Author/Authors :
Sanaei-Zadeh, Hossein Emergency Room - Division of Medical Toxicology - Hazrat Ali-Asghar Hospital - Shiraz University of Medical Sciences, Shiraz, Iran , Marashi, Mahdi Emergency Room - Division of Medical Toxicology - Hazrat Ali-Asghar Hospital - Shiraz University of Medical Sciences, Shiraz, Iran , Dehghani, Rouhullah Social Determinants of Health Research Center and - Department of Environmental Health - College of Health - Kashan University of Medical Sciences, Kashan, Iran
Abstract :
Background: Scorpionism is a public health problem in some provinces in Iran. The present study aimed to assess the clinical manifestations
of scorpion envenomation in Shiraz and determine a clinical severity grading for Iranian scorpion envenomation in order to
suggest a treatment guideline for emergency physicians.
Methods: In this analytic retrospective study, all medical charts of patients with scorpion sting admitted in the adult medical toxicology
center in Shiraz during July 2012 to July 2016 were assessed. Data regarding the patient's age, gender, sting site, month of envenomation,
time of sting, clinical manifestations, vital signs, presence of blood or hemoglobin in urine analysis, duration of admission,
color of scorpion, received treatments, and administration of scorpion antivenin were recorded.
Results: The scorpions in Shiraz and its suburban area were classified into two groups: yellow scorpions (Mesobuthus eupeus, Mesobuthus
caucasicus, and Compsobuthus matthiesseni) and Hottentotta scorpions (Hottentotta jayakari and Hottentotta zagrosensis). A
total of 126 cases of scorpion stings were assessed. About 59% (n=74) were males. The patients aged 8-63 years (mean age, 33.8±11.5
years). About 38.4% (n=48) of the stings occurred during summer. More than 40% of patients (n=51) referred to the emergency department
(ED) at night. Localized pain was the most frequent presenting complaint (76.2%). The most frequent general symptom was
nausea (6.3%). The most prevalent envenomation site was the lower extremities followed by upper extremities (43.5% and 41.9%,
respectively). Based on the clinical severity grading for Iranian scorpion envenomation, 65, 43, and 18 patients (51.6%, 34.1%, and
14.3%) were classified in the grades I, II, and III, respectively. Eighty-one (73%) patients stayed in the ED from 1 to 6 hours, and 30
(27%) patients stayed for >6 hours for observation. Severe localized pain was more prevalent in stings with Hottentotta scorpions than
yellow scorpions (P=0.01). The season of envenomation with Hottentotta scorpions was summer in all cases, but envenomation with
yellow scorpions was seen throughout the year. All patients received symptomatic treatment, and five were given scorpion antivenin.
No death was reported.
Conclusion: Hottentotta jayakari is recommended to be listed among the medically important scorpions in Iran. Moreover, scorpion-
stung patients in geographical regions where Hemiscorpius lepturus and Androctonus crassicauda are not prevalent may be treated
in outpatient departments. The presented grading system can be used for treating patients with scorpion envenomation.
Keywords :
Clinical Severity Grading , Clinical Manifestations , Epidemiology , Iran , Scorpion Stings , Scorpions
