J Arthropod-Borne Dis, December 2018, 12(4): 325–333 R Dehghani et al.: A Review on … 325 http://jad.tums.ac.ir Published Online: December 25, 2018 Review Article A Review on Scorpionism in Iran *Rouhullah Dehghani 1, Esmail Charkhloo 2, Nedasadat Seyyedi-Bidgoli 1, Elahe Chimehi 1, Maedeh Ghavami-Ghameshlo 1 1Social Determinants Research Center of Health and Engineering Department of Environmental Health, Medical Science University of Kashan, Kashan, Iran 2Department of Environment Health Engineering, Faculty of Health, Jiroft University of Medical Sciences, Jiroft, Iran (Received 17 Dec 2017; accepted 15 Oct 2018) Abstract Background: Scorpions are one of the most important venomous animals in Iran. Their sting has more prevalence in the south and southwest areas. The aim of this study was to introduce their sting agent species in the country. Methods: Data were extracted by a mini review on scorpion stinging articles in Iran until early 2018 and then the sting agent species in each area were studied. Geographical and provincial distribution of each species also was provided. Results: Twelve scorpion species are causative agents of sting. According to their deadly rate and clinical symptoms, some of them are considered the most dangerous venomous animals in Iran. Some death cases have been reported be- cause of the sting of 3 species of Hemiscorpius lepturus, H. acanthocercus and Androctonus crassicauda. Remaining species have not deadly sting but because of their frequency, they encounter the individuals and cause the stinging. Conclusion: The highest number of sting agents is in Khuzestan, however Gilan and Mazandaran have the lowest fre- quency. Because of the high prevalence of sting agent species in that province, the necessity of providing control and prevention programs is very important. Keywords: Province, Sting agent, Scorpion, Iran Introduction Scorpion stinging has been reported in most of the warm areas of the world. These animals belong to the Arthropoda. Scorpion’s geographic distribution is all over the world and the latitude between equator North 50 degree and south 52 degree (1) but even in this geographic area, they have different distribution. These animals have been seen in many habitats and are able to live in very tough conditions. They use the least en- ergy (2). They sting in order to defend and feed. They are opportunist in terms of selecting their habitat and using any natural and artificial or human-made spaces and gaps for hiding and habitat (3, 4). Some of them are nest makers and diggers. They make nests in the soil with smother soil pattern and proper physical struc- ture (5-7). Some species of these animals have adapted their activity inside or around the hu- man residential areas and for this reason their probable encounter with humans has increased. Therefore, in these cases, sting threat is more in comparison with active species which are out of and farther from the human residential places (8-11). In Iran, the species which sting humans are more opportunist in terms of habitat se- lection. They use ready spaces and gaps pro- vided in the buildings because of using tradi- tional building materials. This arthropod starts its activities at night and uses its venomous sting to defend or hunt insects to feed. The hab- itat of most of them is desert and non-residen- tial places (12-14). Since these animals are hunt- ers, like tarantulas, this kind of habitats attract the animals which are these hunters’ food. On the other hand, the scorpion hunters are attract- ed and make a complete food web with differ- ent food chains. Therefore, this kind of plac- *Corresponding author: Dr Rouhullah Dehghani, E- mail: dehghani37@yahoo.com J Arthropod-Borne Dis, December 2018, 12(4): 325–333 R Dehghani et al.: A Review on … 326 http://jad.tums.ac.ir Published Online: December 25, 2018 es, in addition to providing proper shelter and habitat, make their food available (15-17). Scorpions are dangerous for humans be- cause of having toxic and deadly sting and for this reason they are medically important so that according to the available statistics, they have the highest human casualties by venomous ar- thropod in the world (8, 18). Till now, 64 scor- pion species have been reported in Iran (2) but no report is available if they all sting or not. The population frequency of scorpion species in Iran is more than other stinging and biting an- imals like venomous and non-venomous snakes; therefore, their consequence is more stings (19, 20). In Iran, scorpion sting is about 10 times more than snake biting. The highest human fa- talities are caused by venomous arthropods in the world (21-23). Scorpion sting which threat- ens many people to death annually is one of the most important health issues in tropical and sub- tropical areas like Iran. The highest statistics of stings and fatalities belong to Khuzestan and Hormozgan (24-30). Since many species live in Iran but sting of all of them has not been reported, the purpose of this study is introducing the sting agent spe- cies and determining their province distribu- tion during the past 50 years in Iran. Materials and Methods In this review article, keywords like scor- pion, sting agents, dangerous species, provincial distribution, Iran, identification, studies, fami- ly and species were used in the sites related to valid medical and health journals, searching in databases like Web of Science, Ovid, PubMed, Systematic Review, SID, Iran Medex, Scirus, Google Scholar and Medline to have access to the articles during 1977 until early 2018. The including criteria for entry in this study articles were as follows, the first all Iranian articles about animal bites were searched. In the next step, they study focused on venomous animal bites and stings. Then the sting agents among of the scor- pions were noticed, and then all articles of the scorpion sting agents in the past decades till now have been noticed. Overall, 150 sources were found, but only 75 of these considering the pur- pose of the study; i.e., report of the sting agent and concentration of study on Iran, 73 sources were surveyed. In addition to the survey of these studies, their application in Iran was done. Then the gained results were provided in tables, graph and figure. Results Up to now, three scorpion families have been reported in Iran. The sting agent scorpions in Iran include two families of Buthidae and Hemiscor- piidae. They have 12 species from the 8 genus which 10 species belong to Buthidae family and 2 species belong to Hemiscorpiidae family. More than 83.5% of the identified sting agent species in Iran belong to Buthidae family and 16.5% be- long to Hemiscorpiidae family (29, 2, 31, 32, 33). Identification of sting agent species among the scorpions of Iran has been done by different re- searchers especially in the field of medical sci- ences. Still, there are changes in the number of families, genus and species of sting agents in Iran so that in the initial reports of researchers, sting agent scorpions in Iran were introduced to be 3 to 4 species while they are 12 species now (2, 31). According to the last studies about scorpion sting agent species, there are 2 families in Iran: Buthidae and Hemiscorpiidae. The species of Mesobuthus eupeus are in Ar- dabil, Kerman, Isfahan, Markazi, Mazandaran, Sistan and Baluchistan, Yazd, Kohgiluyeh and Boyer-Ahmad, Semnan, Fars, Khuzestan, Hor- mozgan, Golestan, Tehran, Kordistan, Kerman- shah, Ilam, west Azarbaijan, Khorasan Razavi and Khorasan Jonoobi. Then, Compsobuthus matthiesseni in Bushehr, Chaharmahal and Bakhtiari, Fars, Hamadan, Kerman, Kohgiluyeh and Boyer-Ahmad, Kordistan, Lorestan, Marka- zi, Qom, Khuzestan, Hormozgan, Khorasan, Kermanshah, Ilam, west Azarbaijan and Isfahan, Hottentotta saulcyi in Lorestan, Hamadan, Cha- harmahal and Bakhtiari, Khuzestan, west J Arthropod-Borne Dis, December 2018, 12(4): 325–333 R Dehghani et al.: A Review on … 327 http://jad.tums.ac.ir Published Online: December 25, 2018 Azarbaijan, Kermanshah, Hormozgan, Ilam, Sis- tan and Balochistan, Kordestan, Kohgiluyeh and Boyer-Ahmad, Fars, Isfahan, Kerman and Ardabil, Odontobuthus doriae in Hormozgan, Kerman, Yazd, Isfahan, Markazi, Ghazvin, Teh- ran, Alborz, Semnan, west Azerbaijan, Kerman- shah, Busher, Hamedan, Hormozgan, Hemiscor- pius lepturus in Khuzestan, Semnan, Fars, Kor- destan, Hormozgan, Bushehr, Ilam, Lorestan, Kermanshah, Isfahan, Hamedan, Kohgiluyeh and Boyer-Ahmad and Kerman, Orthochirus scrobiculosus in Khuzestan, Hormozgan, Teh- ran, Sistan and Balochestan, Qom, Isfahan, me- dian (Razavi) Khorasan, Khorasan Jonobi, Gi- lan, Semnan, Kermanshah, Ilam, Androctonus crassicauda in Bushehr, Semnan, Khuzestan, Ilam, west Azarbaijan, Kordestan, Khorasan Ra- zavi, south Khorasan, Kermanshah, Kerman and Sistan and Balochistan, Mesobuthus or Olivierus caucasicus in west Azarbaijan, Sistan and Balochestan, Isfahan, south Khorasan, Tehran, Markazi and Semnan, Hottentotta jayakari in Qom, Hormozgan and Fars, Hottentotta schach in Fars and Khuzestan, Hemiscorpius acantho- cercus in Hormozgan and Apistobuthus ptery- gocercus in Khuzestan have been reported, re- spectively (31-53) (Table 1, Fig. 1). All the provinces of Iran have at least one or some species of scorpions of Scorpionida order which cause the sting. In Iran, the num- ber of sting agents of order Scorpionida in Fars Province is 12 species. Overall, 64 species of scorpions have been reported in Iran so far (2, 29). Mesobuthus eupeus has a wide geograph- ic distribution in Iran and at least has been re- ported in 20 provinces. Most of the sting agent species are found in the South of Iran specially Khuzestan. During the last years, about 80% of all the reported sting cases in Iran have been from this area. The sting of H. jayakari has been first reported from Iran (8, 18). According to the reports, scorpions’ venoms which their LD50 is measured less than 1.5mg/ kg, in mice are considered to be in the danger- ous and or deadly group. Among the species in Iran, LD50 of 5 species of this arthropod has been measured among which M. eupeus is in the dead border and has been measured as 1.45mg but LD50 of others is less (Table 2). LD50 of H. lepturus is much more than Buthidae family species but because of the delay mechanism of the venom of this arthropod, it is considered as one of the most deadly species in Iran (8, 18, 33, 54, 55). The highest geographical distribution of sting agent scorpions is related to M. eu- peus and C. matthiesseni reported in 20 and 18 provinces, respectively. In this study, the min- imum geographical distribution belongs to H. acanthocercus reported from Hormozgan and A. pterygocercus reported from Khuzestan (8, 18, 21). Apistobuthus pterygocercus is de- scribed as A. susanae based on new samples in Khuzestan Province. However, in the re- ports, the name is A. pterygocercus as a sting- ing agent in Khuzestan (8, 18, 56) (Fig. 2). Discussion The number of scorpion species has been rapidly increasing in the last 3 decades in the world (57-61). The number of described species in the world has reached 2231 classified in 208 genus and 20 families. The family Buthidae with a higher frequency than others are scattered all over the world. This family includes the most dangerous species. From this family, deadly species live in Iran. In addition, the family Hemiscorpiidae from Hemiscorpius genus in- cludes dangerous and deadly species in the Mid- dle East especially Iran and Iraq and are classi- fied as the most deadly scorpions of the world (62-71). At present, one of the control methods of health is the use of pesticides, that it may cause resistance to several of urban pests such as scorpions, flies and etc., therefore, the im- provement of the environment and the remov- al of shelters could reduce the risk of scorpion stings (72-75). J Arthropod-Borne Dis, December 2018, 12(4): 325–333 R Dehghani et al.: A Review on … 328 http://jad.tums.ac.ir Published Online: December 25, 2018 Table 1. Scorpion sting agent in Iran based on family, genus and species Family Genus Species Number of provinces Author Buthidae Mesobuthus Mesobuthus eupeus (C. L. Koch,1839) 20 2, 30, 29, 28, 24, 23 Buthidae Compsobuthus Compsobuthus matthiesseni (Birula, 1905) 18 8, 13, 14, 2, 16 Buthidae Hottentotta Hottentotta saulcyi (Simon, 1880) 15 8, 18, 23–28 Buthidae Odontobuthus Odontobuthus doriae (Thorell, 1876) 14 8, 23, 25, 31, 32, 33 Hemiscorpiidae Hemiscorpius Hemiscorpius lepturus (Peters, 1862) 13 34–51 Buthidae Orthochirus Orthochirus scrobiculosus (Birula, 1900) 12 8, 18 Buthidae Androctonus Androctonus crassicauda (Olivier, 1807) 12 8, 18, 28, 27, 30, 52 Buthidae Mesobuthus or Olivierus Mesobuthus or Olivierus caucasicus (Nordmann, 1840) 7 8, 18 Buthidae Hottentotta Hottentotta jayakari (Pocock, 1895) 3 28 Buthidae Hottentotta Hottentotta schach (Birula, 1905) 2 8, 18 Hemiscorpiidae Hemiscorpius Hemiscorpius acanthocercus (Monod et Lourenço, 2005) 1 53 Buthidae Apistobuthus Apistobuthus pterygocercus (Finne- gan,1932) 1 8, 18 2 8 12 Table 2. LD50 of sting agent scorpions in Iran based on the injection method Species LD50* Method** Family Androctonus crassicauda 0.08–0.50 Sc/iv Buthidae Odontobuthus doriae 0.19 iv Buthidae Hottentotta saulcyi 1.01 iv Buthidae Mesobuthus eupeus 1.45 iv Buthidae Hottentotta schach 3.36–4.2 iv Buthidae Hemiscorpius lepturus 5.81 iv Hemiscorpidae *The dose is expressed in mg of venom per kg of mouse **Method: iv= intravenous injection, ip= intraperitoneal injection, sc= subcutaneous injection Fig. 1. Provincial abundance of scorpion sting agents in Iran J Arthropod-Borne Dis, December 2018, 12(4): 325–333 R Dehghani et al.: A Review on … 329 http://jad.tums.ac.ir Published Online: December 25, 2018 Fig. 2. Species provincial distribution of major scorpion sting agents in Iran Conclusion At present, the most dangerous species of scorpions are in the South and Southwest of Iran. However, completing the data about the sting agent scorpions’ species in Iran needs more efforts of young researchers. Meanwhile, the completion of data in the field of Iran’s sting agent scorpion species and different aspects of it needs cooperation between the physicians of the venomous animal's sting therapy units and the entomologist in this field. More accurate studies will be done with the cooperation of specialists of different fields about the sting agent species and the clinical effects of each species. This work necessitates a complete re- search in the country with a similar method and in the provinces and cities. Still, the highest spe- cies diversity is seen in the South and Southwest provinces but the diversity of scorpions in the Northeast and Northwest of Iran is less than the Southwest. In high-risk cities and villages, we recommend to the authorities of emergency department of hospitals and treatment centers, to emphasis on having scorpion sting agent by victim companions, because it helps to accu- rately identify sting agent. 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