Manuela B. Pucca1,2,3*
Joeliton S. Cavalcante2
Sewbert R. Jati3
Felipe A. Cerni3,4
Rui Seabra Ferreira Jr.2,5
Eliane C. Arantes6*- 1Department of Clinical Analysis, School of Pharmaceutical Sciences, São Paulo State University (UNESP), Araraquara, SP, Brazil
- 2Center for the Study of Venoms and Venomous Animals of UNESP (CEVAP), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- 3Graduate Program in Tropical Medicine (PPGMT), State University of Amazonas, Manaus, Brazil
- 4Medical School, Federal University of Roraima (UFRR), Boa Vista, Roraima, Brazil
- 5Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
- 6Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
Scorpionism, or scorpion sting envenoming, is a global issue (1), affecting several regions worldwide, including north-Saharan Africa, Sahelian Africa, South Africa, Near and Middle-East, South India, Mexico and Latin America (2–6). In the Americas, Brazil, Paraguay, Bolívia, Mexico, Guyanas and Venezuela have witnessed a particularly alarming rise in scorpionism over recent decades, evolving into a significant public health crisis (1, 6–8). This surge is driven by a complex interplay of environmental, social, and biological factors (9). Rapid, unplanned urbanization, especially in areas with poor infrastructure, inadequate sanitation, and inconsistent waste management, creates ideal environments for scorpions to thrive (10). These conditions provide abundant shelter in debris, sewage systems, and within homes, bringing humans and scorpions into close proximity. Additionally, climate change, marked by hotter summers and alternating periods of intense rainfall and drought, further facilitates the proliferation of scorpion populations, as these creatures are highly adapted to warm and humid environments (11).
In Brazil, the genus Tityus is medically significant, with T. serrulatus, T. bahiensis, T. stigmurus, and T. obscurus capable of causing clinically significant envenomation (12). The clinical manifestation including: (i) local manifestations: pain, burning sensation, erythema, paresthesia, swelling, and tingling; (ii) minor systemic manifestations: agitation, headache, nausea, vomiting, sweating, unhealthy pallor, salivation, somnolence/lethargy, tachycardia, hypertension, hypothermia, hyperthermia, myoclonia, fasciculation, ataxia, dystonia, miosis, and mydriasis; and (iii) major systemic manifestations: hypotension, ventricular arrhythmia, bradycardia, cardiovascular collapse, cyanosis, dyspnea, pulmonary edema, paralysis, and Glasgow score < 6 (in absence of sedation) (13–15). Laboratory abnormalities include hyperglycemia, hypokalemia, leukocytosis, elevated CK, CK-MB, and troponin T levels in serum, bicarbonate consumption, and increased base deficit and blood lactate (16–18). In cases of minor and major systemic manifestations, associated or not with laboratory alterations, treatment with antivenom is indicated.
Children and the older adults are especially vulnerable due to their reduced capacity to withstand the rapid and overwhelming effects of the venom (19). Given the potency and swift action of the venom, immediate medical attention is critical, often requiring the administration of antivenom and intensive care. This deadly venom cocktail, combined with the species' adaptability and rapid reproductive rate, firmly establishes Tityus scorpions as a major public health concern in Brazil.
In Brazil, 1,171,846 cases were reported between 2014 and 2023. The Southeast region was the most affected during this period, with 580,013 cases (49.5%), followed by the Northeast region, with 439,033 cases (37.5%). Over time, we have seen an increase in cases annually, with a decrease between 2020 and 2021 caused by the trajectory of the COVID-19 pandemic. During that period, isolation measures, hospital overload, and fear of contamination by victims may have generated low rates of scorpion stings. After the pandemic, the number of new cases of scorpionism increased from 136,795 and 130,665 cases in 2020 and 2021, respectively, to 152,384 in 2022, reaching 170,616 cases in 2023 (Figure 1A). It is noteworthy that, compared to 2014, 2023 showed a 254.70% increase in reported cases, jumping from 66,986 to 170,616 cases (data from 2024 were updated and available during the research). In this scenario, we performed a projection using the ARIMA (Autoregressive Integrated Moving Average) model (20) that regulates time series with trends, also known as Box-Jenkins procedure (21). Based on error metrics such as RMSE (Root Mean Square Error), a trendline was used to project the next 10 years based on historical data and its variation by region of Brazil. The data obtained indicate that between 2024 and 2033, ~274,246 new cases of scorpionism may occur. Of these, 2,148,576 cases in the Southeast, 182,836 in the South, 1,383,800 in the Northeast, 158,573 in the North, and 404,219 in the Central-West (Figure 1B). In total, we expect 2,095,146 new cases to occur between 2025 and 2033 (Table 1).
Figure 1. Reported and projected cases of scorpionism in Brazil. (A) Historical data on scorpionism cases (2014–2023). Data obtained from SINAN (Sistema de Informação de Agravos de Notificação, i.e., the Brazilian Notifiable Diseases Information System), January 2024. (B) Projected (2024–2033) based on trend analysis. The black line represents the total number of cases, while the colored lines indicate different Brazilian regions, with improved color contrast to distinguish geographical differences more effectively. The shaded area denotes the projected period. A photograph of Tityus serrulatus (credited to Felipe A. Cerni) is included, highlighting this species as the primary cause of scorpionism cases in Brazil.
Table 1. Number of reported and projected cases of scorpionism in Brazil by region (2014–2033).
The dramatic rise in scorpionism is placing immense pressure on Brazil's public health system. Urbanization has made encounters with scorpions increasingly common, largely due to the accumulation of garbage and inadequate sanitation, which create favorable habitats with abundant resources for these arachnids (10, 22, 23). Additionally, their proliferation is facilitated by parthenogenesis (24), as observed in Tityus serrulatus, a species composed exclusively of females. Given that these scorpions can survive for extended periods—up to 400 days—without food (25), these factors contribute to a rising population density in urban areas, significantly increasing the risk of scorpionism.
If the numbers are already so alarming, what happens when we consider the vast underreporting of scorpionism? The real scale of this issue is likely far greater than the recorded statistics suggest. While pediatric cases requiring medical intervention represent only a small fraction of the affected population, adult cases, often dismissed as minor due to localized pain that can be managed with analgesics, frequently go unreported. Many victims choose to treat themselves at home or forego treatment entirely, allowing the true extent of scorpionism to remain hidden. Thus, this underreporting is not just a statistical issue; it is a major obstacle to effective control measures. Without accurate data, health authorities struggle to assess the real burden of scorpionism and implement targeted interventions.
The official numbers paint a deeply concerning picture, but the reality is likely far worse. Scorpionism is not just an emerging public health issue—it is a hidden epidemic growing unchecked. Worsened by poor sanitation, rapid urban expansion, and widespread public unawareness, this silent crisis continues to escalate, placing an increasing number of lives at risk.
This data clearly illustrates the alarming rise in scorpionism cases over the years. From 2014 to 2023, cases surged by more than 250%, and projections indicate a continued upward trend, with an estimated 274,246 cases by 2033—an increase of 60.7% compared to 2023. Notably, all regions of Brazil are experiencing this surge, with an annual average increase of 10,363 cases, reflecting a rapidly expanding public health crisis.
Given the relentless rise in scorpionism and the significant challenges posed by underreporting, immediate action is essential to prevent further escalation. Strengthening public awareness campaigns on scorpion risks, preventive measures, and the importance of case reporting is crucial for obtaining more accurate data and implementing effective control strategies. Without decisive intervention, scorpionism will continue its upward trajectory, placing an even greater burden on Brazil's healthcare system and putting public safety at increasing risk.
Author contributions
MP: Conceptualization, Formal analysis, Investigation, Supervision, Visualization, Writing – original draft, Writing – review & editing. JC: Formal analysis, Investigation, Visualization, Writing – original draft, Writing – review & editing. SJ: Data curation, Methodology, Visualization, Writing – original draft, Writing – review & editing. FC: Investigation, Visualization, Writing – original draft, Writing – review & editing. RF: Supervision, Visualization, Writing – original draft, Writing – review & editing. EA: Investigation, Visualization, Writing – original draft, Writing – review & editing.
Funding
The author(s) declare that financial support was received for the research and/or publication of this article. This work was supported by Fundação de Amparo a Pesquisa do Estado de São Paulo (FAPESP - São Paulo Research Foundation, n. 2021/11936-3).
Acknowledgments
We are thankful to the Coordination of Superior Level Staff Improvement (CAPES) for the scholarship n° 88887.674376/2022-00 (JC), and the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, São Paulo Research Foundation), Process n° 2022/16060-1 (JC), 2024/14131-4 (JC), and 2023/01554-1 (RF). RF (n. 301608/2022-9), MP (n. 305778/2023-4), and EA (n. 309399/2021-1) are CNPq fellow researchers.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
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Keywords: scorpion, scorpionism, Brazil, Tityus serrulatus, envenoming, venomous animal
Citation: Pucca MB, Cavalcante JS, Jati SR, Cerni FA, Ferreira RS Jr and Arantes EC (2025) Scorpions are taking over: the silent and escalating public health crisis in Brazil. Front. Public Health 13:1573767. doi: 10.3389/fpubh.2025.1573767
Received: 09 February 2025; Accepted: 17 March 2025;
Published: 08 May 2025.
Edited by:
Clara Guerra-Duarte, Ezequiel Dias Foundation (FUNED), BrazilReviewed by:
Adolfo Borges, Center for the Development of Scientific Research (CEDIC), ParaguayCopyright © 2025 Pucca, Cavalcante, Jati, Cerni, Ferreira and Arantes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Manuela B. Pucca, bWFudWVsYS5wdWNjYUB1bmVzcC5icg==; Eliane C. Arantes, ZWNhYnJhZ2FAZmNmcnAudXNwLmJy