Internet shopping continues to be a boom industry. An unlimited marketplace, shop-at-home 24-hour convenience, strong Australian dollar and delivery straight to you door, there seems to be no downside for the consumer, right? Maybe not.
A sixty-two year-old woman presents to the emergency department after opening a package containing a coat bought online from Uzbekistan. After trying it on, she immediately feels pain in her left hand. She shakes the coat, and out crawls…
Australian scorpions are not dangerous to humans. Bites generally cause localised pain, erythema, numbness and paraesthesia. Mild systemic symptoms such as nausea, headache and malaise may occur in a small proportion of patients. Treatment consists of reassurance and analgesia.
Worldwide there are over 1500 species of scorpions distributed over all continents except Antarctica. Only a small number of them are associated with serious envenomation or death, and nearly all of these belong to the family Buthidae.
Scorpion venom consists of a heterogenous group of neurotoxic peptides which primarily target voltage-gated ion channels. Clinical manifestations vary from localised symptoms to myocardial toxicity, autonomic dysregulation, pulmonary oedema and respiratory arrest, cranial nerve palsies and hyperthermia. Treatment consists of supportive care and, for severe case, antivenom. Correct species identification is a pre-requisite for antivenom therapy.
Our patient was observed for a few hours and had no systemic symptoms.
Fortunately, she had the presence of mind to catch the scorpion and bring it with her to the emergency department. It was removed by Australian Customs and thought to be Mesobuthus eupeus, whose venom is not as potent as other dangerous buthid species.
So, next time your eagerly-awaited package arrives from overseas, remember that your internet purchase may not be the only thing that has made the trip!
About Sean Rothwell
