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      Expansión de la distribución de escorpiones del género Tityus C. L. Koch 1836 en Argentina: Implicancias sanitarias Translated title: Expansion of the distribution of scorpions of the genus Tityus C. L. Koch 1836 in Argentina: Implications in public health

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          Abstract

          Se ha observado la presencia de especies de Tityus en diferentes regiones del país, en las cuales su presencia no había sido comunicada previamente: 1- Tityus bahiensis en las provincias de Entre Ríos y Buenos Aires, en esta última en la localidad de Lanús y en San Clemente del Tuyú, y 2- Tityus confluens en la Ciudad Autónoma de Buenos Aires (CABA) y en la provincia de Buenos Aires en las localidades de Pilar, La Plata, Mar del Plata y Bahía Blanca. Estos hallazgos modifican el mapa de la distribución de escorpiones de importancia sanitaria en Argentina por lo que ante la picadura de escorpiones deben considerarse estos nuevos hallazgos. Esto es especialmente importante en el ámbito de la CABA y la provincia de Buenos Aires, en donde la enorme mayoría de los accidentes por escorpiones han sido causados por T. trivittatus y en donde ahora, al menos en algunas de sus regiones se pueden encontrar T. confluens y T. bahiensis. Se discuten posibles razones de esta nueva distribución así como la ocurrencia de accidentes graves en zonas donde no ocurrían históricamente y de sus posibles causas. En base a los casos graves producidos en los últimos tiempos y a este nuevo mapa de distribución, se hace énfasis en la necesidad de capacitación al personal de salud en general y de los médicos de guardia y terapistas en particular, para tratar adecuadamente los accidentes por escorpiones.

          Translated abstract

          Several species of Tityus have been described in regions of Argentina where their presence had not been previously described. These are: 1- Tityus bahiensis in the provinces of Entre Ríos and Buenos Aires (in the localities of Lanús and San Clemente del Tuyú), and 2- Tityus confluens in the city of Buenos Aires and in the province of Buenos Aires in the localities of Pilar, La Plata, Mar del Plata and Bahía Blanca. These findings modify the distribution map of scorpions of sanitary importance in Argentina, reason for which this new distribution must be considered when facing a scorpion sting. This is especially important in the city of Buenos Aires and the province of Buenos Aires, where most of the accidents by scorpions are caused by Tityus trivittatus, and where at least in some of their regions, T. confluens or T. bahiensis can be found at present. The possible reasons of this new distribution, as well as the possible causes for the occurrence of severe envenomations in regions where these were not observed historically, are discussed. Based on the severe envenomations observed and on this new distribution map, emphasis is placed on the need to capacitate health personnel in general and intensivists or critical care physicians in particular to adequately treat scorpion accidents.

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          Most cited references59

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          Snake venom variability: methods of study, results and interpretation

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            Epidemiological and clinical aspects of scorpionism by Tityus trivittatus in Argentina.

            This is a descriptive study of epidemiological and clinical aspects of stings caused by the scorpion Tityus trivittatus in Argentina. We analyzed 511 cases recorded from different health centers in 22 provinces. Most accidents took place during the period November-April (76%), in or nearby houses (86%). Over 50% of the accidents involved children and teenagers. Envenomation by T. trivittatus was mainly characterized by local symptoms: pain (85%), edema (26.6%), burning sensation (24.7%), erythema (20.7%), local hyperthermia (13.1%), paresthesia (9.8%) and general manifestations such as vomiting (25%), paleness (18.8%), headache (11.4%) and sweating (8.2%). Neurological, cardiovascular and respiratory disorders were uncommon. Almost 90% of the injured people got treated with specific antivenom within 2 h, 6% were treated 2-h after the accident and only 2 people were treated 12 or more hours after being stung. The global mortality recorded was 6 per 1000 cases. Scorpionism in Argentina is a public health problem under control due to the relatively low incidence and the accessibility of specific antivenom.
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              Clinical update on scorpion envenoming

              Abstract: Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a significant public health problem globally. Only scorpions of the Tityus genus are of medical importance in Brazil, and Tityus serrulatus is responsible for the most serious envenomations and deaths. The toxic effects of scorpion envenomation are due to a massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. The pathophysiology of cardiac involvement has been discussed for decades and has been attributed to adrenergic discharge and a possible toxic effect of venom on the myocardium, while acute pulmonary edema may have a cardiogenic and/or non-cardiogenic origin. Currently, the clinical data point to catecholamine excess as the cause for reversible scorpion cardiomyopathy . These data include electrocardiographic changes, profiling of cardiac enzymes and troponin I, echocardiographic data with global or regional left ventricle dysfunction, and myocardial perfusion alterations compatible with spasm in the coronary microcirculation. Furthermore, recent data on cardiac magnetic resonance imaging findings, which are similar to those observed for stress-induced cardiomyopathy, have also been linked to catecholamine excess. The efficiency of antivenom serum treatment is controversial in the literature. Our experience in Brazil is that the management of patients with systemic manifestations of scorpion stings is based on three approaches, all of which are extremely important. These include symptomatic treatment, antivenom serum, and cardiorespiratory support.
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                Author and article information

                Journal
                ata
                Acta toxicológica argentina
                Acta toxicol. argent.
                Asociación Toxicológica Argentina (Ciudad Autónoma de Buenos Aires, , Argentina )
                1851-3743
                December 2019
                : 27
                : 3
                : 109-119
                Affiliations
                [09] orgnameHospital de Infecciosas “Dr. Francisco Javier Muñiz” orgdiv1Sección Zoopatología Médica
                [07] orgnameMinisterio de Salud orgdiv1Hospital “Profesor Alejandro Posadas” orgdiv2Centro Nacional de Intoxicaciones
                [10] orgnameMinisterio de Salud de Nación orgdiv1Coordinación de Zoonosis
                [04] orgnameUniversidad Nacional de La Plata orgdiv1Facultad de Medicina orgdiv2Cátedra de Toxicología
                [03] orgnameMinisterio de Salud de la Provincia de Buenos Aires orgdiv1Centro Provincial de Referencia en Toxicología (CEPROTOX)
                [01] orgnameMinisterio de Salud orgdiv1Instituto Nacional de Producción de Biológicos “Dr. Carlos G. Malbrán”
                [11] orgnameMuseo Argentino de Ciencias Naturales “Bernardino Rivadavia” orgdiv1División Aracnología
                [02] orgnameUniversidad de Buenos Aires orgdiv1Facultad de Medicina orgdiv2Primera Cátedra de Toxicología
                [05] orgnameHospital de Pediatría “Dr. Ricardo Gutiérrez” orgdiv1Servicio de Toxicología
                [06] orgnameHospital de Agudos “Dr. Juan A. Fernández” orgdiv1Servicio de Toxicología
                [08] orgnameHospital de Infecciosas “Dr. Francisco Javier Muñiz” orgdiv1Centro Municipal de Patologías Regionales Argentinas y Medicina Tropical (CEMPRA-MT)
                Article
                S1851-37432019000300003 S1851-3743(19)02700300003
                56bbe416-4b35-419c-8d36-4bfef38c3779

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 31 May 2019
                : 19 June 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 60, Pages: 11
                Product

                SciELO Argentina


                Tityus,Scorpion,Epidemiología,Epidemiology,Distribución,Distribution,Escorpión

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