2.1 General

Introduction
Scorpion sting is a life threatening medical emergency. The effect of envenomation
is greatest among children below 5 years of age. Adults too can succumb to scorpion
sting. Many social and environmental factors contribute to scorpion sting. Hence, it
becomes an important public health problem. The epidemiology, presenting features,
clinical course, complications, therapeutic response and outcome are variable in
different series. However, early recognition and appropriate intervention infl uence the
outcome. Hence, scorpion sting deserves special attention and cases should never be
taken lightly.
Though the research on scorpion venom and knowledge on treatment of scorpion
sting have advanced, these newer ideas are yet to reach the health care provider and
the community. In this context, it is worthwhile to remember Dr.H.S.Bawaskar, a
private practitioner from Maharashtra who for the fi rst time in world has introduced
the usefulness of alpha blocker in scorpion sting nearly 25 years ago. This has been
accepted globally now in the treatment of scorpion sting.
Epidemiology
In general for every case of snakebite, there may be 10 or more numbers of scorpion
stings. If that is the case, the number of cases of scorpion sting may run to millions.
There is no reliable statistics on the scorpion sting in India. Scorpion sting is underreported.
Published reports are institution based, hence include only serious cases of
scorpion sting treated in such institutions. As most of the cases of scorpion sting have
mild symptoms, the general practitioners or family physicians or a traditional medical
practitioners provide treatment and they never appear in health statistics.
In Mexico, 1000 deaths due to scorpion sting occur per year whereas in USA four
deaths were reported in 11 years. Of the 13,000 stings reported in USA, majority was
due to non lethal scorpions. Most deaths occur during the fi rst 24 hours of the scorpion
sting and are secondary to respiratory and cardiovascular failure. Children and elderly
are at great risk of death due to their decreased physiological reserve. Death due to
scorpion sting occurs in 25% of children below 5 years, if not treated, whereas only
1% of scorpion stings are lethal to adults.
In India too, deaths due to scorpion sting occurs across the country but do not get
due attention. Larger the scorpion population, greater is the number of scorpion sting
cases. Scorpion stings are reported more from rural areas and the rural to urban ratio
is approximately 3:1. Mostly stings occur between 6 P.M. to mid-night and between
6 A.M. to 12 Noon, which correlate very well with human activity. Scorpion sting
occur more in temperate and tropical zones, and more during summer than winter.The Institute of child health, Madras Medical College, Chennai, has recorded nearly
1900 cases between 1980 and 1999 and the death rate varied from 4 to 7%. Of the 727
cases of scorpion stings treated during the period of 2000-2007 which included 406
males and 321 females [M: F= 4:3]; the death among them were 11 and 8 respectively.
The death rate in children due to scorpion sting was 2% which has come down from
4 to 7% earlier.
In general, male to female ratio of scorpion sting is approximately 2:1 but females
suffer more due to lower body weight. There is no racial predilection but clinical
symptoms, course, and outcome vary because of individual’s genetic constitution and
other factors [vide infra]. Human stinging occurs accidentally, when scorpions are
touched, threatened, cornered or disturbed (stepped upon) while in their hiding places.
So, people involved in handling construction materials, carpentry works, clearing
bushes or house cleaning as well as children playing nearby these areas are susceptible
to scorpion sting.
Eco- biological aspects of scorpion
Scorpions are shy creatures and not aggressive by and large. These are nocturnal
creatures and hunt for their prey at night. Scorpions hide normally in crevices and
burrows during daytime to avoid light. Scorpions are found elsewhere outside the
environmental range. eg., accidentally crawl into luggage, boxes, containers, or shoes,
pile of bricks, wooden materials, fi rewood, etc. They may also be transported in
traveller’s luggage and cargo.
There are about 1500 scorpion species of which 50 are dangerous. In India 86
species of scorpion have been identifi ed. Among them, Mesobuthus tamulus and
Palamneus swammer-dami are important medically. Except Hemiscorpius species,
all lethal scorpions belong to the family called the Buthidae. The lethal members
of Buthidae family include the genera of Buthus, Parabuthus, Mesobuthus, Tityus,
Leiurus, Andractonus and Centruroides. Among the 30 scorpion species found in USA,
only one of them is dangerous to human beings.
Scorpions live in temperate and tropical regions especially between the latitudes of
50o north and 50o south of equator. The distinguishing features between lethal and non
lethal scorpions are provided in Table 16 given below.
Table No. 16: Distinguishing features of lethal and non-lethal scorpion

Scorpions use their pincers to grasp the prey. It arches its tail over its body and
stings into its prey. Thus it injects its venom, sometimes more than once. The venom
glands are situated in the tail. The striated muscles in the stings regulate the amount of
venom injected. When entire venom is used, it takes several days to replenish venom.
Scorpion with large venom sacs such as Parabuthus species can even squirt their
venom.
Distribution of various species of scorpions
Buthus is found in Mediterranean area, Parabuths in Western andSouthern Africa,
Mesobuthus in Asia, Tityus in Central and South America, and Caribbean, Leiurus
in Northern Africa and Middle East, Andractanus in Northern Africa to Southeast
Asia, and Centruroides in South West USA, Mexico and Central America.
Socio cultural aspects
For scorpion sting also, patients are taken for magico religious treatment where
mantras are chanted, herbal medicines are applied externally and / or given orally. Since
the scorpion sting has mild effects in many, most of them improve with local practices.
Hence the community has confi dence on the local / traditional practitioner or priest. If
the pain continues or symptoms get aggravated or general condition deteriorates and
in children if crying or restlessness continues, the patients are brought to the hospital.
Thus local practices contribute to delay in health seeking.