Pediatric scorpionism in northern Amazonia: a 16-year study on epidemiological, environmental and clinical aspects

Abstract Background: The Amazon basin is one of the seven major geographical areas where scorpionism is recorded. In French Guiana, 90 stings per 100,000 inhabitants are registered per year. As the severity of cases is higher in children, descriptive studies are needed to have a better understanding of this pathology. The aim of the present study is to describe pediatric scorpionism in French Guiana. Methods: We conducted a monocentric descriptive retrospective study on scorpion stings in all pediatric patients admitted to Cayenne General Hospital from January 1, 2002 to December 31, 2018. Results: In this survey, 132 patients were included. Of them, 63% were male. Patients with general signs of envenomation were younger and lighter (p = 0.04). The picture was “one sting” (95.3%) by a “big” (47.6%), “black” (60%) and “small pincer” (58%) scorpion on the extremity of the body (84%). Stings occurred mainly during the day, while patients changed clothes. There was no envenomation during night. The monthly evaluation highlights that the number of stings and percentage of general signs of envenomation were closely connected to a composite variable including the variation of the level of rivers (p = 0.005). Cardiac symptoms were recorded in 82% of cases with general signs of envenomation. The presence of pulmonary; ear, nose, and throat (ENT); or gastrointestinal symptoms are related to major envenomation (p = 0.001, p = 0.01, and p = 0.02 respectively). Leukocytosis and glycemia increased according to the envenomation grade whereas serum potassium and alkaline reserve decreased. Forty-six patients needed hospitalization and seven of them required intensive care. No patient died nor presented sequelae at discharge from the hospital. Conclusion: Pediatric scorpionism in French Guiana is closely associated with child activities and climatic conditions. Severe envenomation presented most of the time with cardiac, pulmonary, and gastrointestinal symptoms.

摘要：背景：亚马逊流域是全球七大记录有蝎螫中毒的地理区域之一。在法属圭亚那，每年每10万居民中就有90例蝎螫伤登记病例。由于儿童患者的病情严重程度更高，因此亟需开展描述性研究以加深对该疾病的认识。本研究旨在描述法属圭亚那的儿童蝎螫中毒情况。
方法：本研究为单中心描述性回顾性研究，纳入2002年1月1日至2018年12月31日期间收治于卡宴综合医院的所有蝎螫伤儿科患者。
结果：本研究共纳入132例患者，其中63%为男性。出现全身中毒症状的患者年龄更小、体重更轻（p=0.04）。本次研究中，95.3%的病例为单次螫伤，螫伤由体型“较大”（47.6%）、“黑色”（60%）且“螯钳较小”（58%）的蝎子造成，螫伤部位多位于肢体（84%）。螫伤事件主要发生在日间患者更衣时段，夜间未出现蝎螫伤病例。月度数据分析显示，蝎螫伤数量及全身中毒症状占比与包含河流水位变化在内的复合变量密切相关（p=0.005）。在出现全身中毒症状的患者中，82%存在心脏相关症状。肺部、耳鼻咽喉（Ear, Nose and Throat, ENT）及胃肠道症状与重度中毒相关（分别对应p=0.001、p=0.01及p=0.02）。白细胞计数升高及血糖水平随中毒等级升高而上升，而血清钾及碱储备则随之下降。46例患者需要住院治疗，其中7例需转入重症监护。所有患者均未出现死亡或出院时遗留后遗症的情况。
结论：法属圭亚那的儿童蝎螫中毒与儿童日常活动及气候条件密切相关。重度中毒患者多表现为心脏、肺部及胃肠道症状。