Arachnid Science: Article Reviews
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Wheatley, G.O. III, M.A. Wait & M.E. Jessen. 2005. Infective endocarditis associated with a scorpion sting. Annals of Thoracic Surgery 80:1489-1490.
Handlers with heart disease may be at an elevated risk of bacterial infection of the heart following scorpion envenomation. This article provides case reports of two male patients who both suffered multiple scorpion stings and, despite initial treatment with oral antibiotics, subsequently developed infective endocarditis—an inflammation of the interior lining of the heart and/or the heart valves. Unfortunately, the scorpion species delivering the repeated stings were unknown in both cases.
Endocarditis was caused by bacterial (streptococcus) attack of the aortic valves in both patients. One patient (age 55) had a pre-existing heart prosthetic device that became infected and had to be removed one week after the scorpion stings; the aortic root was replaced with donated human tissue and coronary artery bypass was achieved with veins taken from elsewhere in the body. The other patient (age 34), who had developed chest pain and difficulty breathing two weeks following his scorpion stings, had an artificial aortic valve implanted and bovine tissue grafts to heal a severe abscess. Following these surgical interventions, both men went through six weeks of intravenous antibiotic treatment. Finally, both received permanent transvenous pacemakers in later surgical procedures.
Streptococci are the most common bacterial culprits of infective endocarditis, accounting for up to 70% of such diagnoses. However, the two species of streptococcus (group G streptococcus and S. milleri) that attacked the heart valves of these two sting victims have rarely been implicated in infective endocarditis (approximately 5% of cases). Moreover, these unusual streptococcus strains typically lead to skin cellulitis, which is relatively easy to treat. It is presently not known whether bacterial transmission occurs during scorpion stings, but the severity of the heart tissue damage described here hints at the possibility that the scorpion stings somehow played an important role.
Scorpion envenomation should be treated with antibiotic drugs that cover a wide range of streptococci species and any sustained or recurring infection should be promptly evaluated by a physician. Individuals who are immunocompromised or have heart valve disease or man-made valves may be at increased risk for dangerous infections.
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