Serum TNF-α levels reflect the clinical severity of envenomation following a Hemiscorpius lepturus sting.

Hemiscorpius lepturus (H. lepturus), found in south-western areas of Iran and south of Iraq, is considered to be the most dangerous scorpion in the region, and poses a significant risk to the health of the indigenous population due to the unique, clinical manifestations associated with its sting.. In the present study, 36 patients from the Khuzestan province in the southwest of Iran, displaying varying degrees of envenomation following an H. lepturus scorpion sting, were admitted to hospital. Serum levels of interleukin-1 (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumour necrosis factor-α (TNF-α) were measured using double-ligand, enzyme-linked, immunosorbent assay (ELISA) kits, and were compared with 30 healthy controls and ten age-matched patients stung by the Mesobuthus eupeus (M. eupeus) scorpion, a less dangerous species that produces primarily neurotoxic manifestations. Blood samples from M. eupeus and H. lepturus victims were taken on admission, and from H. lepturus-stung patients six hours after serotherapy with multivalent anti-venom. When compared to healthy volunteers, with the exception of TNF-α, significantly higher serum cytokine levels were measured in patients following M. eupeus envenomation. However, all three groups of H. lepturus-stung patients showed significantly, and in a severity-related manner, higher mean values for all the interleukins that were measured, including TNF-α, when compared with M. eupeus-stung cases. Six hours after serotherapy, there was a greater reduction in cytokine and TNF-α levels in patients classed as having mild symptoms, in comparison with patients classed as having moderate to severe symptoms. The results of the present study suggest that, unlike M. eupeus, the toxic manifestations observed following being stung by H. lepturus are associated with increased serum TNF-α levels and correlate positively with the clinical severity of the symptoms. Furthermore, serotherapy is only effective when administered to mild cases of H. lepturus scorpion envenomation.

A review of epidemiological, clinical and in vitro physiological studies of envenomation by the scorpion Hemiscorpius lepturus (Hemiscorpiidae) in Iran.

Many of the published accounts of envenomation by Hemiscorpius lepturus (H. lepturus) are in a form that makes it difficult for non Farsi readers to access. The purpose of this review is to summarise the Iranian literature on the toxinological effects of the venom of H. lepturus using both in vivo and in vitro data and where appropriate, details of methods and ethics statements will be reported.

An epidemiological and a clinical study on scorpionism by the Iranian scorpion Hemiscorpius lepturus.

The aim of this retrospective descriptive study was to describe the epidemiological and some common clinical symptoms and signs among humans stung by Hemiscorpius lepturus (H. lepturus) in the southwest province of Iran, Khuzestan. Cases were collected from hospital patients' files referred to two major Khuzestan hospitals over 5 years. Only definite stings of this species, identified by trained health-caring personnel, were included in this study. Epidemiological and clinical signs and symptoms were recorded. There were 354 scorpion victims, 43% of whom were from rural areas. Stings mainly occurred at night between 7p.m. and 5a.m. (56.1%), or from early morning 5a.m. to 12a.m. (38.6%), 41% of which occurred in the lower extremities. Eighty three percent of accidents occurred in mild/hot months of this area between April and October. The age most inflicted was between 1 month to 10 years and 11-20 years old, observed in 39.6% and 26.8% of victims, respectively. Among all the 26,397 scorpion stung files studied over the period of the study, while only 10-15% of stung cases occurred due to this not highly prevalent scorpion of Iran, it was responsible for 89% of the deaths and 92% of hospitalized scorpion-stung patients. The majority of cases were children aged less than 12 years old. Clinical signs and symptoms were both local and systemic. The local symptoms ranged from erythema to severe necrosis with no immediate sensation of pain. Renal toxicity is one of the serious systemic effects, which, if not treated early by administration of the polyvalent antivenom, can progress to severe renal and cardio-respiratory failure. Overall, the findings demonstrate that the characteristic clinical features of envenomation produced by this scorpion differ significantly from those reported for other scorpions in the world.