To the Editor:
Scorpion envenomation is common in tropical and subtropical regions. In Tunisia, almost 40,000 patients are stung per year, around one thousand of them have systemic features requiring hospitalisation with about 10 patients eventually die.Citation1 Severe scorpion envenomation requiring hospitalisation in the intensive care unit (ICU) usually results from a sting by one of the two species: Androctonus australis or Buthus occitanus.Citation1, Citation2 Scorpion envenomation is more often observed in the middle and south of Tunisia which are rural endemic areas. Scorpion envenomation occurring in hospital (nosocomial) has not been previously reported.
A 33-year-old male presented in August 2010 to the department of surgery for suspected appendicitis. After biological and radiological explorations, the diagnosis of likely appendicitis was made. A few hours after hospital admission and during changes of his cloths, the patient was envenomed by a scorpion (Androctonus australis) requiring his admission in our ICU. Clinical examination on admission showed local pain without inflammatory signs. However, the patient exhibited systemic manifestations with nausea, vomiting, agitation and sweating. Blood pressure on ICU admission was 130/80 mmHg, and heart rate 85/min. There were no signs of respiratory distress, oxygen saturation measured by pulse oximetry [SpO2] was 96% on air room. Electrocardiogram and chest radiograph performed on admission were normal. A diagnosis of scorpion envenomation grade II (with systemic manifestations) was made, and the patient received scorpion antivenom. Evolution was favourable and the patient quickly improved.
We have previously shown that intoxications caused by scorpions in south Tunisia region are mostly seen in hot summer months especially in July and August.Citation2–5 Moreover, we have postulated that in many of these cases, the patients were stung because of careless behaviour such as walking bare foot. We have never previously encountered scorpion envenomation during hospital stay. This patient came from an endemic region, and we postulate that the scorpion was carried in the patient bag and cloths into hospital.
Our observation shows that scorpion envenomation can occur in hospital as an unusual nosocomial event.
References
- Goyffon M, Vachon N, Broglio N. Epidemiological and clinical characteristics of the scorpion envenomation in Tunisia. Toxicon 1982; 20:337–344.
- Bouaziz M, Bahloul M, Kallel H, Samet M, Ksibi H, Dammak H, et al. Epidemiological, clinical characteristics and outcome of severe scorpion envenomation in South Tunisia: multivariate analysis of 951 cases. Toxicon 2008; 52:918–926.
- Bahloul M, Ben Hamida C, Chtourou K, Ksibi H, Dammak H, Kallel H, et al. Evidence of myocardial ischemia in severe scorpion envenomation: “Myocardial perfusion Scintigraphy study”. Intensive Care Med 2004; 30:461–467.
- Bouaziz M, Bahloul M, Hergafi L, Kallel H, Chaari L, Hamida CB, et al. Factors associated with pulmonary edema in severe scorpion sting patients – a multivariate analysis of 428 cases. Clin Toxicol (Phila) 2006; 44:293–300.
- Bahloul M, Bouaziz M, Dammak H, Ben Hamida C, Ksibi H, Rekik N, et al. Value of the plasma protein and hemoglobin concentration in the diagnosis of pulmonary edema in scorpion sting patients. Intensive Care Med 2002; 28:1600–1605.