Scorpion envenomation in Brazil: Current scenario and perspectives for containing an increasing health problem

Abstract

Opportunistic scorpion species can colonize urban environments, establishing high-density communities that enhance the chances of human accidents. This scenario has been taking place in Brazil, in which some Tityus species have taken city centers, causing an explosion in the number of scorpion envenoming cases. The characteristics of this scorpionism epidemic in Brazil is discussed in the present work. The number of Brazilian scorpion stings has surpassed 120,000 cases in 2017, and has been maintained above this number ever since, representing a more than 3-fold increase in 10 years, which was higher than the number of cases for most of the neglected tropical diseases in the country. The escalation in scorpionism cases is even higher in some regions of Brazil. Fortunately, the proportion of mild cases has also increased in the analyzed period, as well as the number of victims seeking for medical attention within the first hour after the accident. The species Tityus serrulatus, Tityus stigmurus, Tityus bahiensis, and Tityus obscurus are traditionally accountable for most of the scorpion accidents in different regions of Brazil, but other species deserve to be closely watched. Despite scorpionism being a notable health problem in Brazil, accident prevention and pest control regarding this venomous animal have not been properly addressed by the scientific community nor by policy makers. Therefore, this review also aims to point possible fields of research that could help to contain the aggravation of the current scorpionism landscape in Brazil. Author summary The presence of scorpions in Brazilian urban centers has been increasing over the last decade and has led to an important augmentation in the number of human accidents in this country. This review aimed to better understand this scorpionism epidemic in Brazil, analyzing the evolution and dynamics of the accidents per region, the victim’s profile, and the outcomes of the resulting reported cases. The main scorpion species related to these accidents were reviewed, but emerging threatening species are also pointed and discussed. Considering this current medical emergency, it would be expected to have more preventive measures being proposed by the political and scientific community, but this has not been observed. Therefore, this work also suggests different fields that could be important points of action to reduce and contain problems related to scorpionism. These recommendations ranges from improvements in housing and education in all levels to chemical, biological, and genetic forms of control of scorpion populations. The effort made in this review intended to call attention to the scorpion problem in Brazil and to be part of the solution.