Manifestations of Compsobuthus Persicus Scorpion Envenomation in Southern Iran

Article info: Received: 23 Jan 2020 Accepted: 21 Jun 2020 Online Published: Research Paper: Clinical Manifestations of Compsobuthus Persicus Scorpion Envenomation in Southern Iran * Corresponding author: Hossein Sanaei-Zadeh, MD. Associate Professor Address: Emergency Room, Division of Medical Toxicology, Hazrat-e Ali Asghar Hospital (p), Shiraz University of Medical Sciences, Shiraz, Iran. E-mail: sanaeizadeh@sums.ac.ir

Little information is available on the clinical manifestations of the stinging and venom effects of some scorpions in the blood and urine samples of the human victims in Iran [6]. According to studies, there are no data available on the clinical manifestations of the envenomations and the effects of C. persicus scorpion venom on the clinical parameters of the stung victims ( Figure 1). Therefore, the aim of this study was to evaluate the clinical manifestations and effects of C. persicus scorpion venom on the biochemical and hematological indices of the blood and urine samples of the stung subjects.

Materials and Methods
In this analytical and retrospective study, laboratory and clinical data recorded in medical charts of patients who were stung by C. persicus and admitted to the Emergency Departments of Shahid Mohammadi and Children's Hospital of Bandar Abbas, Iran, were reviewed between May 2014 and November 2015. Scorpion samples also were collected and identified by an expert entomologist.

Results
In total, 275 patients who were stung by scorpions and admitted to the hospitals were investigated. Of these, 55 cases had been stung by C. persicus, which consisted of 28 (50.9%) male and 27 (49.1%) female at ages ranging from 2 to 57 years old. The clinical symptoms observed and the percentages of patients involved are presented in Figure 2. The results of urinalysis are listed in Table 2. Tables 3 and 4 present the patients' biochemical and hematological parameters, respectively.

Discussion
Our findings indicated that C. persicus with a frequency of 18% was one of the most frequent causes of scorpion envenomations. Dehghani et al. reported that C. matthiesseni was a major agent of scorpion stinging (20.6%) in Khoozestan province [22]. So far, 11 scorpions belonging to Compsobuthus species have been reported from the southern areas of Iran. These species are found in Bushehr, Fars, and Hormozgan provinces [5,23,24]. This scorpion genus belongs to the Buthidae family, the color of which is bright to dark yellow and 28-37 mm in length (Figure 1) [18,21]. There are 51 scorpion species identified in Iran, 13 of which are clinically dangerous (Table 1) [9,14].
This article is the first report of stings by C. persicus species in Iran. The species is endemic to Iran [25] and has been found frequently in Hormozgan [23], Bushehr, and Fars  provinces [25]. The most commonly reported clinical symptoms in patients stung with C. persicus were pain and burning sensation at the stung sites. Other less prevalent symptoms include erythema, vertigo, nausea, malaise, headache, vomiting, itching, and blurred vision. The least frequently reported clinical sign was edema, with the associated symptoms being fever, weakness, dyspnea, and chest pain.
Clinical symptoms of scorpion stinging are related to various factors including species, size, and age of scorpion, the time elapsed between sting to hospital admission, the age of the patient, the site of the sting, and allergic and systemic reactions to the venom [26,27]. The results of the urinalysis in the patients including color, pH, protein, glucose, blood, WBC, RBC, and Hb were normal and no changes were observed. The urine appearance in five patients (9%) was semi-turbid. All of these patients were recovered without a subsequent renal failure. In contrast, it has been reported that the urinalysis results in most patients who are stung by H. lepturus, H. enischnochela, and H. acanthocercus showed positive evidence of proteinuria, blood, intact RBCs, and rarely myoglobinuria. Moreover, glucosuria, hemoglobinuria, and proteinuria have been reported in patients stung by A. crassicauda. Also, hematuria in patients stung by C. matthiesseni is questionable [6].
Based on our results, it appears that C. persicus venom does not cause abnormal urine changes. Also, the results of patients' blood biochemical analyses demonstrated that the mean serum levels of such parameters as Cr, Na+, K+, BUN, and urea were within normal ranges. Thus, it appears that the C. persicus venom had no significant effect on the biochemical parameters of the victims' blood. The results of hematologic tests for all patients showed that C. persicus venom did not make significant alterations in the WBC, RBC, Hb, HCT, MCV, MCH, and MCHC levels. Some Buthidae scorpions are known to be neurotoxic; however, no severe neurological symptoms were reported in any of the patients stung by C. persicus. Based on our findings, it appears that the clinical symptoms of envenomation by C. persicus scorpions are relatively mild in the stung patients.

Conclusions
The severity of poisoning with the C. persicus venom, as documented in this study, was mild. The most commonly reported symptoms were pain and burning sensation at the stung sites. Biochemical and hematological parameters from the analyses of the patients' blood and urine were within normal ranges. Therefore, there is no need for antivenin administration [28].

Compliance with ethical guidelines
This study was approved in 2015 by the Committee on Ethics in Research, Medical School, Hormozgan University of Medical Sciences (Registered #: HUMS.REC.1394.83).

Funding
This study was provided solely by the authors without any other financial support.

Author's contributions
Both authors contributed equally in preparing all parts of the research.

Conflict of interest
The authors declare no competing or conflict of interests with any internal or external entity.