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J Pediatr Intensive Care 2018; 07(04): 219-224
DOI: 10.1055/s-0038-1673624
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Severe Troponin I Elevation and Myocardial Dysfunction in a Child with Scorpion Sting

Nagehan Aslan
1   Division of Pediatric Intensive Care, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
,
Dincer Yildizdas
1   Division of Pediatric Intensive Care, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
,
Ozden Ozgur Horoz
1   Division of Pediatric Intensive Care, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
,
Didar Arslan
1   Division of Pediatric Intensive Care, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
,
Celal Varan
2   Division of Pediatric Cardiology, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
,
Sevcan Erdem
2   Division of Pediatric Cardiology, Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
,
Hayri Levent Yılmaz
3   Division of Pediatric Emergency Care, Department of Pediatrics, Cukurova University, Faculty of Medicine, Adana, Turkey
› Author Affiliations
Further Information

Publication History

21 March 2018

03 June 2018

Publication Date:
03 October 2018 (online)

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Abstract

Background Scorpion sting is a common medical problem and major cause of mortality and morbidity in many countries. The symptoms of envenomation are more severe in the pediatric population. The clinical manifestations of scorpion envenomation appear by activation of sympathetic and parasympathetic nervous system. Envenomation can cause multiorgan dysfunction and death.

Case Presentation and Findings In this case report, we present a pediatric patient from Adana, Southeast Anatolia, with severe scorpion envenomation with Leiurus abdullahbayrami which is an especially dangerous species for children. Severe systolic dysfunction was detected by echocardiography. Troponin I levels elevated significantly and rapidly responded to three doses of antivenom therapy.

Conclusion Early echocardiographic examination is an important procedure for patients with scorpion envenomation. Troponin I is a significant parameter to monitor the degree of cardiac injury. Antivenom therapy is the only recommended specific therapy for children with severe scorpion envenomation due to Leiurus abdullahbayrami. Abnormal echocardiography findings may require repeated doses of scorpion antivenom.

Keywords

child - scorpion - high troponin - three doses of antivenom - severe systolic dysfunction
 

  • References

  • 1 Isbister GK, Bawaskar HS. Scorpion envenomation. N Engl J Med 2014; 371 (05) 457-463
    CrossrefPubMedGoogle Scholar
  • 2 Espino-Solis GP, Riaño-Umbarila L, Becerril B, Possani LD. Antidotes against venomous animals: state of the art and prospectives. J Proteomics 2009; 72 (02) 183-199
    CrossrefPubMedGoogle Scholar
  • 3 Bahloul M, Chaari A, Dammak H, Algia NB, Bouaziz M. Nosocomial scorpion envenomation: an unusual mode of scorpion sting. Clin Toxicol (Phila) 2010; 48 (09) 962
    PubMedGoogle Scholar
  • 4 Vazirianzadeh B, Nourmandi Pour S, Hashemi Shahraki A, Dehghani R, Amraee K. A study on some epidemiologic parameters among scorpion stung people who referred to Sirjan health center, Kerman province of Iran in 2007–2009. Jentashapir 2012; 3 (04) 539-543
    PubMedGoogle Scholar
  • 5 Sofer S, Zucker N, Bilenko N. , et al. The importance of early bedside echocardiography in children with scorpion envenomation. Toxicon 2013; 68: 1-8
    CrossrefPubMedGoogle Scholar
  • 6 Boyer LV, Theodorou AA, Berg RA. , et al; Arizona Envenomation Investigators Antivenom for critically ill children with neurotoxicity from scorpion stings. N Engl J Med 2009; 360 (20) 2090-2098
    CrossrefPubMedGoogle Scholar
  • 7 Abroug F, Nouira S, Haguiga H. , et al. High-dose hydrocortisone hemisuccinate in scorpion envenomation. Ann Emerg Med 1997; 30 (01) 23-27
    CrossrefPubMedGoogle Scholar
  • 8 Dokur M, Dogan M, Yagmur EA. Scorpion-related cardiomyopathy and acute pulmonary edema in a child who is stung by Leiurus abdullahbayrami. . Turk J Emerg Med 2017; 17 (03) 104-108
    PubMedGoogle Scholar
  • 9 Ozkan O, Yagmur EA, Ark M. A newly described scorpion species, Leiurus abdullahbayrami (Scorpion: Buthidae), and the lethal potency and in vivo effects of its venom. J Venom Anim Toxins Incl Trop Dis 2011; 17 (04) 414-421
    PubMedGoogle Scholar
  • 10 Ozkan O, Uzun R, Adıguzel S, Cesaretli Y, Ertek M. Evaluation of scorpion sting incidence in Turkey. J Venom Anim Toxins Incl Trop Dis 2008; 14: 128-140
    CrossrefPubMedGoogle Scholar
  • 11 Khatony A, Abdi A, Fatahpour T, Towhidi F. The epidemiology of scorpion stings in tropical areas of Kermanshah province, Iran, during 2008 and 2009. J Venom Anim Toxins Incl Trop Dis 2015; 21: 45
    CrossrefPubMedGoogle Scholar
  • 12 Karatas A, Karatas AH. Mesobuthus eupeus (C.L. Koch, 1839) (Scorpiones: Buthidae) in Turkey. Euscorpius 2003; 7: 1-6
    PubMedGoogle Scholar
  • 13 Dutertre S, Lewis RJ. Use of venom peptides to probe ion channel structure and function. J Biol Chem 2010; 285 (18) 13315-13320
    CrossrefPubMedGoogle Scholar
  • 14 Deshpande SB, Alex AB. On the management of scorpion stings. Heart 2000; 83 (05) 585-586
    PubMedGoogle Scholar
  • 15 Gwee MC, Nirthanan S, Khoo HE, Gopalakrishnakone P, Kini RM, Cheah LS. Autonomic effects of some scorpion venoms and toxins. Clin Exp Pharmacol Physiol 2002; 29 (09) 795-801
    CrossrefPubMedGoogle Scholar
  • 16 Khattabi A, Soulaymani-Bencheikh R, Achour S, Salmi LR. ; Scorpion Consensus Expert Group Classification of clinical consequences of scorpion stings: consensus development. Trans R Soc Trop Med Hyg 2011; 105 (07) 364-369
    CrossrefPubMedGoogle Scholar
  • 17 Altınkaynak S, Ertekin V, Alp H. Scorpion envenomation in children. Turk Pediatri Ars 2002; 37: 48-54
    PubMedGoogle Scholar
  • 18 Abroug F, Souheil E, Ouanes I, Dachraoui F, Fekih-Hassen M, Ouanes Besbes L. Scorpion-related cardiomyopathy: clinical characteristics, pathophysiology, and treatment. Clin Toxicol (Phila) 2015; 53 (06) 511-518
    CrossrefPubMedGoogle Scholar
  • 19 Mahadevan S. Scorpion sting. Indian Pediatr 2000; 37 (05) 504-514
    PubMedGoogle Scholar
  • 20 Teixeira AL, Fontoura BF, Freire-Maia L, Machado CR, Camargos ER, Teixeira MM. Evidence for a direct action of Tityus serrulatus scorpion venom on the cardiac muscle. Toxicon 2001; 39 (05) 703-709
    CrossrefPubMedGoogle Scholar
  • 21 Ismail M, Osman OH, Petkovic D. Electrocardiographic studies with scorpion (Buthus minax, L. Koch) venom. Toxicon 1976; 14 (02) 79-83
    CrossrefPubMedGoogle Scholar
  • 22 Mishra OP, Prasad R. Myocardial dysfunction in children with scorpion sting envenomation. Indian Pediatr 2015; 52 (04) 291-292
    PubMedGoogle Scholar
  • 23 Meki AR, Mohamed ZM, Mohey El-deen HM. Significance of assessment of serum cardiac troponin I and interleukin-8 in scorpion envenomed children. Toxicon 2003; 41 (02) 129-137
    CrossrefPubMedGoogle Scholar
  • 24 Gueron M, Ilia R, Sofer S. The cardiovascular system after scorpion envenomation. A review. J Toxicol Clin Toxicol 1992; 30 (02) 245-258
    PubMedGoogle Scholar
  • 25 Cupo P, Hering SE. Cardiac troponin I release after severe scorpion envenoming by Tityus serrulatus. Toxicon 2002; 40 (06) 823-830
    CrossrefPubMedGoogle Scholar
  • 26 Sagarad SV, Thakur BS, Reddy SS, Balasubramanya K, Joshi RM, Kerure SB. Elevated cardiac troponin (cTnI) levels correlate with the clinical and echocardiographic evidences of severe myocarditis in scorpion sting envenomation. J Clin Diagn Res 2012; 6 (08) 1369-1371
    PubMedGoogle Scholar
  • 27 Bawaskar HS, Bawaskar PH. Efficacy and safety of scorpion antivenom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthus tamulus) sting: randomised open label clinical trial. BMJ 2011; 342: c7136
    CrossrefPubMedGoogle Scholar
  • 28 Adiguzel S, Ozkan O, Inceoglu B. Epidemiological and clinical characteristics of scorpionism in children in Sanliurfa, Turkey. Toxicon 2007; 49 (06) 875-880
    CrossrefPubMedGoogle Scholar
  • 29 De Rezende NA, Dias MB, Campolina D, Chavez-Olortegui C, Diniz CR, Amaral CF. Efficacy of antivenom therapy for neutralizing circulating venom antigens in patients stung by Tityus serrulatus scorpions. Am J Trop Med Hyg 1995; 52 (03) 277-280
    CrossrefPubMedGoogle Scholar
  • 30 Peker E, Oktar S, Dogan M, Kaya E, Duru M. Prazosin treatment in the management of scorpion envenomation. Hum Exp Toxicol 2010; 29 (03) 231-233
    CrossrefPubMedGoogle Scholar