Elsevier

Acta Tropica

Volume 107, Issue 2, August 2008, Pages 71-79
Acta Tropica

Review
Epidemiology of scorpionism: A global appraisal

https://doi.org/10.1016/j.actatropica.2008.05.021Get rights and content

Abstract

The scorpionism is an actual public health problem in several parts of the world because, either incidence, or severity of envenomations is high and managed with difficulty by health services, or for these two reasons at the same time. The treatment of scorpion envenomation is complex and controversial, in particular regarding the utility of the antivenoms and symptomatic treatments that must be associated. The authors reviewed the literature of last 30 years to discuss the epidemiologic importance of the scorpionism and to point out the principal therapeutic or preventive measures. According to the most recent studies, seven areas were identified as at risk: north-Saharan Africa, Sahelian Africa, South Africa, Near and Middle-East, South India, Mexico and South Latin America, east of the Andes. These involve 2.3 billion at risk population. The annual number of scorpion stings exceeds 1.2 million leading to more than 3250 deaths (0.27%). Although adults are more often concerned, children experience more severe envenomations and among them, mortality is higher. Improvement of therapeutic management would reduce the lethality very significantly.

Introduction

Scorpion stings and their consequences represent an important cause of emergency, in particular pediatric, in many countries (Dehesa-Dávila and Possani, 1994, El-Amin et al., 1994, Goyffon et al., 1982, Lourenço et al., 1996, Otero et al., 2004).

The epidemiology of the scorpionism in the world is poorly known. There are considerable geographical variations, at the level of both the incidence and severity, and our scope was to precise the risks for the population from various areas as well as the principal risk factors.

Evaluation of the severity of the envenomation, mainly in children, is essential to establish the prognosis and institute adequate treatments. The management of scorpion stings remains a subject of controversy. The use of antiscorpionic serum (ASS), which is the only specific treatment, is disputed by certain specialists (Abroug et al., 1999, Bawaskar and Bawaskar, 2000) and symptomatic or adjuvant treatments the importance of which is now recognized by all the experts, require in many places precise useful drugs, indications, and dosages (Freire-Maia et al., 1994).

Based on recent literature, we have sought to specify the incidence and the severity of scorpion stings at global scale and to precise the principles of the management and treatment.

Section snippets

Material and methods

We questioned the Medline data bank with key words “scorpion*” alone or associated with “sting”, “antiven*”, “envenom*”, “epidemiology” and “treatment”. We obtained about 5500 references and selected 301 articles in which we look for local references not indexed in Medline. After obtaining the corresponding articles, we kept all those related to epidemiology and general clinical or therapeutic reviews in one of the following languages: English, Spanish, Portuguese or French.

We kept only the

Scorpion fauna and venom composition

In the world, approximately 1500 species of scorpions are described, currently distributed in 18 families (Prendini and Wheeler, 2005). About thirty of them are recognized as potentially dangerous for humans (Table 1). They all belong, except one Scorpionidae, to the family of Buthidae which includes nearly 80 genera distributed in both the old and new worlds. Less than a dozen of them are responsible for serious envenomation or death. World distribution of scorpions is given in Fig. 1.

Conclusion

The scorpionism, although geographically limited, concerns an at risk population of almost 2 billion and half people. Scorpions live in dry and hot areas but some species can be adapted to man made environment. The scorpion stings occur in summer, mainly during the night and at home. The risk also exists in city downtowns, even if it is definitely higher in rural areas (Celis et al., 2007). Climatic conditions, dryness and heat, are also important risk factors (Chowell et al., 2005).

The

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