SCORPIONISM IN SOUTH-AFRICA - A REPORT OF 42 SERIOUS SCORPION ENVENOMATIONS

Forty-two cases of serious scorpion envenomation, of which 4 had a fat al outcome, are presented. The clinical profile, differential diagnosi s and management of scorpionism are discussed. Most envenomations occu rred in the summer months, peaking in january and February. An immedia te local burning pain was the most prominent symptom. Systemic symptom s and signs developed within 4 hours of the sting in most instances, c haracterised by general paraesthesia, hyperaesthesia, muscle pain and cramps. Other striking features included dysphagia, dysarthria and sia lorrhoea with varying degrees of loss of pharyngeal reflexes. The bloo d pressure and the temperature were often raised and the tendon reflex es increased, while motor power was often impaired. In a considerable number of patients the course was complicated by varying degrees of re spiratory dysfunction, which tended to be more serious in children. Th e outstanding feature in children was an extreme form of restlessness characterised by excessive neuromuscular activity. Victims of scorpion sting, particularly in high-risk localities, should be closely observ ed for 12 - 24 hours. Children and other high-risk patients should be hospitalised. All patients with symptoms and signs of systemic envenom ation should receive antivenom. Parabuthus granulatus (Hemprich & Ehre nberg, 1828) has been identified as the most important venomous specie s in the western Cape. The antivenom is produced from the venom of the medically less important P. transvaalicus Purcell, 1899. A strong cas e can therefore be made for the inclusion of P. granulatus venom in th e production of a polyvalent antivenom.