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PubMed1998

Effect of Tityus serrulatus scorpion toxin on serum gastrin levels in anaesthetized rat.

Scorpion toxin induces gastric secretion of acid and pepsin in rats. These effects seem to be mediated by the release of acetylcholine and histamine. However, the role of gastrin in the scorpion-toxin-induced gastric secretion is unknown. We describe the effects of the T1 fraction purified from Tityus serrulatus scorpion venom on serum and on antral tissue gastrin levels in anaesthetized rats. Gastrin levels in serum and in the antral mucosa were measured before and at intervals 5, 15, 30, 60, 90 up to 120 min after the intravenous injection of saline or the T1 fraction of scorpion venom (0.25 mg/kg) into anaesthetized rats. Antral G-cells were submitted to immunocytochemistry and electron microscopy. The data on gastrin were correlated with the gastric juice volume, and the acid and pepsin output increases induced by toxin. Scorpion toxin induced a significant increase in volume, acid output and pepsin output of gastric juice and gastrin serum levels 15-60 min after injection. Simultaneous measurements of antral gastrin levels did not show significant effects. The number of dense, intermediate and empty granules per microm(2) in the cytoplasm of antral G-cells was not significantly changed 60 min after saline or toxin injection. Scorpion toxin significantly increased serum gastrin; levels in rats.

Acetylcholine↗
PubMed1985

Scorpion toxins from Centruroides noxius and Tityus serrulatus. Primary structures and sequence comparison by metric analysis.

The complete primary structures of toxin II-14 from the Mexican scorpion Centruroides noxius Hoffmann and toxin gamma from the Brazilian scorpion Tityus serrulatus Lutz and Mello have been determined. Cleavage of toxin gamma after Met-6 with CNBr produced the 55-residue peptide 7-61, which maintained the four disulphide bonds but was not toxic to mice at a dose 3 times the lethal dose of native toxin gamma. Pairwise comparison by metric analysis of segment 1-50 of toxin gamma and the corresponding segments from two other South American scorpion toxins, five North American scorpion toxins, nine North African scorpion toxins and one Central Asian scorpion toxin showed that the three Brazilian toxins are intermediate between the North American and North African toxins. This result is consistent with the hypothesis that the South American and African continents were joined by a land connection in the distant past.

Amino Acid Sequence↗
PubMed2006

Structure and function of the voltage sensor of sodium channels probed by a beta-scorpion toxin.

Voltage sensing by voltage-gated sodium channels determines the electrical excitability of cells, but the molecular mechanism is unknown. beta-Scorpion toxins bind specifically to neurotoxin receptor site 4 and induce a negative shift in the voltage dependence of activation through a voltage sensor-trapping mechanism. Kinetic analysis showed that beta-scorpion toxin binds to the resting state, and subsequently the bound toxin traps the voltage sensor in the activated state in a voltage-dependent but concentration-independent manner. The rate of voltage sensor trapping can be fit by a two-step model, in which the first step is voltage-dependent and correlates with the outward gating movement of the IIS4 segment, whereas the second step is voltage-independent and results in shifted voltage dependence of activation of the channel. Mutations of Glu(779) in extracellular loop IIS1-S2 and both Glu(837) and Leu(840) in extracellular loop IIS3-S4 reduce the binding affinity of beta-scorpion toxin. Mutations of positively charged and hydrophobic amino acid residues in the IIS4 segment do not affect beta-scorpion toxin binding but alter voltage dependence of activation and enhance beta-scorpion toxin action. Structural modeling with the Rosetta algorithm yielded a three-dimensional model of the toxin-receptor complex with the IIS4 voltage sensor at the extracellular surface. Our results provide mechanistic and structural insight into the voltage sensor-trapping mode of scorpion toxin action, define the position of the voltage sensor in the resting state of the sodium channel, and favor voltage-sensing models in which the S4 segment spans the membrane in both resting and activated states.

Amino Acid Sequence↗
PubMed2000

Evidence for the existence of insect defensin-like peptide in scorpion venom.

Insect defensin refers to a group of antibacterial peptides derived from a variety of insect species as well as from scorpion and possessing a three-dimensional structure highly similar to that of scorpion toxins. A full-length cDNA encoding an insect defensin-like peptide was isolated from the venom gland cDNA library of the Chinese scorpion Buthus martensii Karsch. The precursor, the overall organization of which is similar to that of insect defensins, consists of 61 amino acid residues with a putative signal peptide of 15 residues, a propeptide of 7 residues, and a mature peptide of 39 residues (named BmTXKS2). The positions of six cysteines and a conserved glycine in mature BmTXKS2 are the same as those in LqDef, the first defensin found in scorpions, which suggests these peptides should present a similar cysteine-stabilized alphabetamotif. Phylogenetic analysis further shows that the structure of BmTXKS2 is closer to that of ancient defensins (e.g., LqDef and AaDef, two insect defensins present in the scorpion hemolymph) than to scorpion toxins.

Amino Acid Sequence↗
PubMed1979

Binding of scorpion toxin to receptor sites associated with sodium channels in frog muscle. Correlation of voltage-dependent binding with activation.

Purified scorpion toxin (Leiurus quinquestriatus) slows inactivation of sodium channels in frog muscle at concentrations in the range of 17-170 nM. Mono[125I]iodo scorpion toxin binds to a single class of sites in frog sartorius muscle with a dissociation constant of 14 nM and a binding capacity of 13 fmol/mg wet weight. Specific binding is inhibited more than 90% by 3 microM sea anemone toxin II and by depolarization with 165 mM K+. Half-maximal inhibition of binding is observed on depolarization to -41 mV. The voltage dependence of scorpion toxin binding is correlated with the voltage dependence of activation of sodium channels. Removal of calcium from the bathing medium shifts both activation and inhibition of scorpion toxin binding to more negative membrane potentials. The results are considered in terms of the hypothesis that activation of sodium channels causes a conformational change in the scorpion toxin receptor site resulting in reduced affinity for scorpion toxin.

Animals↗
PubMed1991

HIV-1 Nef protein exhibits structural and functional similarity to scorpion peptides interacting with K+ channels.

The persistent infection of human glial cells with HIV-1 is characterized by prominent expression of the Nef protein. In order to evaluate the possible role of Nef in the development of HIV-1-associated neurological disorders, we compared Nef with known neuroactive proteins. We found that HIV Nef shares sequence and structural features with scorpion peptides known to interact with K+ channels. Sequence similarity encompasses two distinct regions of scorpion peptides. Based on crystallography data, both regions in scorpion peptides cooperate in forming a common domain stabilized by ion pairs between charged amino-acid residues. Recombinant Nef protein, as well as a synthetic part of a scorpion channel active peptide (M10), reversibly increased the total K+ current of chick dorsal root ganglions in patch-clamp experiments without killing the cells. These results indicate that a region conserved in HIV Nef and scorpion peptides concurs in both structure and electrophysiological activity and suggest that Nef, like scorpion peptides, may affect neuronal cell function.

Amino Acid Sequence↗
PubMed1999

Effects of adrenergic-receptor blockade and ligation of spleen vessels on the hemodynamics of dogs injected with scorpion venom.

OBJECTIVE: In dogs, scorpion venom evokes a rapid increase in cardiac output (CO) that decreases below baseline level in 1 hr. The changes in CO have recently been shown to be related to the effect of the venom on venous return. In the present study, we tested the hypothesis that changes in determinants of venous return are secondary to sympathoadrenal stimulation evoked by the venom, which causes splenic contracture in the first stage of envenomation leading to increased mean circulatory pressure (MCP) and CO. Persistence of adrenergic response is the main factor leading to the second stage of envenomation, characterized by an increase in resistance to venous return (Rv) and a decrease in CO. DESIGN: Repeated measures, prospective study in dogs. SETTING: University-affiliated research laboratory. SUBJECTS: Mixed-breed dogs injected with scorpion venom. INTERVENTIONS: The effects of alpha- and beta-adrenergic-receptor blockade (blockade group, n = 9 dogs) and effects of ligation of spleen vessels (spleen ligation group, n = 11 dogs) following intravenous injection of scorpion venom from Leiurus quinquestriatus (0.05 mg/kg) were tested on the determinants of venous return and compared with the effects of scorpion venom alone (control group, n = 6 dogs). MEASUREMENTS AND MAIN RESULTS: Scorpion venom in the control group caused a marked increase in CO from 2.9+/-0.2 SD L/min to 6.5+/-2.2 L/min (p<.001) and MCP from 8.7+/-2.7 torr (1.2+/-0.35 kPa) to 21.6+/-1.4 torr (2.9+/-0.19 kPa) (p<.001) within 5 mins after venom injection. Cardiac output and MCP markedly decreased at 60 mins to 1.8+/-0.3 L/min (p<.001) and 7.3+/-3.8 torr (1.0+/-0.5 kPa) (p<.05), respectively. Rv did not change at 5 mins but increased from 196+/-50 dyne x sec/cm5 to 335+/-102 dyne x sec/cm5 (p<.01) at 60 mins. Adrenergic-receptor blockade attenuated the increase of CO and MCP at 5 mins, from 2.1+/-0.5 L/min to 2.7+/-1 L/min (p<.001) and from 5.6+/-2.0 torr (0.8+/-0.27 kPa) to 7.5+/-2.3 torr (1.0+/-0.31 kPa) (p<.05), respectively. By 60 mins, both CO and MCP returned to baseline, while Rv was not affected and was maintained at 204+/-158 dyne x sec/cm5. Ligation of spleen vessels prevented a CO increase at 5 mins and it was maintained at baseline value (2.5+/-0.6 L/min). However, MCP increased from 7.9+/-0.5 torr to 12+/-1.3 torr (p<.05). At 60 mins, CO decreased to 1.6+/-0.7 L/min (p<.01) while MCP returned to baseline. The changes in MCP were accompanied by significant increases of Rv from 152+/-24 dyne x sec/cm5 to 383+/-93 dyne x sec/cm5 (p<.001) at 5 mins, and 510+/-175 dyne x sec/cm5 (p<.01) at 60 mins. CONCLUSIONS: The changes in CO and MCP following scorpion venom injection in dogs are in part related to sympathetic stimulation. Adrenergic-receptor blockade attenuated the initial inotropic effect of the venom and completely prevented a late decrease in CO and MCP. The increase in Rv is the most important factor for late decrease in CO, and results from persistent adrenergic-receptor stimulation. In addition, an Rv increase apparently expresses vasoconstriction and redistribution of blood flow. The initial increase in CO and MCP is explained mainly by adrenergic-receptor effects on the spleen leading to augmented circulatory blood volume.

Analysis of Variance↗
PubMed2003

Scorpion venom decreases lung liquid clearance in rats.

It has been reported that scorpion venom causes respiratory failure and pulmonary edema. However, the effects of this toxin on lung edema clearance have not been previously studied. We examined the effects of scorpion (Tityus serrulatus) venom on the ability of the lung to clear fluid and on alveolar epithelial Na,K-ATPase. The wet-to-dry lung weight ratio was increased in anesthetized rats injected intraperitonally with scorpion venom. Lung edema clearance decreased by up to approximately 60% in rats injected with the venom. Na,K-ATPase alpha1- and beta1-subunit protein abundance and activity decreased at the basolateral membranes of alveolar epithelial type II cells incubated with scorpion venom as compared with that of control animals. There was no difference in cell injury in alveolar epithelial type II cells incubated with scorpion venom for 60 minutes compared with that of control animals. We provide here the first evidence that scorpion venom decreases lung liquid clearance, probably by downregulating Na,K-ATPase in the alveolar epithelium.

Animals↗
PubMed2002

Myocardial injury in scorpion envenomed children: significance of assessment of serum troponin I and interleukin-8.

OBJECTIVES: (1) To investigate the significance of assessment of serum levels of cardiac troponin I (cTnI) and interleukin-8 (IL-8) beside other biomarkers of myocardial injury in scorpion envenomed children. (2) To find the correlation between these biochemical indices with clinical status, prognosis and outcome of these cases. METHODS: Forty-one children in Upper Egypt were admitted to Pediatric Intensive Care Unit, Assiut University Hospital, for scorpion envenomation. They were compared with fifteen apparently healthy children of matching age as controls. The victims and controls were subjected to complete clinical examination, full blood count and arterial blood gases analysis. According to severity of scorpion envenomation, 17 children had manifestations of severe envenomation and clinical signs of toxic myocarditis (severe cases), 14 children had moderate manifestations of envenomation without clinical evidence of carditis (moderate cases) and 10 cases showing only mild symptoms of envenomation (mild cases). The serum levels of cTnI and IL-8 beside the enzymatic activities of creatine phosphokinase (CPK), CPK-MB isoenzyme (CPK-MB) and lactate dehydrogenase (LDH) were determined once for mild cases and controls on admission and twice for severe and moderate cases on admission and after 24 hrs. The measurements of electrocardiography (ECG), echocardiographic measurement of % fractional shortening of left ventricule (%SF), left ventricular ejection fraction (LVEF) and cardiac chambers dilatation were done for severe and moderate cases. RESULTS: All the envenomed victims showed significantly higher mean values of CPK, CPK-MB, LDH, and IL-8 on admission in comparison to control group. cTnI was not detectable in the sera of control group as well as patients with mild envenomation. The mean values of CPK, CPK-MB, LDH, and IL-8 were significantly higher in severe cases while only IL-8 and CPK-MB were significantly higher in moderate cases in comparison with mild cases. The mean values of IL-8, cTnI, CPK, CPK-MB and LDH were significantly higher in severe cases both on admission and on follow-up comparing with moderate cases. The case fatality rate was 12.5% and all were from severe cases with toxic myocarditis (5/41=12.5%). The non-survivors victims showed significant higher mean values of only cTnI on admission and both cTnI and IL-8 on follow up in comparison to the survivors. Significant reduction of % SF and LVEF were noticed among the non-survivors in comparison to survivors. The cTnI showed 100% specificity and sensitivity for diagnosis of myocardial injury in relation to Echo finding in the envenomed victims. In severe cases, cTnI was positively correlated with IL-8 while negatively correlated with %SF and LVEF. CONCLUSION: it may be suggested that cTnI is the most specific marker for diagnosis of myocardial injury in scorpion envenomation, which is almost associated with skeletal muscle injury. Other biochemical markers did not show such specificity. Also, IL-8 may be involved in the pathogenesis of myocardial injury of scorpion envenomation. Both cTnI and IL-8 may be useful to forecast the fatal outcome in scorpion envenomation.

Biomarkers↗
PubMed2003

[Analysis of the genomic organization of a novel scorpion toxin BmTXK beta].

Scorpion venoms contain different types of low molecular mass toxic peptides acting on ion channels. Many cDNAs and genomic genes encoding these toxins have been isolated and sequenced while the mechanisms of expression and regulation of scorpion toxins is not well studied yet. BmTXK beta, one of the four putative long-chain potassium channel toxins, is isolated from the cDNA library of the venom gland of Chinese scorpion BmK (Buthus martensii Karsch). It has an 886 bp intron located in the mature peptide while other scorpion toxins' introns are located in the signal peptide. The special genomic organization of BmTXK beta makes it a good object to study the mechanism of expression and regulation of scorpion toxins. With primers designed according to the already known sequence of BmTXK beta, its 5' and 3' flanking regions are cloned by the Vecttorette II Staorette Pack method and sequenced. Analysis of the sequence shows that another intron longer than 997 bp is located in the signal peptide region of BmTXK beta, which makes BmTXK beta different from all the other scorpion toxins that have no intron or only one intron in the signal peptide. The special genomic organization of BmTXK beta indicates that BmTXK beta is a new membership of long-chain potassium channel toxin.

Amino Acid Sequence↗
PubMed1976

Purification of a toxic protein from scorpion venom which activates the action potential Na+ ionophore.

Venom of the scorpion Leiurus quinquestriatus acts cooperatively with the alkaloids veratridine, aconitine, and batrachotoxin in activating the action potential Na+ ionophore. A small (Mr = 6700), basic (pI approximately 9.8), toxic polypeptide purified approximately 80-fold from this venom by ion exchange chromatography appears homogeneous by gel electrophoresis and isoelectric focusing and, like whole venom, acts cooperatively with the alkaloids veratridine, aconitine, and batrachotoxin to activate the action potential Na+ ionophore. The action of the scorpion toxin is slowly reversible. Concentration-response curves suggest interaction with a single class of sites with KD - 1.3 to 2.4 nM. The scorpion toxin is a poor activator of the Na+ ionophore when tested alone. However, treatment of cells sequentially with scorpion toxin followed by veratridine activates as well as treatment with both simultaneously suggesting that scorpion toxin binds in the absence of veratridine but does not activate the Na+ ionophore unless veratridine is present. In contrast, scorpion toxin causes 3- to 20-fold decreases in apparent KD for aconitine, veratridine, and batrachotoxin. The effect of the toxin is inhibited competitively by divalent cations and noncompetitively by tetrodotoxin (KI - 4 nM).

Aconitine↗
PubMed1998

Immunotherapy for scorpion envenoming in Brazil.

Using the ELISA we have shown that in rats subcutaneously injected with Tityus serrulatus scorpion venom there is a fast absorption rate, a fast and high distribution of venom to tissues, a great affinity of the venom for the tissues and a slow elimination half-life. Because of these experimental data, i.v. immunotherapy should be given to patients stung by scorpions as soon as possible after hospital admission. The severity of scorpion envenoming is related to plasma venom concentration (ELISA). The high levels of plasma scorpion venom antigens (ELISA) were cleared 1 h after the infusion of antivenom (5-30 ml of Fab2 fragment) and high concentrations of circulating antivenom persisted for at least 24 h, confirming the efficacy of immunotherapy to neutralise circulating venom. Some symptoms (e.g. local pain and vomiting) decreased 1 h after the starting of immunotherapy, whereas the other symptoms disappeared from 12-48 h later. Using our tripartite approach of treating scorpion envenoming (symptomatic measures, support of vital functions and serotherapy), the mortality rate was very low (0.28%).

Animals↗
PubMed1991

Scorpion sting in children in the Jerusalem area: a review of 54 cases.

Fifty-four children from the Jerusalem area were studied prospectively following scorpion envenoming. Their ages ranged from 11 months to 10 years. Severe symptoms (convulsions, brain oedema, shock, respiratory distress and myocarditis) were encountered in 19. Respiratory distress was the main feature in 17 of the children, in two cases owing to pulmonary oedema and in a third because of adult respiratory distress syndrome and myocarditis; mechanical ventilation was required in three cases. The severity of the symptoms and signs was not related to sex, age, weight, interval between scorpion sting and admission or to the type of offending scorpion; it was most likely dependent upon the susceptibility of the individual and/or the dose of venom injected by the scorpion. Intravenous antivenom quickly reversed the symptoms, and no side-effects were seen in the patients studied. The two patients who died had not received the antivenom intravenously. We recommend that specific antivenom should be given intravenously in all children who show significant symptoms. Furthermore, a longer period of observation is necessary following scorpion sting in this age group.

Animals↗
PubMed2000

Prazosin therapy and scorpion envenomation.

BACKGROUND: 25-30% fatality due to acute pulmonary oedema in victims of Indian red scorpion (Mesobuthus tamulus) sting have been reported from Western Maharashtra, India. The advent of prazosin in recent years has revolutionized the management of severe scorpion sting cases. Majority of cases developed acute pulmonary oedema in 4-8 hours in a hospital setting irrespective of control of their arterial blood pressure with six hourly oral prazosin regimen, these cases recovered with extra dose of prazosin. We developed a standardised protocol for acute phase of treatment of these cases with the aim of preventing the development of pulmonary oedema. METHOD: We compared scorpion sting cases managed by non-protocol conventional (NPC) treatment and those by standardised protocol (SP) that included three hourly dose of oral prazosin. SP group included severe scorpion sting cases admitted to general hospital at Mahad in the year 1998 (Jan.-Dec.). While those admitted in the year 1997 (Jan.-Dec.) before the SP was implicated were the NPC group. FINDING: Characteristics on arrival of severe scorpion sting patients SP (n-17) and NPC (n-15) groups were similar that more case 6 (35%) from SP group had several hypertension on arrival. On arrival two cases from SP group and one from NPC group had pulmonary oedema. 16 (94.11%) patients from SP group recovered uneventfully, compared with 8 (53.33%) in NPC group (p-0.05). 0% Vs 5 (38.46%) developed acute pulmonary oedema (p < 0.0001) from SP and NPC group respectively, three (one had on arrival two patients during hospitalization) from NPC group had massive pulmonary oedema recovered with i.v. nitroprusside drip (SNP). While from SP group one had massive pulmonary oedema on arrival recovered with i.v. SNP, other one had pulmonary oedema recovered with oral prazosin. Cool extremities (vasoconstriction) persisted 11.5 (5-20) VS 18 (12-26) hours in SP and NPC group respectively. INTERPRETATION: Compared with NPC management; development of acute pulmonary oedema prevented by standardised protocol regimen at rural setting.

Adolescent↗
PubMed2003

Clinical profile of severe scorpion envenomation in children at rural setting.

he present study is an attempt to evaluate the clinical manifestations of severe scorpion sting in children and their management at a rural setting. Twelve patients with severe scorpion sting referred from primary health center are presented in this report. Eight children had pulmonary edema and hypotension; two had pulmonary edema and hypertension while one each presented with hypertension and tachycardia in isolation. Oral prazosin, dobutamine infusion and sodium nitroprusside drip (SNP) were used as therapeutic options based on the symptomatology. Two children died of massive pulmonary edema despite use of SNP and dopamine drip. Anti scorpion venom did not prevent the cardiovascular manifestations of severe scorpion sting. Early administration of prazosin alleviated the severity of scorpion envenomation

Adolescent↗
PubMedDate not supplied

An equilibrium ELISA for the dosage of Androctonus australis garzonii (Aag) and Buthus occitanus tunetanus (Bot) scorpion venoms: set up and calibration.

Scorpion stings are very frequent in Tunisia; yet a method for evaluating envenoming severity and consequently victim treatment, has never been adequately established nor has its efficiency been properly evaluated. Indeed, a management of envenomed patients requires the optimization of envenoming antivenom immunotherapy. This task requires either, an accurate evaluation of toxicokinetic parameters of scorpion venoms in absence and in presence of antivenom, using animals as models, and the establishment of a quantitative relationship between human blood scorption venom levels, envenoming severities and clinical symptoms. A performant sandwich ELISA was set up and calibrated for measuring scorpion venom levels in human and rabbit sera. This assays was performed with polyclonal F(ab')2 specific to the two North African scorpion (Androctonus australis garzonii; Aag and Buthus occitanus tunetanus: Bot) venoms. It is simple, rapid, very sensitive (detection limit = 0.9 ng/ml) and shows a good linearity for venom concentrations in human sera comprised between 0.5 and 15 ng/ml. The ELISA is also reproducible: the coefficient of variation, determined at different venom concentrations (low: 4 ng/ml; medium: 8 ng/ml and high: 12 ng/ml) prepared in a pool of sera collected from several healthy donors, were lower than 10%. Such an ELISA has been successfully used, either in experimental toxinokinetic and immunotherapeutic studies carried out in rabbits or for the quantification of Aag and Bot venom levels in the serum of human victims stung by these scorpion.

Animals↗
PubMed2003

[National strategy in the battle against scorpion stings and envenomations. Application and evaluation].

Scorpion stings represent the first cause of poisoning with an incidence of 30 to 50% of all declared cases in the Centre Anti Poison of Morocco (CAPM). Aware of this increasing problem, the CAPM paid special attention to this pathology. Thanks to its retrospective and prospective studies, the scorpion species mapping has been determined as well as the demographic features of stung patients, the nature and the chronology of clinical events in scorpion envenimation, and the epidemiological, clinical and therapeutical factors of severity. On this basis, the CAPM worked out a national strategy to struggle against scorpion stings whose aim was to decrease the morbidity and mortality caused by stings of scorpion as well as to rationalise economic expenses. The components of this strategy were based on the training of the medical and paramedical staff, on information, education, communication involving different sectors, on identification of needs and on follow-up and assessment. A nationwide campaign was implemented to change the population and health-care staff's behaviour regarding this pathology. Its evaluation permitted to improve the compilation of cases with census of 14104 cases, to reduce lethality rate and to rationalise expenses while banishing some medicines and avoiding useless hospitalization.

Animals↗
PubMed1985

Criteria map audit of scorpion envenomation in the Negev, Israel.

A criteria map audit is a medical record audit in which quality of care is evaluated according to algorithmically arranged criteria. Thus, a particular criterion is applied to the patient record only if other criteria have been met. For example, if a stung child's condition is severe but not life threatening and if he has had a positive skin test for antivenom sensitivity then he should receive antivenom only after receiving adrenaline and hydrocortisone. We used a modified criteria map audit to determine both the clinical picture of scorpion envenomation and quality of care process in 94 children. Related outcomes of care measured included mortality, persistent morbidity, allergic reaction to scorpion antivenom and length of stay in hospital. Scorpion stings in the Negev region are usually due to the yellow scorpion, L. quinquestriatus, and usually occur in the summer months on the extremities in exposed male children under 10. The clinical picture is more severe when the scorpion is yellow, when the child is younger and when the sting is on the trunk or head. Symptoms apparently mediated by the central nervous system (2.6 findings/child) were more frequent than parasympathetic symptoms (2.3 findings/child). Treatment with antivenom and specific therapy for complications led to very low persistent morbidity and mortality in symptomatic cases, but was also accompanied by a longer hospital stay (64% equal to or greater than 3 days) than for asymptomatic cases (18% equal to or greater than 3 days). Testing for antivenom sensitivity was omitted in an unacceptably high percentage of cases (69%) and its omission led to an allergic reaction in 4 out of 40 cases (10%). Inadequacy in treatment of 7 secondary clinical problems ranged from 71% for hypertension to 29% for seizures (mean 46%). Persistent morbidity was negligible and mortality was 1.2%. We conclude that criteria map audit can be used to describe the clinical and epidemiological picture of a clinical problem while at the same time providing an audit of the process of care.

Adolescent↗