French Scorpionism (Mainland and Oversea Territories): Narrative Review of Scorpion Species, Scorpion Venom, and Envenoming Management

Abstract

Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French Guiana. The number of stings is also heterogenous, with up to 90 stings per 100,000 inhabitants occurring annually. Scorpion species can frequently be determined through simple visual factors, including species of medical importance (i.e., Buthus, Centruroides and Tityus). Scorpion venom is composed of local enzymes and peptides with a cysteine-stabilized α/β motif (NaTxs, Ktxs, Calcines), which allow for venom diffusion and the prey's incapacitation, respectively. Harmful scorpion species are limited to Centruroides pococki in the French West Indies, which can induce severe envenoming, and the Tityus obscurus and Tityus silvestris in French Guiana, which can cause fatalities in children and can induce severe envenoming, respectively. Envenomation by one of these scorpions requires hospital monitoring as long as systemic symptoms persist. Typical management includes the use of a lidocaine patch, pain killers, and local antiseptic. In the case of heart failure, the use of dobutamine can improve survival, and pregnant women must consult an obstetrician because of the elevated risk of preterm birth or stillbirth. France does not have scorpion antivenom, as scorpion stings are generally not fatal.

Keywords: intensive care units; poison control centers; public health; scorpion stings; scorpion venom.

Figure 1

Brief anatomical description of a scorpion and photos of scorpions of medical interest present on French territory: (A) anatomical description of a scorpion; (B) Tetratrichobothrius flavicaudis; (C) Buthus occitanus.; (D) Centruroides pococki; (E) Isometrus maculatus; (F) Tityus obscurus adult; (G) Tityus obscurus juvenile; (H) Tityus silvestris. (B–D) are available on the site https://inpn.mnhn.fr (accessed on 1 October 2022.) under Creative Commons license: (B) by J.-C. De Massary, (C) by F. Chevaillot, and (D) by E.-A. Leguin. (E–H) are already published [19] and they are presented here with the permission of E. Ythier.

Figure 2

3D structure diagrams of typical cysteine-stabilized α/β motif peptides of scorpion venom obtained from https://www.rcsb.org/ (accessed on 1 October 2022): (A): classical α-NaTx (AaH II from Androctonus australis hector); (B): classical β-NaTx (Cn2 from Centruroides noxius); (C): classical α-KTx toxin (Agitoxin 2 from Leiurus quinquestriatus hebraeus); (D): classical β-KTx toxin (β-KTx14.3 from Lychas mucronatus); (E): classical γ-KTx (CnErg1 Ergtoxin from Centruroides noxius); (F): classical κ-KTx toxin (HelaTx1 from Heterometrus laoticus); (G): classical δ-KTx (BmK-M10 from Mesobuthus martensii); (H): classical λ-KTx (λ-MeuTx from Mesobuthus eupeus); (I): classical ε-KTx (TsPep1from Tityus serrulatus); and (J): classical calcine (Agitoxin A from Pandinus imperator).

Figure 3

High performance liquid chromatography separation soluble venom. (A): Tityus. Obscurus venom from Guerrero-Vargas and et al [72]; (B): Tityus metuendus venom from Batista and et al [87]; (C): Buthus occitanus venom from Martin-Eauclaire and et al [56].