Dear Editor,
Scorpion stings are a prevalent medical issue across all provinces of Iran (1, 2). Each year, approximately 40,000 to 50,000 scorpion stings and 16 to 18 fatalities are reported in Iran, with the majority of deaths occurring in the southern regions of the country. The most lethal scorpion species in Iran are Hemiscorpius lepturus (commonly known as Gadim in Persian) and Androctenus crassicauda (3). Identifying the Gadim scorpion is relatively straightforward compared to other yellow scorpions. It features a tall, narrow tail and broad claws with dark tips (4, 5). Another species with a similar appearance is Scorpio maurus, but the treatment for stings from these two species differs significantly (5).
Hemiscorpius lepturus stings are often painless but can result in hemolysis and hemoglobinuria several hours to a week after the sting. Based on experience (unpublished data), S. maurus stings typically cause mild to moderate pain lasting 4 - 5 hours. For a long time, S. maurus has been excluded from the list of dangerous and medically significant scorpions in Iran. Furthermore, the anti-scorpion venoms available in Iran (produced by the government-owned Razi Institute and the private company Padra Serum) do not include antiserum targeting S. maurus (5).
Treatment for S. maurus stings primarily involves pain relief and, if necessary, injections of tetabulin and tetanus toxoid (5). Conversely, H. lepturus stings necessitate hospital admission and one or two doses of scorpion antivenom (5, 6). Additionally, urine analysis should be performed every 4 - 6 hours on the first day and every 12 - 24 hours thereafter for up to a week to monitor for hemoglobinuria. If blood is detected in the urine, further doses of intravenous scorpion antivenom are administered (5, 6).
The clinical manifestations of H. lepturus stings typically appear late and may include cutaneous symptoms, systemic effects, and laboratory abnormalities (5). Therefore, if the scorpion responsible for the sting is brought in with the patient or if a photo of it is available, distinguishing between H. lepturus and S. maurus is essential. Figure 1 presents images of both species, highlighting the differences in claw size, body size, and tail size and shape. Paying close attention to these details is critical for ensuring proper treatment for their stings.
Figure 1.
A, Scorpio maurus; B, Hemiscorpius lepturus. Both scorpion species have wide claws with dark tips, but the claws, body and tail of S. maurus are wider than those of H. lepturus. Additionally, its tail is shorter than that of H. lepturus. In other words, it could be said that S. maurus is plumper than H. lepturus. Photos are original.
As shown in Figure 1, S. maurus, like Gadim scorpions, has very broad claws with dark tips. However, upon closer inspection, the claws and body of S. maurus are much broader than those of Gadim scorpions, and its tail is shorter and wider (5). Scorpio maurus is endemic to Iran, while H. lepturus is endemic to Iran, Iraq, Yemen, and Saudi Arabia (4).
