PKISSN 0006 – 3096 (Print)
ISSN 2313 – 206X (On-line)
BIOLOGIA (PAKISTAN)
December, 2015, 61 (2), 279-285
First report of Scorpion Envenomization in District Sargodha, Punjab, Pakistan
MUHAMMAD MOHSIN AHSAN, *HAFIZ MUHAMMAD TAHIR & JAFAR AQEEL NAQI
Department of Zoology, University of Sargodha, Sargodha, Pakistan.
ABSTRACT
Scorpion envenomization is a worldwide problem and causes a broad range of clinical manifestations.
Present study was planned to record the epidemiology of scorpion bites in urban and rural areas of District
Sargodha, Punjab, Pakistan. Data were collected during February, 2013 to March, 2015. Information, such
as age of victim, gender, stinging time, stinging sites in the body, symptoms after scorpion sting, number of
victims receiving treatment and number of deaths (if any) was recorded. Results of the study revealed that
scorpion envenomization is common in the age groups ranging from 16 - 45 years. Female victims (52%)
were slightly more than males (48%). Most (57.39%) of the incidents of scorpion bites occurred between 7
PM and 2 AM. On the body of the studied victims, hands (41.10%) and feet (48.28%) were more prone to
scorpion stings. Scorpion sting cases were higher (77%) in rural areas than in urban (23%) areas. The
common symptoms recorded after scorpion bites included pain, restlessness, hypertension, sweating,
tachycardia, vomiting or nausea, pallor, dehydration, semi-consciousness, face shock and allergy. Only
56.05% of the total victims received treatment either from the doctors or traditional healers. Scorpion
envenomization was found to be positively correlated with high temperature, humidity and rain fall. These
environmental conditions are predicted to be conducive for population growth of scorpions and their
abundance.
Key words: scorpions, envenomization, stings, scorpionism.
INTRODUCTION
Scorpions are the most venomous
arachnids (Gomes et al., 2010). There are
approximately 2000 described species of scorpions
(Rein, 2012) including 50 species that are
dangerous due to their neurotoxic venoms (Chowel
et al., 2006; Shirmardi et al., 2010). Scorpion bites
cause high lethality throughout the world, especially
in tropical and sub-tropical countries (Bawaskar &
Bawaskar, 2012; Kassiri et al., 2012; Rafizadeh et
al., 2013). More than one million scorpion stings and
approximately 3250 deaths have been reported
worldwide in one year (Ozkan et al., 2006). Risk of
scorpion bite is more in semi-desert areas due to
high scorpion population (Dehghani & Fathi, 2012).
Scorpion sting is universally characterized by
severe pain, with or without local tissue damage;
severity is also dependent on the scorpion species
that introduce the neurotoxic venom into the victim
(Luca & Meier, 1995). Symptoms of scorpion bite
also depend upon the amount of venom that is
delivered by scorpion, size and age of the victims
and the season in which scorpion bites (Gueron &
Yaron, 1970).
Most of the incidents of scorpion bites
occur at night due to their nocturnal feeding habit.
Mostly the victims do not require hospitalization or
extensive medical care (Otero et al., 2004, Forrester
& Stanely, 2004). Climatic conditions, such as
*Corresponding author: [email protected]
humidity, heat and dryness are the risk factors of
scorpion bites (Chowell et al., 2005). At present,
epidemiology of scorpion bites is poorly studied in
the world (Ismial, 1995).
Scorpion envenomization is a real threat to
humans in many parts of the world, but fragmented
studies have been conducted in countries like
Tunisia (Goyffon et al., 1982), Iran (Radmanesh,
1990), Morocco (Touloun et al., 2001), Brazil
(Lourenço & Cuellar, 1995) and Mexico (Velascocastegon, 1976). In tropical and subtropical
countries incidents of scorpion sting are more
common compared to other part of the world and
lethality is higher in children than in adults (Ismial,
1995).
Although scorpion bites are common in
Pakistan, especially in dry and sandy areas, so far
no recorded data on scorpion bites (published or
unpublished) are available. Most victims do not seek
proper medical treatment and rely mostly on
spiritual treatment from holy persons or contact
traditional healers. In view of the above facts, the
present study was designed to provide first
documentary record of specific epidemiological
aspects of scorpionism in District Sargodha,Punjab,
Pakistan.
MATERIALS AND METHODS
The
Sargodha,
study was conducted in District
(Latitude
32.05°; Longitude
280
M. M. AHSAN ET AL
72.67°; Elevation, 187 m) Punjab, Pakistan.
Epidemiological survey for scorpion stings was
conducted from February, 2013 to March, 2015.
During the survey data were collected from rural
health centers, rural dispensaries and directly from
the victims. For the data collection, Sargodha city
and 14 nearby villages (i.e., Bhagtanwala (Chowki
bhagat), Chak # 34 SB, Chak # 76 SB, Mateela,
Chak # 58 SB, Chak # 48 NB, Chak # 81 SB, Chak
# 75 SB, Dodha, Chak # 88 SB, Chak # 46 SB,
Mangnee, Chak # 69SB and Chak # 40SB) were
randomly selected. Victims were divided into four
age categories, i.e., category I (1 - 15 years),
category II (16 - 30 years), category III (31 - 45
years) and category IV (46 and above). A
questionnaire was prepared to record the
information regarding the age of victim, gender,
stinging time, stinging location on the body,
symptoms after scorpion sting (i.e., severity of pain,
vomiting, allergy, skin colour change, restlessness,
tachycardia, dehydration and hypertension), number
of victims who received treatments, number of
deaths (if any) and the month of scorpion sting.
Histograms of the collected data were prepared
using MS-Excel (2003). Chi-square test and
Pearson’s correlation was performed to analyse the
collected data and Minitab (version14) was used for
the statistical analyses.
BIOLOGIA (PAKISTAN)
healed without any treatment. No case of death was
recoded during the study period due to scorpion
bites. Incidence of scorpion stings was higher
between the months of May to September (Fig., 7).
Only few cases of scorpion stings were recoded
from October to March. Number of scorpion bites
were positively correlated with the prevailing air
temperature (Pearson’s correlation = 0.77; P =
0.003), rainfall (Pearson’s correlation = 0.75; P =
0.005) and relative humidity (Pearson’s correlation =
0.72; P = 0.003).
Fig., 1: Number of males and female victims
recorded from February, 2013 to March, 2015.
Note: Similar alphabets on the bars are indicating
non-significant difference
RESULTS
In total, data of 669 victims were collected
during the study period of 26 months. Of the total
victims, 322 (48%) were male and 347(52%) were
female (Fig., 1). Figure 2 depicts that most of the
victims were in the age range of 16 - 45 years. It is
evident from Figure 3 that most of the scorpion sting
(57.39%) incidents occurred from 7 PM to 2 AM. It
was also recorded during the study that most of the
people suffered from scorpion bites on hands
(41.10%) and feet (48.28%) (Fig., 4), while other
parts of their body were less prone to scorpion bites
(10.46%). People of rural areas were more affected
from scorpion bites (77%) than those inhabiting
urban areas (23%) (Fig., 5).
All victims reported pain after scorpion sting
that ranged from mild to severe (Fig., 6). Other
common symptoms were restlessness (37.81%),
hypertension
(26.30%),
sweating
(21.22%),
tachycardia (18.83%), vomiting or nausea (17.63%),
pallor (15.24%), dehydration (15.09%), semiconsciousness (11.21%), face shock (10.31%) and
allergy (9.26%), Out of the total victims, 56.05%
contacted the doctors or traditional healers for the
treatment. However, the remaining (43.94%) got
Fig., 2: Incidences of scorpion’s envenomization
among different age groups.
Note: Different alphabets on the bars are indicating
significant difference.
DISCUSSION
Scorpion envenomization is a serious but
neglected issue in many parts of the world
particularly in the Middle East, Africa, Mexico, South
America and the Indian sub-continent (WHO, 2007).
Exact information about scorpion envenomization is
poor because most of the victims do not seek
medical treatment, however, millions of people face
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SCORPION ENVENOMIZATION IN DISTRICT SARGODHA
Fig., 3: Scorpions biting during different time periods.
Note: Different alphabets on the bars are indicating significant difference.
Fig., 4: Human body parts vulnerable to scorpion bites.
Note: Different alphabets on the bars are indicating significant difference.
Fig., 5: Comparison of scorpion envenomization in urban and rural areas.
Note: Different alphabets on the bars are indicating significant difference.
281
282
M. M. AHSAN ET AL
BIOLOGIA (PAKISTAN)
Fig., 6: Profile of common symptoms in patients after scorpion bite(s).
Fig., 7: Seasonal dynamics of scorpion envenomization (February 2013 to March 2015).
scorpion sting every year. Approximately 250,000
victims face scorpion sting in Mexico annually.
About 400,000 victims are reported in Tunisia
annually, with 1000 admissions in hospitals and 100
deaths every year. Likewise, high numbers of
scorpion sting accidents are reported each year
from other part of the world including the Middle
East, Latin America, and the Indian subcontinent
(WHO, 2007).
Our results showed gender based
difference in frequency of scorpion bites. Females
encountered scorpion bites more frequently (52%)
than males (48%). In rural areas of district
Sargodha, females are at greater risk of scorpion
stings as they are more exposed as compared to
the males while working in the fields. Results are in
accordance with the findings of Karami et al. (2013)
and Vazirianzadeh et al. (2008). They also reported
higher incidents of scorpion stings in females. But
our results are contradictory to the findings of Alsadoon and Jarrar (2003) and Jarrar and Al-rowaily,
(2008). They worked in Saudi Arabia and reported
that the victims of scorpion bites were more males
than females. Higher incidents of scorpion bites
reported among females in rural areas during our
study might be due to their more involvement in
indoors domestic activities. Our results of greater
rates of scorpion bites among the people in the age
ranging between 16 - 45 years, is in accordance to
conclusion of Karami et al. (2013), Dehghani et al.
(2010), Emam et al. (2008) and Ghaderi et al.
(2006). These workers had also reported that most
of victims of scorpion bites were more than 15 years
old.
Our study showed that most of scorpion
stings were on hands (41.10%) and feet (48.28%).
This finding was not unusual as feet and hands are
the body parts which are more exposed than the
rest of the body and are mostly used in activities.
Results of our study are in agreement with findings
of many other researchers (Kassiri et al., 2014,
Isbister et al., 2003, Ozkan et al., 2006). These
authors also reported more scorpion bites on hand
and foot areas.
The frequency of scorpion stings showed
that most of the victims (77%) were from rural
areas. This might be due to the reason that the
scorpion genus Mesobuthus dominates in the area
VOL. 61 (2)
SCORPION ENVENOMIZATION IN DISTRICT SARGODHA
(unpublished data) and is perhaps more involved in
biting humans. The most preferable habitats of
scorpions are wood logs, rocks, stone cracks, or in
burrows dug beneath the loose layer of substrates
(Polis, 1990). Similarly, cracks or crevices of old
muddy houses in rural areas are also favourable
habitat for scorpion of the genus Mesobuthus. Our
results are in agreement with those of Pourrezai et
al. (2010) and Karami et al. (2013); however, the
results of Vazirianzadeh et al. (2008) are
contradictory to our results as these authors had
reported that scorpion envenomization is an urban
problem in Khuzestan, Iran. This could be due to the
type of scorpion species perhaps inhabiting
primarily urban settings.
No death was recorded during the present
study due to scorpion bite before or after the bite
and subsequent treatment. Similar results were
reported by Vaziriznzadeh et al. (2012) and Kassiri
et al. (2012) in the scorpion bite victims in
Khuzistan, Iran, but Karami et al. (2013) reported
seven death cases due to scorpion bites in
Ramhormoz, South-West of Iran. Similarly, about 10
deaths occur in Tunisia every year due to scorpion
bites (Abroug et al., 1999, Bahloul et al., 2004).
These results are contradictory to present study and
the reasons for this could be species difference of
biting scorpions, age of victims, body size of victims,
and time of the year of scorpion bite in the particular
area where deaths occurred. In present study
different types of symptoms, such as
pain,
vomiting, allergy, pallor, restlessness, dehydration,
and cardiovascular effects like tachycardia, and
hypertension were observed among the patients of
scorpion bites Bawaskar and Bawaskar, (2012),
Bahloul et al. (2010), Ismial, (1995) and Khattabi et
al. (2011) also reported similar symptoms among
patients of scorpion bites in their studies.
Although 56.05% of the total victims
received medical treatment from the local hospitals
or dispensaries, no specific treatment for scorpion
bites was available for the patients in the study
area. Some types of anti-inflammatory (Pheniramine
maleate,
Dexamethasone)
and
analgesic
(Paracetamol) drugs were administered to victims
as first aid. In a similar study in Morocco, Touloun et
al. (2001) reported that only 28% of the total victims
were treated with modern medicines alone. They
further elaborated that most of the patients were
treated exclusively with the traditional medicines
and 7% victims did not received any treatment.
In the present study, most incidences of
scorpion bites were observed during warmer
months, i.e., May to September. Similar results were
283
noted by Cesaretli and Ozkan, (2010), Chowell et al.
(2005), Kassiri et al. (2012), Kassiri et al. (2013),
Ozkan and Kat, (2005), Ozkan et al. (2006).
Scorpions remain active during summer season
under high relative humidity and air temperature
(Kassiri et al., 2013). Furthermore, populations of
scorpions were also higher during these months
which might be the possible explanation of higher
scorpion stung in these months.
Conclusions
It is concluded from this study that scorpion
envenomization is a common problem in the study
area. Although no death related to scorpion bite was
recorded, scorpion sting is highly painful and can
cause a variety of clinical manifestations that may
lead to serious complications. It is, therefore,
suggested that detailed survey of scorpion
envenomization should be conducted. Furthermore,
scorpion bite awareness programmes from preschool to higher level, especially in rural areas be
introduced to minimize the cases of scorpion bites.
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