Acute myocarditis in children with scorpion sting envenomation

Abstract

Objective: Prospective observational analysis of all children admitted with scorpion sting and identifying acute myocarditis in these children. Methods: All children admitted at Pediatric ICU in the period between Jan 2018– Dec 2019 with scorpion sting were included in the study after taking informed consent from parents. History noted in detail. They were evaluated with complete hemogram, serum electrolytes, urea, creatinine, cardiac markers (CPKMB, Troponin-T), Electrocardiography (ECG), X-ray chest and 2D echocardiography. Data of Children who developed cardiovascular complications, positive cardiac markers and positive ECHO findings were studied. Children were managed as per the standard treatment protocol. Results: During the study period from Jan 2018–Dec 2019 total 61 children were admitted with scorpion sting. Forty five were male and 16 were female, mean age 6.9 ± 3.9 years. Among 61 cases, 21 (34.4%) of them developed myocarditis. In children with myocarditis Troponin-T was positive in 16 (76.2%) children, CPK–MB high in all (100%) the patients, mean CPK MB found to be 55.05 ± 4.52, ECG changes in four patients (19.04%) and X-ray chest changes in 7 (33.3%) cases. All these 21 cases showed varied abnormal ECHO findings. Ten (47.6%) patients required inotropes. Four children (19%) were on mechanical ventilation support. Twenty (98.36%) patients improved, 1(4.8%) patient had mortality. Repeat ECHO was done in all these cases before discharge which showed return of normal cardiac function. Conclusion: Scorpion venom can have a potent cardiotoxic effect. Hence ECG, cardiac markers and echocardiography must be included in all cases with scorpion sting which helps in early diagnosis and treatment of acute cardiac complications.