Iran J Public Health, Vol. 48, No.12, Dec 2019, pp.2140-2153 Review Article Scorpions and Their Human Mortality Report in Iran: A Review Article Faranak FIROOZFAR 1, *Abedin SAGHAFIPOUR 2, Nahid JESRI 3 1. Vector-Borne Diseases Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran 2. Department of Public Health, Faculty of Health, Qom University of Medical Sciences, Qom, Iran 3. Remote Sensing & GIS Center, Shahid Beheshti University, Tehran, Iran *Corresponding Author: Email: [email protected] (Received 21 Aug 2018; accepted 12 Oct 2018) Abstract Background: The scorpions have enjoyed medical importance from ancient times because of their morpholog- ical structure and venom. The identification of the species of these arthropods has been more emphasized than any other aspects. The purpose of this study was to determine scorpion’s fauna and mortality rates of their victims as reported in Iran. Methods: In this review, published documents during 1966–2018 related to medically important scorpions and mortality reports due to scorpionism were searched in the data bases such as Web of Science, PubMed, Scopus, Google Scholar and etc., using key words including scorpion, species, classification, Iran, family, species, and the names of all 31 provinces of Iran. Results: Overall, 169 sources were found. Based on the STROBE checklist, the quality of the documents was also considered, and ultimately, 95 sources were selected. Sixty-four species of scorpions have been identified in Iran and 86% of the species belong to the Buthidae family, and the rest (9.5%, 4.5%) belong to the Hemiscorpi- idae and Scorpionidae families, respectively. These species live mostly in tropical regions of Iran. The dangerous scorpions and their mortality reports are often recorded from southern regions such as Khuzestan and Hor- mozgan provinces. Conclusion: Due to the significant increase in the abundance of scorpions in Iran over the past 30 years, it is expected that this trend will continue by researchers, and the fauna of scorpions is regularly reconsidered. Keywords: Scorpions; Mortality; Spacial distribution; Iran Introduction Scorpions have been living on the earth for more Scorpions are hazardous to humans as they have than 450 million years. These creatures belong to toxic and deadly stings. The highest human mor- the class: Arachnida; Lamarck, 1801. They have al- tality rate due to poisonous arthropods in the ways been considered by humans because their world is related to scorpionism (4, 5). painful and deadly stings. Scorpions are nocturnal The scorpions are distributed in the world be- arthropods. They have venom stings that are used tween the latitudes 23°N and 38°S of the equator to feed upon insects and self-defense (1,2). Their (6, 7). In 1997, Kovarik categorized Iran's scorpi- breeding places are mostly in the desert and in ons into three families: Buthidae, Scorpionidae, non-residential areas, but if their nests are de- and Diplocentridae (8). Other researchers have stroyed, they also enter human dwellings (3). mentioned four families of scorpions in Iran: 2140 Available at: http://ijph.tums.ac.ir Firoozfar et al.: Scorpions and Their Human Mortality Report in Iran … Buthidae, Scorpionidae, Hemiscorpiidae, and Dip- Materials and Methods locentridae (9). Nevertheless, in 2016, Dehghani et al. reported three families for this anthropode in Study area Iran: Buthidae, Hemiscorpiidae and Scorpionidae Iran is located in southwest Asia and the Middle (10). East with an area of 1.648 million km² and a pop- The scorpion sting (scorpionism) is considered as ulation of 79, 926, 270, based on the last census in one of the health problems in tropical and sub- 2016. This country is divided geographically into tropical countries, such as Iran (11-14). Due to the 31 provinces. Iran has a high climatic diversity. diversity of scorpion species in the vast zone of From the north to the south, it has different cli- Iran, from the southern islands in the Persian Gulf mate zones. The four climates of Iran are as fol- to the northernmost regions, scorpion stings lows: 1) the moderate and humid climate (north- (scorpionism) have always been considered as one ern Iran), 2) the warm and dry climate (considera- of the medical issues in most areas of Iran (10,15). ble parts of central regions), 3) the cold and moun- Many victims of these venomous arachnids have tainous climate (west and northwest of Iran) and been reported from different regions of Iran (16). 4) the warm and humid climate (southwest to- According to statistics released by CDC of the Ira- wards southwest of Iran) (21). nian Ministry of Health and Medical Education, Iran has the second rank of venomous animal Study design bites in the world by a recording of about 250,000 The present study is a review on medically im- bites, following Mexico (17). In addition, many portant scorpions, as well as their mortality reports deaths caused by scorpions occur in Iran, espe- from all 31 provinces of Iran. The results of this cially in southern and southern tropical regions of study were obtained by searching related docu- the country (18). For instance, scorpionism inci- ments in scientific databases including Web of Sci- dence rates and mortality of scorpionism were es- ence, PubMed, Medline, Scopus, Systematic Re- timated to be 54.8 to 66/100000 populations in view, SID, Iran Medex, and Google Scholar. The Iran during 2002-2011, respectively (13). Further- manuscripts related to the present study were more, the mortality of scorpion stings in Iran is searched and extracted by two researchers inde- about 10 times greater than snakebites as one of pendently using MeSH keywords such as Scor- the health problem related to other Iranian dan- pion, Classification, Iran, Identification, Study, gerous animals and the human deaths associated Mortality, Family and Species, from 1966 to 2018 to scorpion stings are about one third to one sec- (Fig. 1). Moreover, MSc theses and Ph.D. disser- ond of the snakebites (19, 20). tation for those students who graduated in Medi- It seems that having enough information on med- cal Entomology, Vector Control, and Medical En- ically important scorpions, their geographical dis- tomology were reviewed from the libraries of tribution in different regions of the country, and medical universities of Iran, such as Tehran, Shi- the mortality reports of scorpionism can help raz, Ahvaz, Urmia, Bandar Abbas, Hamadan, health policy makers plan for the prevention of Tarbiat Modares, and others. Data categorization scorpion sting cases and design effective interven- was performed by searching articles related to tions to reduce scorpion sting cases. Provinces, Scorpions, Medicaly important scorpi- Therefore, we aimed to determine the medically ons, and mortality reports of scorpionism from important scorpions and their mortality report in different parts of Iran. Iran, using Geographical Information System. Available at: http://ijph.tums.ac.ir 2141 Iran J Public Health, Vol. 48, No.12, Dec 2019, pp.2140-2153 Fig. 1: Historical trend of published documents in relation with scorpions, scorpionism and their reported mortality in Iran. Inclusion criteria were as follows: documents that 12 dangerous and medically important scorpions mentioned scorpion fauna or indicated on mortal- of Iran. ArcGIS software ver. 9.3 ity of scorpion stings from each of the 31 prov- (http://www.esri.com/arcgis) was employed to inces of Iran; identification of scorpions based on provide the special distribution maps of scorpions valid keys, mortality reports from the Center for and their mortality reports. Disease Control of the Ministry of Health in the form of an epidemiological survey forms that ap- Results proved by the General physicians. In addition, the case reports on the scorpion deaths published in Overall, 169 potentially related documents were Persian or English journals were considered. Arti- found. According to the inclusion and exclusion cles and theses that were not related to the subject criteria and the qualitative evaluation of docu- of this study and faunistic studies of scorpions ments, 74 sources were eliminated. Ultimately, 95 with incomplete sample size or invalid identifica- related sources were extracted and included in the tion keys were excluded from the study. study (Fig. 1). Iranian scorpions can be classified At this stage, the Strengthening the Reporting Ob- as three families: Buthidae, Scorpionidae, and servational Studies in Epidemiology (STROBE); Hemiscorpiidae, including 64 species and 20 gen- the standard STROBE checklist, which has 22 era. Of these scorpions, 55 species (86%) belong items, was used to assess the quality of the docu- to the Buthidae family, six (9.5%) and three (4.5%) ments. This checklist evaluates all aspects of meth- species were reported to belong to the Hemiscor- odology including the study design, sampling piidae and Scorpionidae families, respectively. methods, measurement of variables, data analysis, I. Family Buthidae (C. L. Koch, 1837) and so on (22). The minimum score for entering 1.1 Genus Androctonus articles in the study was considered to be 15 .5 1. Androctonus crassicauda (Olivier, 1807) (Note 1, points. The studies with scores less than 15.5 were Fig.2) excluded. Distribution: Bushehr, Semnan, Khuzestan, High and medium-quality documents, which re- Ilam, Kurdistan, Razavi Khorasan, South Khora- ceived minimum 16 points out of 44 points in the san, Kermanshah, Kerman, Sistan and Ba- checklist, were included in the present study. luchestan, Qom, West Azerbaijan, East Azerbaijan Thus, the data collected from these documents and Ardabil (7, 9, 12, 23- 31). were entered into Microsoft Office Excel 2010 for 2142 Available at: http://ijph.tums.ac.ir Firoozfar et al.: Scorpions and Their Human Mortality Report in Iran … Fig. 2: Presence of Androctonus crassicauda (left) and Apistobuthus pterygocercus (right) and their mortality report in Iran at the county 2. Androctonus baluchicus (Lournco 2005) 1.3 Genus Buthacus Distribution: Sistan and Baluchestan (9, 24).