27 May, 2011

Scorpion Envenomations in Mali

The knowledge about scorpion envenomations and species of medical importance in North-Africa and Southern Africa is quite good. Less is known about the status of scorpionism in Central (Sub-Saharan) Africa.

Dabo and co-workers have now published an article on scorpion envenoming in the North of Mali, increasing our knowledge on scorpions impact on health in this area. Leiurus quinquestriatus and Androctonus amoreuxi are mentioned as species involved in sting incidents, but unfortunately the involved species is unknown in 93% of the cases.

Scorpion envenomation remains a poorly known problem in sub-Saharan Africa, particularly in Mali, where the incidence is high in Northern area of the country (Sahara desert). We conducted a prospective study in two district health centers, Kidal and Tessalit (Northeast of Mali), to describe the epidemiological, clinical and therapeutic features of scorpion stings. This study consisted of an exhaustive follow-up from admission to discharge of all patients stung by scorpions. Of a total of 282 cases recorded during one year, 207 (73.4%) occurred in Kidal, and the remaining 75 (26.6%) took place in Tessalit. The annual incidence was significantly higher in Tessalit (437 cases/100 000 population/year) than in Kidal (243 cases/100,000 population/year) (p < 10-6). Two hundred two (71.6%) stings occurred inside human dwellings, 142 (50.4%) during sleeping/resting, especially in August. One hundred ninety-one (67.7%) were on the lower extremities. Nocturnal stings, 168 (59.6%), occurred more often than diurnal stings, 114 (40.4%). Most patients, 163 (57.8%), were admitted less than 1 h after being stung. Local pain at the sting site was the common primary complaint. However, moderate and severe clinical signs were significantly higher in children than in adults (p < 0.05). The death rate (3.9%) was higher in children (3.5%) than in adults (0.3%) (p ¼ 8.10-6; RR ¼ 0.90 [IC: 0.84–0.06]). Of the 22 scorpion species identified, 13 (59.1%) were Leiurus quinquestriiatus, 8 (36.4%) were Androctonus amoreuxi, and 1 (4.5%) specimen was Buthiscus bicalcaratus. From these species, L. quinquestriiatus and A. amoreuxi were responsible of stings. The medical treatment was only symptomatic, and one hundred twenty-eight (45.3%) patients received traditional remedies before seeking medical attention. Our findings suggest that scorpion stings are common in the north of Mali and are a significant threat to human health.

Dabo A, Golou G, Traoré MS, Diarra N, Goyffon M, Doumbo O. Scorpion envenoming in the North of Mali (West Africa): Epidemiological, Clinical and Therapeutic aspects. Toxicon. 2011;In Press. DOI: . 10.1016/j.toxicon.2011.05.004 .Subscription required for fulltext]

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