IAJPS 2017, 4 (08), 2702-2709 Hamid Kassiri and Firoze Rajabi ISSN 2349-7750 CODEN [USA]: IAJPBB ISSN: 2349-7750 INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES http://doi.org/10.5281/zenodo.884455 Available online at: http://www.iajps.com Research Article EPIDEMIOLOGICAL DESCRIPTION OF SCORPION ENVENOMATION SYNDROME, A THREEE YEAR EXPERIENCE, DEZFUL COUNTY, SOUTH-WESTERN IRAN Hamid Kassiri 1,*, Firoze Rajabi 2 1 School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 2 Student Research Committee of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Abstract: Objective: Scorpions envenomation cases are prevalent in Iran due to its socioeconomical structure, weather and geographical situations. Scorpion sting is significant health challenge in Khuzestan Province, South-western Iran. This study aims to evaluate the epidemiology findings of scorpion stings in Dezful, a county in the southwest of Iran. Methods: This study was based on the 2281 subjects with scorpion stings from 2012 to 2014. A questionnaire was distributed to physicians in county health care facilities to collect patient data [age, gender, month, geographical region, location of sting in the body, sting time in the day, interval time between sting and antivenin injection, sting scorpion history, history of receiving antivenin, color of scorpion and injection site of antivenin]. Scorpion [color of scorpion] identification was made according to the color of scorpion defined by the patient. This information was analyzed by SPSS software. Results: Analysis of questionnaire data revealed that 506 of the 2281 scorpion stings resulted from black scorpions [22.2%]. Also, 1775 of the cases [77.8%] were reported as yellow scorpion stings. Out of the 2281 scorpionism cases, 770 took place in the summer period [33.7%], the monthly distribution being as October [12.6%], July [11.9%] and June [ 11.9%]. Meantime, 39 of the cases were encountered in February [1.7%] and 36 in January [1.5%]. It is also seen from the findings that women were more liable to scorpion sting than men, the cases being reported as 54.9% for women and 45.1% for men. With respect to age groups, it is shown the 25 – 34 age group has faced more scorpion sting [26.7%] than the other groups, the distribution being 24.5% for the 15-24 age group, 14% for the 35-44 age group and 8.9% for 45-54 age group. The body locations of stings given in the study are 37.1% for upper extremities and 42.7% for lower extremities. Conclusion: Results of this study showed that intoxications caused in Dezful County were seen in summer and in hot months, especially in October, June and July. Females and males above 15 years of age were mostly affected and stung from extremities. Key Words: Epidemiology, Scorpion Sting, Iran. Corresponding author: Hamid kassiri, QR code School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Email address: [email protected] Please cite this article in press as Hamid Kassiri and Firoze Rajabi, Epidemiological Description of Scorpion Envenomation Syndrome, a Threee Year Experience, Dezful County, South-Western Iran, Indo Am. J. P. Sci, 2017; 4[08]. www.iajps.com Page 2702 IAJPS 2017, 4 (08), 2702-2709 Hamid Kassiri and Firoze Rajabi ISSN 2349-7750 INTRODUCTION: medical field, scorpion sting prevention and control Scorpions are among the oldest organisms on programs, as well as studying other aspects of this Earth. They have real stingers with a venom sac, organism, including biology, ecology, toxicology is where venom is produced from a pair of glands of the responsibility of different disciplines, which near their tail and, therefore, they are considered is very time-consuming. Therefore, studies should the most dangerous arthropods to humans [1]. be placed together, and it is clear that until Scorpion sting is a health issue in undeveloped achieving the ultimate result and resolving scorpion tropical and subtropical countries that endangers sting complications, knowledge of various bio- thousands of people each year. At present time, ecologic aspects of scorpion species and scorpion sting is a major health problem in South recognizing dangerous species in each region are Africa, Middle East, southern states of America basic principles of management of scorpion sting [Mexico], and the Indian subcontinent. It is said prevention and treatment [12]. According to the that about 1.2 billion people are living in areas with studies , little research has been done in Dezful the possibility of scorpion sting, and about one County in this field so far, and the present study million people are stung each year by scorpions, aimed to investigate the epidemiologic aspects of resulting in a mortality rate of 0.027% [2]. The scorpion sting during 2012-2014. severity of poisoning is influenced by various factors, such as patient age and weight, sting MATERIALS AND METHODS: location, sting time, and scorpion species. The This cross-sectional study was performed in Dezful scorpion sting is more dangerous in the elderly and County next to Dez River in Khuzestan Province in children. The less the weight of a stung, the more southwestern Iran. The city is located on the slopes will be the ratio of venom amount to body weight, of the central Zagros and dates back to the Sassanid resulting in a higher risk of poisoning [3]. era. Dezful enjoys of a hot and humid weather. The status of scorpion sting varies in different Dezful city is the center of Dezful County and is regions and countries according to lifestyle, socio- bounded by Andimeshk and Aligoudarz [Lorestan economic status, housing, health services and Province] cities from north, to Lali and Masjed scorpion species in different geographical regions Soleiman Counties and Gotvand County from east, [4,5]. Scorpions are widely distributed, and the and to Shush County from south and west. Dezful highest species diversity is seen in the subtropical city, center of Dezful County, is geographically regions, i.e. at latitudes 23°-38° [6]. located at 48°24’ east longitude and 32°22’ north Given the geographical location of Iran at northern latitude and at 140 meters above sea level. latitudes 25°-40°, there is a fairly substantial The study was performed through attending at the diversity and distribution of scorpion species [7,8]. covering health care centers and reviewing all Due to its climate and weather, Iran is a very rich records of scorpion stings during 3 years of 2012 to country in terms of arthropods, especially scorpions 2014. A checklist was used to collect the [9]. Iran is among the countries with many species demographic [age, gender, etc.] and epidemiologic of scorpions particularly the dangerous types [10]. [scorpion color, sting site, etc.] characteristics and In a manuscript entitled “identification of the data were entered into SPSS and analyzed using venomous animals of Iran” in 1908, cities such as descriptive statistics [mean and SD]. Tehran, Qazvin, Qom, Kashan, Tafresh, Khorramshahr, Ahvaz, Soleymanieh, Kordestan, RESULTS: Kerman, Bampoor, Shushtar and Shahrood are A total of 2281 cases of scorpion sting were reported as scorpion habitats, and their stings were recorded from 2012 to 2014 in the health centers of one of the most important problems of residents of Dezful. Given the city population, the incidence of these cities [7]. Sting-induced deaths occur in all scorpion sting during these 3 years was estimated parts of the country, but about 75% of deaths as 2.6 per thousand population. Findings of this happen in provinces of Sistan -Baluchestan, study showed that during these years, the incidence Kerman and Hormozgan [11]. of scorpion sting was about 750 cases per year with In the most recent period [past 2-3 decades], with no fluctuation. the start of Iran-Iraq war, medical importance of In terms of month, the highest and lowest scorpions was more concerned [1]. incidence rates were recorded in October [n=287; Due to the increasing population and expanding 12.6%] and in January [n=36; 1.6%], respectively. urban and rural areas, the advancement of Regarding the seasons, 719 patients [31.5%] knowledge and greater use of public media, health were stung in spring, 770 [33.7%] in summer, 631 issues have gained more attention. Given that [27.7%] in autumn, and 161 [7.1%] in winter. scorpion sting is a health problem in Iran, it should Table 1 shows the incidence of stings by the be further addressed due to painful complications months of the year. and injuries of stings. In addition, the economic Regarding gender, 54.9% of subjects were female damage should not be forgotten. Of course, apart and 45.1% were male [Table 2]. By age, the highest from health issues and anti-venom serum in the and lowest incidence of stings was occurred in the www.iajps.com Page 2703 IAJPS 2017, 4 (08), 2702-2709 Hamid Kassiri and Firoze Rajabi ISSN 2349-7750 age range of 25-34 years [n=609; 26.7%] and over majority of cases [99.2%] had not a history of 65 years [3.7%], respectively. The frequency of receiving antivenin [Table 9]. Totally, 47 cases scorpion stings by age groups is demonstrated in [2.1% of victims] recovered using convenience Table 3. treatments without scorpion antivenin serum. During these years, the highest incidence of sting However, the rest treated by scorpion antivenin [32.2%] happened at evening from 18 to 24 and the serum including intra-venin [0.8%] and lowest [19.0%] at morning from 6 to 12 [Table 4]. intramuscular [97.2%] injections and convenience Regarding on the residence, 1168 patients [51.2%] treatments [Table 10]. The most of cases [99%] had lived in the city, while 1113 [48.8%] lived in rural not a history of scorpion sting [Table 11].