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Author's personal copy
Toxicon 53 (2009) 454–459
Contents lists available at ScienceDirect
Toxicon
journal homepage: www.elsevier.com/locate/toxicon
Epidemiological and clinical survey of scorpionism in Khuzestan
province, Iran (2003)
Delavar Shahbazzadeh a, *, Aref Amirkhani b, Navid Dinparast Djadid a, Shahla Bigdeli c,
Abolfazl Akbari d, Hamed Ahari a, Hossein Amini a, Rouhullah Dehghani e
a
Biotechnology Research Center, Pasteur Institute of Iran, Pasteur Sq., Pasteur St., P.O. Box: 131694-3551, Tehran, Iran
Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran
c
Public Health Center of Khuzestan Province, Ahvaz, Iran
d
Razi Vaccine Research & Serum Development Institute, 31975/148 Karaj, Iran
e
Department of Environmental Health, Kashan University of Medical Sciences, Kashan, Iran
b
a r t i c l e i n f o
a b s t r a c t
Article history:
Received 9 June 2008
Received in revised form 31 December 2008
Accepted 9 January 2009
Available online 19 January 2009
Epidemiological and clinical survey of scorpion envenomation was carried out by statistical method of stratified cluster random sampling in Khuzestan, the southern province of
Iran, cross-sectionally. We analyzed 12,150 cases recorded in Emergency Unit of the
hospitals of six cities in Khuzestan province during the year 2003. The prevalence rate of
human scorpion stings in the province is 3.1/1000 inhabitants. The percentage of prevalence in selected cities was as follows: Masjed-Soleiman (27.1%), Ramhormoz (26.6%), Izeh
(15.3%), Shush (12%), Baghmalek (11.7%), and Behbahan (7.3%). The scorpions, responsible
for the majority of stings in Khuzestan province of Iran were identified as 53.3% yellow
(Mesobuthus eupeus, Hottentotta saulcyi, Odonthobuthus doriae and Hemiscorpius lepturus),
and 17.4% black (Androctonus crassicauda and Hottentotta schach), and 29.3% unknown
colors. Most stings occurred throughout the year, however, the highest and lowest
frequency occurs in June (16.0%) and February (0.6%), respectively. Nocturnal envenomations (60.9%) were more common than diurnal (39.1%), and 39.3% of stings were on the
hands and 37.3% on the feet. Most envenomings were mild (74.5%) that all evolved to cure,
except for three deaths. Envenomation was characterized by local pain (63.3%), erythema
(10.1%), vomiting (1.3%), restlessness (0.6%), hyperthermia (0.5%), sweating (0.4%), and
spasmic (0.3%). With respect to the outcoming results, scorpionism in Khuzestan province
of Iran is a public health problem, which needs to be monitored carefully by the
government.
Ó 2009 Elsevier Ltd. All rights reserved.
Keywords:
Epidemiology
Scorpion envenoming
Ramhormoz
Izeh
Baghmalek
Behbahan
Masjed-Soleiman
Shush
Khuzestan Province
Iran
1. Introduction
In Khuzestan, a southwestern province of Iran, as in
numerous tropical areas nearby the Persian Gulf region,
envenomation by scorpion stings is a major public health
problem, particularly in children (Mirdehghan and Motlagh, 2001). There are more than 23 scorpion species in
Iran, in which six species are dangerous, medically
* Corresponding author. Tel./fax: þ98 21 648 0780.
E-mail address: [email protected] (D. Shahbazzadeh).
0041-0101/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.toxicon.2009.01.002
important and responsible for envenomings (Vachon,
1966). Except for one species of Hemiscorpius lepturus,
others belong to the Buthidae family and include Androctonus crassicauda, Hottentotta saulcyi, Hottentotta schach,
Odontobuthus odonturus, and Mesobuthus eupeus (Radmanesh, 1990a,b; Akbari et al., 1997; Fet et al., 2000; Bucherl,
1971).
Envenomations are characterized by various symptoms
such as pain, sweating, fever and hypertension. The venom
of Buthidae family has neurotoxic effects (Radmanesh,
1990b; Mirdehghan and Motlagh, 2001), and H. lepturus
Author's personal copy
D. Shahbazzadeh et al. / Toxicon 53 (2009) 454–459
with cutaneous reaction. In most severe cases, hematuria
due to hematolytic effect of H. lepturus venom was reported
(Radmanesh, 1998; Pipelzadeh et al., 2007).
In Iran, serotherapy has been one of the major therapeutic measures used in the treatment of scorpion envenoming for the last 30 years (Akbari et al., 1997; Latifi and
Tabatabai, 1979). The dose of choice for the antivenom and
the administration protocol are based on the instructions
advised by the manufacturer or by the National Expert
Committee, which mainly includes physicians, engaged in
scorpion envenomation treatment.
Information on envenomation accidents in Khuzestan
province is scarce and very little is known about the rate of
scorpion stings in different areas of this province
(Mirdehghan and Motlagh, 2001; Radmanesh, 1990a,b,
1998; Pipelzadeh et al., 2007). The current study was
designed in order to investigate the demographic and
clinical features of scorpion envenomation, the amount of
antivenom required for treatments, and revision of current
protocols. To achieve this goal, questionnaire was distributed to the Emergency Units of selected hospitals from six
cities in the province during the year 2003. Statistical
analyses were performed on the collected data.
2. Materials and methods
2.1. Study area and population
Due to its high envenomation frequency reports among
30 provinces in Iran, Khuzestan, a southern province with
the population of 3,972,309 consisting 6.6% of the whole
country population was selected for the purpose of this
study. The study was carried out on the data obtained from
the six major cities in the province which were selected by
stratified cluster random sampling method. The selected
cities were as follows. Shush (183,409 inhabitants), Ramhormoz (146,364), Masjed-Soleiman (237,418), Izeh
(179,337), Baghmalek (105,504), and Behbahan (170,694).
2.2. Data collection and recording process
Questionnaire containing information on the envenoming accidents was distributed to the designated
hospitals in the selected cities. The questionnaire contained
information about the city where the incident was recorded, the date and place of the accident (inside or outside
home, at work, etc.), the site of scorpion stung, as well as
the age and sex of the injured, the signs and/or symptoms
recorded at the time when patients admitted to the
Emergency Units; possible known species of the scorpion;
and measures taken by the Emergency Units for every
envenomed individuals. The time between the sting and
administration of antivenom and the amount of antivenom
given to each patient was also recorded.
2.3. Patients
A total of 12,150 cases of scorpion envenomed patients
were documented in Emergency Units of the selected
hospitals which were responsible for admission of envenomed patients from both the rural and urban areas.
455
2.4. Use of antivenom
Most patients included in this study (7782 out of 12,150)
received scorpion polyvalent antivenom. The antivenom is
prepared by Razi Vaccine and Serum Research Institute in
Karaj, Iran, through injecting the horses with a pool of
venoms collected from six different scorpions including:
A. crassicauda, H. saulcyi, H. schach, O. doriae, M. eupeus and
H. lepturus. This antivenom is usually presented in the vials
of 5 ml.
2.5. Statistics
Data in the completed questionnaires were analyzed by
EPI-info2007 research statistical software (www.cdc.gov/
epiinfo).
3. Results
The 12,150 questionnaires related to the cases of
reported scorpionism were collected during 2003 (Fig. 1).
The accidents were reported from six cities located in
different parts of the province, which were selected by
stratified cluster random sampling method (Fig. 2). The
percentage of reported cases was as follows: Masjed-Soleiman (Bistodo-e-Bahman hospital) 27.1%, Ramhormoz
(Imam Khomeini hospital) 26.6%, Izeh (Shohada and Hefdah-e-Shahrivar hospitals) 15.4%, Shush (Nezamafi
hospital) 12.0%, and Baghmalek (Tabatabaee hospital)
11.7%. It is estimated that the prevalence rate of scorpion
envenomation in Khuzestan province is 3.1 cases/1000
inhabitants per year.
It is notable that the accidents were occurred yearround. However, about 90% of the accidents took place in
the warmest months of the year (April–October). While,
although scarce, there were cases (2.5%) that detected even
during the seasons in which scorpion activity is lower
(December-March).
There were no significant differences between sexes of
envenomated individuals (52.3% female; 47.7% male). The
highest incidence rate of the scorpion stings fell in the
group aged 6–45 years, which was significantly different
(P < 0.05) from those recorded for the other age groups.
Housewives and students were under high risk for envenomation (63.3%) than those of farmers and workers (9.4%).
On admission to hospital, identification of scorpion species
was difficult by the information provided via the patients
and or their guardians, however, a description of the scorpion’s color was obtained in 6209 (53.3%) cases as yellow
and 2025 (17.4%) cases as black.
About 91.5% of the individuals stung were occurred
indoor, which may be in accordance with the synanthropic
behavior of these scorpions in the region. The frequency of
stings in feet and legs (37.3%), hands and arms (39.3%) was
clearly different from those in bodies (16.8%) and head and
necks (6.5%). Most stings were happened during the night
(6 p.m.–6 a.m.) which is in accordance with the nocturnal
behaviors of scorpions involved.
Clinical signs and/or symptoms were reported in 44.8%
of the accidents. Local symptoms were more frequent than
systemic. The signs which more frequently reported were
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D. Shahbazzadeh et al. / Toxicon 53 (2009) 454–459
Time elapsed between stings and admission at emergency unit (hour):
<3
3-6
>6
Site of sting: Hand
Foot
Body
Head & Neck
Place of sting:
Inside building
Outside building
Time of sting (in 24 hours period):
0-6
6-12
12-18
18-24
Previous sting(s):
Scorpion
Snake
Colour:
Black
Yellow
Unknown
Local name: Tosan (Mesobuthus eupus)
Goadim (Hemiscorpius lepturus)
Other
Asymptomatic
Symptomatic
Pain
Edema
Vomiting
Hyperthermia
Sweating
Spasmic
Semi-consciousness
Necrosis
Tachycardia
Restlessness
Other (specify):_____________
Hemoglobinuria test
IDP*(specify)
Antiserum
therapy
Positive
Previous receipt:
Yes
No
Skin test:
+
Route of injection:
I.V.
I.M.
Amount of Injection:
1-5 ml
> 5 ml
Sensitiveness:
Allergy
Shock
Other
Treatment
Negative
1st test (at admission):
2nd test(after 6 hours):
3rd test (after 12 hours):
4th test (after 24 hours):
Antihistamin
Coricosteroid
non-Narcotic-analgesic
Antibiotic
Other (specify): _____________________________________________
________________________________________________________________
Conclusion
Clinical
data
Scorpion
data
Condition of
sting
General
information
City:_________ Hospital: ____________ Date: ____________ Serial No.: ______
Last name:______________________ First name: ___________________
Sex:
M
F
Age:
Weight:
Occupation: ____________________
Home Address:___________________________________________________
Phone: ______________________________
Discharged
hospitalized
Death
Comments: ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Name and sign of physician: ___________________________Date:_________
*Intensive degree of positive (IDP): 1. (1+) 2. (2+) 3. (3+) 4. (4+)
Fig. 1. Questionnaire sample for the epidemiological survey of scorpion envenomation in Khuzestan province of Iran.
pain (63.3%), and edema (10.1%). Neurological symptoms
like spasm (0.3%) were also observed, while central
symptoms like hyperthermia (0.5%), sweating (0.4%),
vomiting (1.3%), restlessness (0.6%) were less frequently
reported. Other reported symptoms such as tachycardia,
semi-consciousness, and local necrosis (0.1%) were also
observed.
All patients were received medical treatments several
hours after the sting. As depicted in Table 1, the history of
previous treatment with antivenom was given by 997
(9.0%) cases. Most patients (64.0%) received the antivenom
within 3 h after sting, reaching 77.5% up to 6 h, and the
remaining 2647 (22.5%) patients were treated by antivenom after 6 h. About 97.6% of total patients were
administered antivenom via intramuscular injection.
However, a total of 4074 cases did not receive antivenom.
Allergic reactions to antivenom, in the form of skin rash,
were observed in 0.4% of cases and anaphylaxis shock (due
to the horse origin antibodies in serum) occurred in just
three cases. Most patients received 1–5 ml of antivenom;
however, the dose was increased 2–3 folds according to the
clinical presentation in 339 (4.4%) cases. Hemoglobinuria
was observed in 1763 (14.5%), in which 145 (8.2%) cases
showed positive result even after 24 h. The intensive
degree of hemoglobinuria was reported in 1193 envenomed patients, among those 15 cases were with high
degree of hemoglobinuria.
During the study period, three patients reported dead
after being stung by scorpions. Two cases in Izeh city; one,
a 13-year-old girl envenomed by H. lepturus at 2 a.m., with
local necrosis in hand, and 3þ intensive degree hemoglobinuria. She received scorpion antivenom and blood
transfusion, then for further treatment dispatched to the
capital hospital and died at 2 p.m. due to the heart failure
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D. Shahbazzadeh et al. / Toxicon 53 (2009) 454–459
occurred in Masjed-Soleiman which was a 3-year-old boy,
who stung by unknown black scorpion at 2:30 a.m., in the
neck, transferred to the hospital and in spite of receiving
medical cares and scorpion antivenom died due to the
respiratory failure at 6 a.m.
2
4. Discussion
3
1
4
IRAQ
5
Ahvaz
6
Persian Gulf
Fig. 2. Study areas in Khuzestan province of Iran: (1) Shush, (2) MasjedSoleiman, (3) Izeh, (4) Baghmalek, (5) Ramhormoz, and (6) Behbahan.
before arriving to the hospital. The second case, was a 75year-old woman who was stung by unknown scorpion
sting with local necrosis in groin (most probably due to
H. lepturus), with 4þ intensive degree of hemoglobinuria,
received scorpion antivenom and blood transfusion, died
after 3 days of hospitalization due to hematuria. One death
Table 1
Frequency of the patients’ records based on different variables encountered in the designed questionnaire completed in study areas of Khuzestan province.
No.
%
Antiserum receipt
Antiserum previous receipt
Antiserum allergy
7782
997
28
64.0
9.0
0.4
Elapsed time between sting and receive antiserum
<3 h
3–6 h
>6 h
7693
1417
2647
65.4
12.1
22.5
Route of injection
I.M.
I.V.
7598
184
97.6
2.4
Amount of injection
1–5 c.c.
>5 c.c.
Skin reaction
Shock
7356
339
13
3
95.6
4.4
0.2
–
Hemoglobinuria
1st test (6 h)
2nd test (12 h)
3rd test (24 h)
1276
342
145
72.4
19.4
8.2
718
273
187
15
60.2
22.9
15.7
1.3
Intensive degree of hemoglobinuria
1þ
2þ
3þ
4þ
457
Scorpion envenomation is a major public health
problem in developing countries especially in tropical and
subtropical regions (Mahadevan, 2000; Osnaya-Romero
et al., 2001; Ozkan et al., 2006; Radmanesh, 1990a,b, 1998;
Mazzei de Davila et al., 1997; Ghalim et al., 2000). In
southern regions of Iran, especially in Khuzestan province,
as in numerous tropical countries, envenomation by scorpion stings is a major public health problem. Khuzestan
province, neighboring with Iraq in west and Persian Gulf in
south has mild winters, with average January temperatures
ranging from 7 C to 18 C (45 F–64 F), very humid and hot
in summer, with temperature exceeding 48 C (119 F)
during July in the interior areas.
The study of scorpion fauna in Khuzestan indicates that
there are at least 12 scorpion species in Khuzestan from
which 10 species belong to Buthidae family, one to Scorpionidae and one species to Liochelidae (Prendini, 1802;
Vachon, 1966; Farzanpay, 1987; Sissom, 1998; Fet et al.,
2000). Buthidae scorpions in Khuzestan province include:
A crassicauda, Apistobuthus petrygocercus, Hottentotta leptochelys, H saulcyi, H schach, Compsobuthus mattheinsseni,
M. eupeus, O. odonturus, Orthochirus scrobiculosus and
Razianus zarudnyi (Akbari et al., 1997). There is also Scorpio
maurus from Scorpionidae, and H. lepturus, previously
included in the family Scorpionidae (Lourenco, 2001),
which has recently been re-classified into the family Liochlidae (Solegland and Fet, 2003). The black scorpions
(A. crassicauda and H. schach) and the yellow scorpions
(M. eupeus, H. saulcyi, O. doriae and H. lepturus) are the most
dangerous scorpions in Iran and are responsible for the
majority of stings in Khuzestan province (Akbari et al.,
1997; Radmanesh, 1990a, 1998; Mirdehghan and Motlagh,
2001).
To our knowledge the current study is the first epidemiological survey that covers the whole province. In this
present year-round clinical survey in 2003, a number of
12,150 scorpions stung patients, were cross-sectionally
studied by stratified cluster random sampling method. The
designed questionnaire distributed in the province which
was completed by the physicians in the Emergency Unit of
each designated hospitals within the cities located in the
cluster which are known for their high percentage of
scorpionisms reported in the province. The cities of Shush,
Masjed-Soleiman, Izeh, Baghmalek, Ramhormoz, and
Behbahan in Khuzestan province were selected as clusters.
Based on the previous epidemiological data available in
this province, the total of 36,463 scorpion sting cases (April
1990–July 1996) were referred to Abuzar hospital in Ahvaz,
with a mean of 5100 stings per year and totally 61 deaths
(Radmanesh, 1998). In other report, 26,397 patients have
been recorded with 32 deaths during a 5-year period from
1993 to 1997 (Pipelzadeh et al., 2007). Also, Mirdehghan
and Motlagh (2001) reported 28,296 scorpionism during
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D. Shahbazzadeh et al. / Toxicon 53 (2009) 454–459
1995–2000, in which 11,318 (40%) were children, 1316 cases
were hospitalized and 62 died. These studies were performed by using the collected data from one or two major
referral hospitals of Abuzar and Golestan in city of Ahvaz,
the capital of Khuzestan province.
Our finding confirms the morbidity rate in published
data; however, the mortality was less than those reported
in the previous works. This might be due to the improved
efficacy of the local antivenom, and regional education
programs carried out by local health clinics in both rural
and urban areas.
Scorpion stings mostly occurred indoors (7074 cases),
from which 38% were recorded in housewives and 30% in
school students with the age groups of 6–20 (36%), and 21–
45 (42%). About 55% of the patients had no clinical signs,
but the rest showed local signs and symptoms. The most
frequent symptom of scorpion envenomation was pain
(63%), edema (10%), and restlessness (1%). The signs and
symptoms in this study which are in local and systemic
levels are in accordance with other Buthidae scorpion
envenomations (Dehesa-Davila and Possani, 1994; FreireMaia, 1990; Freire-Maia and Campos, 1987; Freire-Maia
et al., 1994; Mazzei de Davila et al., 1997). It can also be
pointed out that our data show that there were no significant differences between sexes across all age groups in
Khuzestan province, which is in agreement with the other
report (Pipelzadeh et al., 2007). Feet and hands accounted
for 76% of the stings, a frequency not very different from
those reported by other authors worldwide (de Roodt et al.,
2003; Chowell et al., 2006; Ozkan et al., 2006).
The type of scorpion species responsible for the stings in
Khuzestan province is unclear, and this is due to the lack of
knowledge of physicians on the type of the scorpion, and
unavailability of scorpions in most accidents. The most
venomous of all types of scorpions in the region is H. lepturus which is categorized as yellow scorpion that
contributes to 10–12% of morbidity and 95% of all mortalities in scorpion stung patients (Mirdehghan and Motlagh,
2001; Radmanesh, 1990a, 1998; Pipelzadeh et al., 2007).
This scorpion can induce severe hemolysis and gross
hematuria in children from a few hours to 6 days after
sting, and results in renal failure development following
hemolysis (Radmanesh, 1990a), and another report from
Iran shows that the venom of H. lepturus produced hemolysis of red blood cells in a concentration-dependent and
duration-of-exposure manner, with 100% of hemolysis
produced after 24 h following exposure to 40 mg/ml of
venom (Pipelzadeh et al., 2006). In our study, local necrosis
was reported in 7 cases out of 4485 patients with clinical
symptoms due to the sting of H. lepturus. It seems that by
local necrosis appearing in the patients stung by H. lepturus,
the systemic dysfunction begins and results in renal failure,
which is discussed by other authors. Radmanesh (1990a,b)
showed that renal toxicity is one of the serious systemic
effects of H. lepturus which, if not treated early by administration of polyvalent antivenom or other medical treatments, can progress to severe renal and cardio-respiratory
failures. Mirdehghan and Motlagh (2001) also shown that
out of 28,296 cases of scorpion stings in Khuzestan province during 5 years, 11,318 patients were children in which
1316 have been hospitalized due to hemoglobinuria and
needed renal dialysis. In the present study 1763 patients
showed hemoglobinuria, from these 187 cases with 3þ, and
15 cases with 4þ intensive degrees were present, and it can
be the result of H. lepturus sting. One female patient
(75 years old) died with hematuria stung with unspecified
yellow scorpion, most probably due to H. lepturus, the only
scorpion which causes renal failure and hematuria. Based
on our knowledge, Buthidae scorpions cannot induce renal
failure. It is not known how H. lepturus venom causes
hemolysis, whether by cell wall damage or by disturbance
of different enzyme systems (Radmanesh, 1990a).
According to the present study most physicians in
Khuzestan province prescribe the following treatments for
scorpion envenomed patients: antihistamines 4962
(43.8%), corticosteroids 4612 (40.8%), antibiotics 555 (4.9%),
and non-narcotic analgesics 634 (5.6%). Our data show that
64% patients received a dose equaling to 1–5 ml serum of
antivenom and 2.8% received more than 5 ml, from which
only 0.5% of the patients showed allergic reaction, indicating the efficacy of the antivenom and its selection as the
best choice for treatment of the scorpion stings. However,
how it covers all features leading to the failure of treatment
and rare death of the patients are not clear and cannot be
verified based on our current knowledge. It is clear that the
current treatment protocol needs to be modified and
doctors advised to use antivenom only by intravenous
route, in the future.
In conclusion, this study shows that scorpion envenomation in Khuzestan province of Iran is a real public health
problem especially in summer times and in the rural areas.
The treatment consists of a combination of symptomatic
conventional protocols and antivenom therapy. Due to the
presence and involving of more than one scorpion species
in the stings in each study in cluster areas of Khuzestan
province, the quantification of venom antigens in body
fluids of stung patients, by the development of immunoassay methods, is a crucial matter to evaluate the severity
of envenomation by scorpions. Based on the previous
studies, it is possible to identify the type of scorpion venom
in the sera of stung patients in each area by developing
a specific immunoenzyme assay kit (Krifi et al., 1998;
Ghalim et al., 2000).
The outcoming results of this study could be useful for
other similar geographical and zoological areas within Iran
and neighboring countries that have common fauna of
scorpions in this region. Furthermore, this data may be
applied in joint collaborative studies on scorpions of
Eastern Mediterranean regions.
Acknowledgements
This research was supported by the project No. 183 of
Institute Pasteur of Iran. We thank Dr. M. Moghisi and Dr. N.
Ajang, Center for Diseases Management and Control
(CDMC), Ministry of Health and Medical Education, Iran for
useful consultancies and to Dr. M. H. Modarresi, Director,
Pasteur Institute of Iran for his continuous support.
Conflict of interest
The authors have no conflict of interest to disclose.
Author's personal copy
D. Shahbazzadeh et al. / Toxicon 53 (2009) 454–459
References
Akbari, A., Tabatabei, S.M., Hedayat, A., Modir Roosta, H., Alizadeh, M.H.,
Kamalzare, M., 1997. A study of the geographical distribution of the
scorpions in the south of Iran. Pajouhesh va Sazandegi 34, 112–115
(in Persian).
Bucherl, W., 1971. Classification, biology and venom extraction of scorpions.
In: Bucherl, W., Buckley, E. (Eds.), Venomous Animals and Their Venoms.
Venomous Invertebrates, vol. III. Academic Press, New York, pp. 317–347.
Chowell, G., Diaz-Duenas, P., Bustos-Saldana, R., Aleman Mireles, A., Fet, V.,
2006. Epidemiological and clinical characteristics of scorpionism in
Colombia, Mexico (2000–2001). Toxicon 47, 753–758.
Dehesa-Davila, M., Possani, L.D., 1994. Scorpionism and serotherapy in
Mexico. Toxicon 32, 1015–1018.
Farzanpay, R., 1987. Identification of Scorpions, first ed. Tehran University
Press, 189 pp. (in Persian).
Fet, V., Sisson, W.D., Lowe, G., Braunwalder, M.E., 2000. Catalog of the
Scorpions of the World (1758–1998). The New York Entomological
Society, New York, NY.
Freire-Maia, L., 1990. Pharmacology of Tityus serrulatus scorpion venom.
Mem. Inst. Butantan 52, 51–57.
Freire-Maia, L., Campos, J.A., 1987. On the treatment of the cardiovascular
manifestations of scorpion envenomation. Toxicon 25, 125–130.
Freire-Maia, L., Campos, J.A., Amaral, C.F.S., 1994. Approaches to the
treatment of scorpion envenoming. Toxicon 32, 1009–1014.
Ghalim, N., El-Hafny, B., Sebti, F., Heikel, J., Lazar, N., Moustanir, R.,
Benslimane, A., 2000. Scorpion envenomation and serotherapy in
Morocco. Am. J. Trop. Med. Hyg 62, 277–283.
Krifi, M.N., Kharrat, H., Zghal, K., Abdouli, M., Abroug, F., Bouchoucha, S.,
Dellagi, K., El Ayeb, M., 1998. Development of an ELISA for the
detection of scorpion venoms in sera of humans envenomed by
Androctonus australis garzonii (AAG) and Buthus occitanus tunetanus
(BOT): correlation with clinical severity of envenoming in Tunisia.
Toxicon 36, 887–900.
Latifi, M., Tabatabai, M., 1979. Immunological studies on Iranian scorpion
venom and antiserum. Toxicon 17, 617–621.
Lourenco, W.R., 2001. The scorpions families and their geographical
distribution. J. Venom. Anim. Toxin 7 (1), 3–23.
Mahadevan, S., 2000. Scorpion sting. Indian Pediatrics 37 (5), 504–514.
459
Mazzei de Davila, C.A., Parra, M., Feunmayor, A., Salgar, N., González, Z.,
Davila, D.F., 1997. Scorpion envenomation in Merida, Venezuela.
Toxicon 35, 1459–1462.
Mirdehghan, M.M., Motlagh, M.I., 2001. Scorpion stings survey (including:
residence, sex and age) and treatment strategy in Abuzar hospitalAhvaz, Khuzestan during 1994–1999, Iran. J. Trop. Med. Hyg. 14 (6),
62–64 (in Persian).
Osnaya-Romero, N., Medina-Hernandez, T.J., Flores- Hernandez, S.S.,
Leon-Rojas, G., 2001. Clinical symptoms observed in children envenomated by scorpion stings, at the children’s hospital from the State
of Morelos, Mexico. Toxicon 39 (6), 781–785.
Ozkan, O., Adiguzel, S., Yakistiran, S., Cesartli, Y., Orman, M., Zafer
Karaer, K., 2006. Androctonus crassicauda (Olivier 1807) scorpionism
in the Sanliurfa provinces of Turkey. Turkiye. Parazitol. Derg. 30 (3),
239–245.
Pipelzadeh, M.H., Dezfulian, A.R., Taha Jalali, M., Mansouri, A.K., 2006. In
vitro and in vivo studies on some toxic effects of the venom from
Hemiscorpius lepturus scorpion. Toxicon 48, 93–103.
Pipelzadeh, M.H., Jalali, A., Taraz, M., Pourabbas, R., Zaremirakabadi, A.,
2007. An epidemiological and a clinical study on scorpionism by the
Iranian scorpion Hemiscorpius lepturus. Toxicon 50, 984–992.
Prendini, L., 1802. Phylogeny and classification of the superfamily Scorpionidea latreille (Chelicerata, Scorpioes): an exemplar approach.
Cladistics 16, 1–78.
de Roodt, A.R., Garcia, S.I., Salomon, O.D., Segre, L., Dolab, J.A., Funes, R.F.,
de Titto, E.H., 2003. Epidemiological and clinical aspects of scorpionism by Tityus trivittatus in Argentina. Toxicon 41, 971–977.
Radmanesh, M., 1990a. Clinical study of Hemiscorpion lepturus in Iran.
J. Trop. Med. Hyg. 93 (5), 327–332.
Radmanesh, M., 1990b. Androctonus crassicauda sting and its clinical study
in Iran. J. Trop. Med. Hyg. 93 (5), 323–326.
Radmanesh, M., 1998. Cutaneous manifestations of the Hemiscorpius
lepturus sting: a clinical study. Int. J. Dermatol. 37 (7), 500–507.
Sissom, W.D., 1998. Redescription of Compsobuthus matthiensseni (scorpions, Buthidae) from southwestern Asia. J. Arachnol. 26, 1–8.
Solegland, M.B., Fet, V., 2003. High-level systematics and phylogeny of the
extant scorpions (Scorpions: Orthosterni). Buscorpions 11, 57–75.
Vachon, M., 1966. List of scorpions known in Egypt, Arabia, Israel, Libya,
Syria, Jordan, Turkey, Iraq, Iran. Toxicon 4 (3), 209–218.