G R Bond1. 1. Department of Medical Toxicology, Good Samaritan Medical Center, Phoenix, Arizona.
Abstract
STUDY OBJECTIVES: To assess the clinical severity of envenomation by the Centruroides scorpion in young children; the potential benefit of antivenin administration with regard to time to resolution of symptoms, prevention of hospitalization, and prevention of invasive intervention; and the risk of acute and delayed hypersensitivity reaction. DESIGN: Retrospective chart review with follow-up contact. SETTING: Referral toxicology management center. TYPE OF PARTICIPANTS: Children less than 10 years of age experiencing severe Centruroides scorpion envenomation. INTERVENTIONS: Administration of goat serum-derived anti-Centruroides antivenin. MEASUREMENTS AND MAIN RESULTS: Stings in young children may be life threatening, resulting in extreme neuromuscular activity, tachycardia, and respiratory distress. Administration of anti-Centruroides antivenin resulted in rapid resolution of all symptoms without acute reaction in all 12 patients so treated; 58% of patients treated with antivenin had a delayed onset of rash or symptoms of serum sickness. CONCLUSION: The benefit of rapid resolution of life-threatening symptoms and potential for outpatient management of severe envenomation in young children may justify the risk of acute and delayed reaction associated with antivenin use in this group. The use of antivenin for the less severe envenomation common in older children and adults may subject them to unjustified risk.
STUDY OBJECTIVES: To assess the clinical severity of envenomation by the Centruroides scorpion in young children; the potential benefit of antivenin administration with regard to time to resolution of symptoms, prevention of hospitalization, and prevention of invasive intervention; and the risk of acute and delayed hypersensitivity reaction. DESIGN: Retrospective chart review with follow-up contact. SETTING: Referral toxicology management center. TYPE OF PARTICIPANTS: Children less than 10 years of age experiencing severe Centruroides scorpion envenomation. INTERVENTIONS: Administration of goat serum-derived anti-Centruroides antivenin. MEASUREMENTS AND MAIN RESULTS: Stings in young children may be life threatening, resulting in extreme neuromuscular activity, tachycardia, and respiratory distress. Administration of anti-Centruroides antivenin resulted in rapid resolution of all symptoms without acute reaction in all 12 patients so treated; 58% of patients treated with antivenin had a delayed onset of rash or symptoms of serum sickness. CONCLUSION: The benefit of rapid resolution of life-threatening symptoms and potential for outpatient management of severe envenomation in young children may justify the risk of acute and delayed reaction associated with antivenin use in this group. The use of antivenin for the less severe envenomation common in older children and adults may subject them to unjustified risk.