia, increased systemic vascular resistance index (SVRI = 5893 dyn.s.cm-5), and normal cardiac index (2.73 l/m2). A predominant myocardial effect with left ventricular dysfunction and normal right ventricular function was seen in the other seven patients, with tachycardia, pulmonary oedema, mild hypotension, reduced stroke volume (mean (SD), 25.9 (8.3) ml/m2), normal SVRI (1812 (831) dyn.s.cm-5), and increased pulmonary artery wedge pressure (PAWP = 25 (4.4) mm Hg). Following mild dehydration pulmonary oedema subsided (PAWP = 14 (8.5) mm Hg) in three of these patients, but hypovolaemic shock developed (right atrial pressure (RAP) = 1.3 (2.1) mm Hg); pulmonary oedema recurred with rehydration. One patient developed fatal cardiogenic shock with raised PAWP (27 mm Hg) and RAP (11 mm Hg), and vasodilatation (SVRI = 1129 dyn.s.cm-5). Stroke volume (30.5 (8.7) ml/m2) and cardiac output (4.3 (1.5) 1/m2) improved with resolution of pulmonary oedema (PAWP = 14.4 (4.2) mm Hg) following afterload reduction with captopril. CONCLUSIONS: Mild envenomation causes severe vasoconstriction and hypertension. Severe envenomation produces predominant left ventricular dysfunction with normal systemic vascular resistance manifesting as pulmonary oedema or severe hypotension depending on the fluid balance. Shock due to biventricular dysfunction and vasodilatation occurs terminally.

Adolescent↗

Poisoning due to insect and scorpion stings/bites.

1. A retrospective study, 1980 to 1989 inclusive, of hospital admission cases due to insect and scorpion stings or bites was carried out in the six main central hospitals of Zimbabwe's four main cities. 2. A total of 92 cases were recorded and analysed. This constituted 1.5% of all hospital admissions for poisoning which were analysed during that time. 3. Of the 92 cases the highest number of victims were seen in the 2-to-5-year age group (29.3%), followed by the 6-to-10-year age group (23.9%). In other age groups the incidence of poisoning was distributed approximately evenly with the 41 to 50 and the over 60-year age groups having the least number of victims, (2.2%). 4. The main groups of insects associated with poisoning were bees, 44.6%; wasps, 8.7%; and spiders 8.7%. A further 32.6% of the insect stings were not specified. Scorpion stings accounted for 5.4% of incidences. 5. No fatalities occurred. 6. Treatment consisted mainly of the administration of promethazine, as an antihistamine in 35% of the cases, steroids (16.5% of the cases), perhaps for their anti-allergic effects, and paracetamol, a mild analgesic, (14.7% of the cases). Interestingly, 22.6% of the cases were given an antibiotic (14.1% of which were penicillins). Adrenaline was administered in only 1.7% of the cases. 7. The majority of the recorded cases, 49.4%, were hospitalized for at least a day and the average duration of hospitalization was 6.4 days.

Adolescent↗

Vasodilators and hypertensive encephalopathy following scorpion envenomation in children.

Twenty-three children were admitted to a pediatric intensive care unit for scorpion envenomation with severe hypertension. The hypertension responded to analgesics and sedatives in 15 (65 percent) of the 23. The remaining eight children required specific antihypertensive therapy, and their condition promptly responded to intravenous hydralazine and sublingual nifedipine; rebound hypertension was observed in one. Hypertension is a frequent complication of a scorpion's sting in children, and specific antihypertensive therapy is indicated in severe cases. Hydralazine and nifedipine are effective and safe in such instances.

Acute Disease↗

[Epidemiological and clinical aspects of scorpion envenomation in the region of Santarém, Pará, Brazil].

This is a descriptive and prospective study on epidemiological and clinical aspects of 72 scorpion accidents admitted to Santarém Municipal Hospital, state of Pará, Brazil, from February 2000 to February 2001. Only 8.3% brought the animal with them, identified as T. cambridgei. The majority of victims were male (83.3%). The mean age and the time of the medical help were respectively 33.6 +/- 18.3 years and 4.6 +/- 3.2 hours. The parts of the body most affected were the superior members (51.5%). Local symptoms occurred in 91.7% cases and systemic manifestations in 98.6% of the accidents. The local symptoms included: paresthesia in 79.2% cases, pain in 52.8% and edema in 26.4%. Among the systemic manifestations neurological disorders predominated in 97.2%, and the symptom of "electric shock" occurred in 88.9% patients. The most common neurological signs were: myoclonia (93%), dysmetria (86.1%), dysarthria (80.6%), and ataxia (70.8%). The accidents were classified as moderate in 76.4% without any serious cases. The specific anti-venom serum was not administered in 32.7% of the moderate cases, due to non-availability of the anti-venom serum at the time of attendance. The victims of scorpion envenomation notified at Santarém, present a different clinical and regional behavior from previous reports in Brazil and Amazonia regions. The predominantly neurological picture has not previously been described in the Brazilian literature.

Adolescent↗

Penis wound by scorpion sting.

CONTEXT: The majority of scorpion stings are oligosymptomatic, occurring mainly on the hands and feet. Fatality is rare. CASE REPORT: A 33-year old man suffered a severe sting on his penis from a scorpion of the species Tytius trivittatus. Alcohol and salt were used without success in an effort to relieve pain. Medical assistance was sought 4 hours after the event, at which time diffuse erythema, edema and punctiform injury on the glans penis were observed, with no systemic manifestation. Intravenous meperidine was administered with immediate relief of the pain. The local signs disappeared within 48 hours, with the patient remaining asymptomatic.

Adult↗

[Primary structure of a short toxin from the venom of a vietnamese scorpion (Buthus sp.)].

The complete amino acid sequence of an important toxin (toxin 14) from the venom of a Vietnamese scorpion (Buthus occitanus sp.) has been determined, which includes 35 amino acid residues and three disulfide bridges (molecular weight, 3843 Da). The comparison of the sequence with sequences of short scorpion toxins led us to conclude that toxin 14 belongs to a novel group of toxins affecting the excitability of myelinated nerves.

Amino Acid Sequence↗

[Effect of immunotherapy on metabolic and histopathological modifications after experimental scorpion envenomation].

Scorpion envenoming is a serious public health problem in many areas in the world. The most dangerous scorpion species in Algeria are Androctonus australis hector (Aah). Little is known about biochemical and histopathological effects of Androctonus australis hector venom after experimental envenomation. In this study, the effects of sublethal dose and lethal dose 50 (LD50) of Aah venom on the enzymatic activities (transaminases, alkaline phosphatase, creatine kinase and lactate dehydrogenase) and histopathological changes from organs (liver, heart, kidneys and lungs) were determined 24 hr following envenoming (s.c) of the mice. The effect of F(ab')2 fragments anti-FToxG-50-Aah was also tested on the same organs. The histopathological studies following Aah envenoming showed degenerative changes in the liver where most hepatocytes were enlarged and necrotic. Nuclei were irregular in size. After envenoming with Aah venom the myocardium showed myocytolysis with interstitial edema and hemorrhage, in the lungs, hemorrhage and thickening of inter-alveolar septa. The glomeruli and the tubules structure of kidneys were disorganized. Results indicate also that the enzyme activities were significantly increased in the serum and decreased in the organs after envenomation by Aah venom. This increase may be due to the enzyme release from organs into the circulation. Neutralization by anti-FToxG-50-Aah F(ab')2 fragments leads to a normalization of the enzyme rate and a partial restoration of the tissues structure after envenomation with Aah venom.

Alanine Transaminase↗

A retrospective study on scorpion sting in a pediatric age group in a hospital in Calcutta.

During 1985-1989, in Calcutta Medical College Hospitals, of 152 children of 1-6 year age group admitted with the history of scorpion sting 18 (11.8%) died. Maximum numbers of stings were inflicted in the fingers. Important clinical features recorded were circulatory failure, breathlessness, profuse sweating, vomiting, local oedema and convulsion. Incidences of scorpion stings were much more frequent in the summer and rainy seasons than in the winter season.

Animals↗

BmTx3B, a novel scorpion toxin from Buthus martensi Karsch, inhibits delayed rectifier potassium current in rat hippocampal neurons.

AIM: To examine the effect of BmTx3B, a novel short-chain peptide isolated from the venom of Asian scorpion Buthus martensi Karsch, on voltage-gated potassium channels. METHODS: Two types of voltage-dependent potassium currents were recorded from dissociated hippocampal neurons of neonatal rat in whole-cell voltage-clamp mode, and separated based upon their kinetic properties. RESULTS: BmTx3B (10-100 micromol/L) selectively inhibited the delayed rectifier potassium current (I(K)), without affecting the fast transient potassium current (I(A)). The inhibition of the peptide on I(K) was reversible, concentration-dependent and voltage-independent. BmTx3B did not affect the steady-state activation and inactivation kinetics of the current. CONCLUSION: The short-chain scorpion peptide BmTx3B selectively blocked the delayed rectifier potassium channel.

Amino Acid Sequence↗

[Delay and characteristics of scorpion bite management in the Sidi-Bouzid region].

Scorpion envenomation represents a potential danger in the 2/3 of Tunisia's territory but Sidi Bouzid area is the most infected with 1/6 of the piqued in Tunisia. The purpose of the study was to assess the result of a program for scorpion control in Sidi Bouzid and especially the delay from being stung to access to health care service. The analysis of data related to program shows that the delay was decreased only in 4 districts out of 11. This situation should be explained by such factors as information and behaviour of population, access to health care.... It is necessary to increase the action recommended by the program and to behold specific characteristics of each district.

Animals↗