Advertisement

Scorpion Stings and Antivenom Use in Arizona

Published:February 21, 2021DOI:https://doi.org/10.1016/j.amjmed.2021.01.025

      Abstract

      Background

      Arizona's rugged desert landscape harbors many venomous animals, including a small nocturnal scorpion, Centruroides sculpturatus, whose venom can cause severe neuromotor disturbance. An effective antivenom is available at selected health care facilities in the state.

      Methods

      We analyzed 4398 calls of scorpion stings to the Arizona Poison and Drug Information Center (APDIC) in Tucson over a period of 3 years, from January 2017 to December 2019.

      Results

      We followed 1952 (44.4%) of the victims to resolution. We excluded 2253 callers with minimal effects of the sting and 193 victims with possible toxic effects who were lost to follow-up. The most common complaints among callers were pain at the sting site in 88.9% and local numbness in 62.2%. Detailed clinical information was obtained from 593 calls from a health care facility. Neuromotor signs consistent with C. sculpuratus envenomation included nystagmus in 163 (27.5%), hypersalivation in 91 (15.3%), and fasciculations in 88 (14.8%). Antivenom (Anascorp; Rare Disease Therapeutics, Inc., Franklin, Tenn) was administered to 145 patients. Most were children <5 years old (n = 76, or 54.4%); 27 (18.6%) were 5-9 years old and 42 (30.0%) were ≥10 years of age. About half, 79 of 145 (54.5%) victims who received antivenom, met the APDIC recommended use criteria.

      Conclusions

      Patients treated with antivenom exhibited a rapid resolution of symptoms without immediate or delayed hypersensitivity reactions. We recommend broadened availability of antivenom at sites where it is most needed.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Boyer LV
        • Theodorou AA
        • Berg RA
        • et al.
        Antivenom for critically ill children with neurotoxicity from scorpion stings.
        N Engl J Med. 2009; 360: 2090-2098
        • Boyer L
        History of scorpion antivenom. One Arizonan's view.
        Toxicon. 2013; 69: 14-20
        • StataCorp
        Stata Statistical Software: Release 16.
        StataCorp LP, College Station, TX2019
        • Likes K
        • Banner Jr, W
        • Chavez M
        Scorpion antivenom use in Arizona. Centruroides exilicauda envenomation in Arizona.
        West J Med. 1984; 141: 634-637
        • Kang AM
        • Brooks DE
        Nationwide scorpion exposures reported to US Poison Control Centers from 2005-2015.
        J Med Toxicol. 2017; 13: 158-165
        • Gonzalez-Santillan E
        • Possani LD
        North American scorpion species of public health importance with a reappraisal of historical epidemiology.
        Acta Trop. 2018; 187: 264-274
        • Webber MM
        • Graham MR
        An Arizona bark scorpion (Centruroides sculpturatus) found consuming a venomous prey item nearly twice its length.
        West N Am Nat. 2013; 73 (Article 13)
        • Bibbs CS
        • Bengston SE
        • Gouge DH
        Exploration of refuge preference in the Arizona bark scorpion (Scorpiones: Buthidae).
        Environ Entomol. 2014; 43: 1345-1353
        • Petricevich VL
        Scorpion venom and the inflammatory response.
        Mediators Inflamm. 2010; 2010903295
      1. Drugs.com. Anascorp prices, coupons and patient assistance programs. Available at:https://www.drugs.com/price-guide/anascorp. Accessed July 7, 2020.

      2. Arizona Archives Online. Inventory of the Herbert L. Stahnke papers 1838-1984 (bulk 1038-1974. Available at:http://azarchivesonline.org/xtf/view?docId=ead/asu/stahnke_acc.xml;query=;brand=default. Accessed July 7, 2020.

        • LoVecchio F
        • Welsch S
        • Klemens J
        • Curry SC
        • Thomas R
        Incidence of immediate and delayed hypersensitivity to Centuroides antivenom.
        Ann Emerg Med. 1999; 34: 615-619
        • Vazquez H
        • Chavez-Harro A
        • Garcia-Ubbelohde W
        • et al.
        Pharmacokinetics of a F(ab’)2 scorpion antivenom in healthy human volunteers.
        Toxicon. 2005; 46: 797-805
        • Bennett BK
        • Boesen KJ
        • Welch SA
        • Kang AM
        Study of factors contributing to scorpion envenomation in Arizona.
        J Med Toxicol. 2019; 15: 30-35
        • Stahnke HL
        The Arizona scorpion problem.
        West J Med. 1950; 7: 23-29