Hemiscorpius Lepturus Research Articles

Development of a recombinant camelid specific diabody against the heminecrolysin fraction of Hemiscorpius lepturus scorpion

Scorpion sting is one of the most important problems in public health practice in many countries. Khuzestan yellow scorpion, scientifically known as Hemiscorpius lepturus, belongs to the family Hemiscorpidae, and is one of the most common and dangerous scorpions in Iran. Hemiscorpius lepturus scorpion has potentially cytotoxic venom. The first treatment for scorpion envenoming is horse antisera. Due to their unique characteristics, camels have been considered as an important source for antiserum and monoclonal antibody (Nanobody) production. In the previous study, we reported a specific nanobody against the hemolytic fraction (heminecrolysin) of Hemiscorpius lepturus venom. In the present study, a recombinant diabody was constructed and produced by fusion of two nanobodies. Results from in vitro and in vivo assays showed that the diabody has a promising ability to neutralize venom activity.

Venom Components of Iranian Scorpion Hemiscorpius lepturus Inhibit the Growth and Replication of Human Immunodeficiency Virus 1 (HIV-1).

Background:During the recent years, significant progress has been achieved on development of novel anti-viral drugs. Natural products are assumed as the potential sources of novel anti-viral drugs; therefore, there are some previous studies reporting the anti-viral compounds from venomous animals. Based on the significant value for tracing of non-toxic anti-viral agents from natural resources, this study was aimed to investigate the anti-viral activity of some HPLC purified fractions derived from the venom of Iranian scorpion, Hemiscorpius lepturus, against human immunodeficiency virus 1 (HIV-1) and herpes simplex virus 1 (HSV-1).Methods:H. Lepturus crude venom was subjected to reverse phase HPLC analysis to determine its active components precisely where four dominant fractions obtained at retention time of 156-160 minutes. The phospholipase A2 and hemolytic activities of the purified fractions were first evaluated. Then the anti-viral activity was measured using single cycle HIV (NL4-3) replication and HSV (KOS) plaque reduction assays.Results:The H. lepturus crude venom inhibited HIV replication by 73% at the concentration of 200 µg/ml, while it did not show significant anti-HSV activity. It also inhibited the cell-free viral particles in a virucidal assay, while it showed no toxicity for the target cells in a proliferation assay. The four HPLC fractions purified from H. lepturus inhibited HIV with IC50 of 20 µg/ml.Conclusion:H. lepturus venom contains components with considerable anti-HIV activity insofar as it has virucidal activity that offers a novel therapeutic approach against HIV infection. Our results suggest a promising pilot for anti-HIV drug discovery with H. lepturus scorpion venom.

Purification and characterization of two novel Hemiscorpius lepturus scorpion venom-derived phospholipases A2 which inhibit angiogenesis in vitro

Purification and characterization of two novel Hemiscorpius lepturus scorpion venom-derived phospholipases A2 which inhibit angiogenesis in vitro

Effects of Different Time Protocols Treatment on Coagulation Parameters of Sheep Injected With Hemiscorpius lepturus Venom

Background: Hemiscorpius lepturus is one of the most dangerous scorpion species, endemic in Khuzestan province. Its venom has hemolytic activity and can lead to hemoglobinuria and death. Objectives: The aim of this study was to determine the effects of three different time treatment protocols on changes of coagulation parameters in sheep received Hemiscorpius lepturus venom. Materials and Methods: Sixteen healthy male lambs were divided randomly into four groups. Hemiscorpius lepturus venom (0.01 mg/kg of body weight) injected subcutaneously. Blood samples were taken at 30 minutes before and 1, 6, 12, 24, 48, 96 and 168 hours after injection. The sheep of group 1 were treated only by injection of Hemiscorpius lepturus venom. In groups 2, 3 and 4 (Experimental groups), treatment of animals began at 1, 24 and 48 hours respectively after the venom injection. In addition to intravenous injection of 5 mL antivenom, supportive therapy was performed as well. Prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen were measured by commercial kit and platelet (PLT) count was performed by hematology analyzer. All results were statistically analyzed using two way repeated measures analysis of variance. Results: In the studied groups, the effect of time on PT and platelets counts was significant (P < 0.05); however, it did not have a significant effect on the amounts of PTT and fibrinogen. No significant statistic difference was found regarding four factors measured between different treatment groups. Interaction of time and treatment groups had significant effect only on the platelet counts (P < 0.05). Conclusions: Hemiscorpius lepturus venom in sheep can cause severe changes in some of the coagulation factors. This should be considered as part of the pathogenesis of scorpion sting and seriously in the treatment protocol of scorpion sting victims.

Study on Distribution of Scorpions to Provide Prevention and Interventions in Combating Scorpionism in Poldokhtar County, Lorestan Province, Iran.

Scorpions are arthropods of medical importance classified in the class Arachnida, inhabiting hot and dry environments. All scorpions have a venomous sting and several thousand people die each year from scorpion stings, but this mortality is due to the venom of about 25 species located in northern Africa, the Middle East, India, Mexico and parts of South America. Poldokhtar County belongs to one of the southern cities of Lorestan Province, providing suitable habitats for many different species of scorpions due to its specific climatic conditions. To examine the fauna of scorpion and its distribution in the Poldokhtar County and to provide appropriate preventive and medical interventions in combating scorpionism. This present study was a descriptive and analytical cross-sectional study. This study was conducted from April 2014 to November 2014 in regions of Poldokhtar County, Lorestan Province, and west of Iran. Cluster sampling methodology was employed in the sampling and scorpion collection procedure. Sampling was undertaken for an eight-month period, in villages and districts, namely, Myankuhe sharqi, Jayedar, Jelogir and Malavi within the county. The Chi-square test and the Fisher-exact test for homogeneity of proportions were used to compare quantitative variables. Totally, 393 specimens were captured entailing 193 (49.1%) males and 200 (50.9%) females. There were at least seven species of scorpions belonging to three families; BU= Buthidae, HE = Hemiscorpiidae, SCN = Scorpionidae in Poldokhtar. Out of 393 collected scorpions, seven species, Androctonus crassicauda, Hottentotta (Buthotus) saulcyi, Compsobuthus matthiesseni, Compsobuthus rugosulus, Orthochirus scrobiculosus, Scorpio maurus and Hemiscorpius lepturus were identified. The overall sex ratio of females to males was 1:1.03. It is crucial to improve the knowledge of residents in this region regarding preventive methods towards scorpion stinging. All the known dangerous Iranian scorpions having medical importance, including Hemiscorpius lepturus and Androctonus crassicauda were found in the study area. Additionally, other complementary research detailing the fauna of scorpions and their morphological, ecological and molecular variety in this region is highly recommended to estimate the correlation between particular scorpions' species and ensuring clinical signs and symptoms.

Acute kidney injury in Hemiscorpius lepturus scorpion stung children: Risk factors and clinical features.

Acute kidney injury (AKI) is frequently seen in Hemiscorpius lepturus scorpion stung children. We have previously reported several victims with hemolytic uremic syndrome (HUS) and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 deficiency. Hence, we conducted this study to identify predictive factors and clinical features of AKI in H. lepturus scorpion stung patients. We included all 215 H. lepturus scorpion stung children with no previous renal diseases in two groups (with and without AKI) and compared them based on their clinical and laboratory findings. AKI was found in 27.4% of patients, they were significantly younger and with lower body weight (P = 0.006, P = 0.011, respectively). There was a significant difference between groups with and without AKI in findings such as fever (P = 0.003), hypertension (P <0.001), hemolytic anemia (P <0.001), thrombocytopenia (P <0.001), massive proteinuria (P <0.001), hemoglobinuria (P <0.001), pyuria (P <0.001), and hematuria (P = 0.004). HUS was in 5.5% and disseminated intravascular coagulation in 14.6% which had a significant association with AKI (P <0.001).There were several independent predictors for AKI in a multivariate regression model including thrombocytopenia (P = 0.002), pyuria (P = 0.01), proteinuria (P =0.01), and fever (P = 0.02). Hemodialysis was performed in four patients but kidney function improved in all patients and there was no findings of renal impairment after three months follow-up. We found several predictors for AKI in children following H. lepturus scorpion sting including younger age, delay in receiving medical care, pigmenturia, microangiopathic hemolytic anemia, proteinuria, and pyuria.

Bioecology and scorpion envenomation in Ramshir district, Khuzestan Province, southwestern Iran

Scorpion envenomation is a leading public health hazard in southwestern Iran. This study was carried out to analyze the bioecology and medical importance of scorpions in Ramshir district in Khuzestan Province of Iran from 2006 to 2011. Epidemiological data of victims in Ramshir was obtained from a standard data sheet and analyzed by SPSS 16 software. Scorpions were collected using standard rock-rolling and UV light methods, as well as the rubber band technique in 2013. Morphological identification was performed using Iranian scorpion’s identification key. During a 6-year period (2006–2012), 1502 envenomed cases—with high prevalence of stinging from June to October in each year—were obtained. More than half of the accidents were in the age group 15–34 years, and the most frequently stung body parts were legs and hands, respectively. There were 283 scorpion specimens collected, which belonged to three families: Buthidae, Scorpionidae, and Hemiscorpiidae. There were five species: Mesobuthus phillipsii (Pocock), Androctonus crassicauda (Olivier), Hemiscorpius lepturus (Peters), Orthochirus iranus (Kovarik), and Scorpio maurus (Linnaeus). All species were classified as epigean (92.2 %) and fossorial (7.8 %) guilds. In conclusion, the high prevalence of scorpion envenomation and distribution of dangerous scorpion species in Ramshir suggest the necessity for educational and preventive programs to decrease scorpionism incidence in terms of scorpion control, patient treatment, and prevention measures.

Epidemiological and Clinical Characteristics of Scorpion Stings in Ahwaz, Southwest Iran (2006-2010)

Background: Scorpion sting is a health problem in the world including tropical regions of Iran as in rural region of Khuzestan province. Therefore appropriate diagnosis and treatment has a special aspect. The aim of present study was to evaluation of demographic status and clinical aspect of scorpion sting patient due to better prevention and treatment and diagnosis.Methods: This survey done by analyzing medical records of patients suffered from scorpion sting, hospitalize in Razi hospital in Khuzestan province (southwest of Iran) among 2006-2010. Patient information have been extracted and inserted in the inquiry form and data were analyzed by SPSS software.Results: In the present study 1922 patients have been studied. Proportion of females stung by scorpion to male was 1.29 to 1. Place of sting were mostly trunk (693 cases =36.05%) and remains were on other part of body. About 419 persons (21.8 %) have come to hospital about 6-24 hours after being stung and 708 people (36.83 %) came there in less than 6 hours. Most sting (41.2 %) were at night time and other were at daylight. 1308 persons were stung by an unknown black and yellow scorpion and 614 cases (31.94%) by scorpion known as Hemiscorpius lepturus. 708 persons of patients (39.83%) have been suffered from hemoglobinoria , 709 persons (39.88%) were suffered from coagulation dysfunction. Totally 508 persons of patients (26.43%) received blood products. 36 of patients were died, of which 24 cases (1.24%) were female and 12 patients (0.62%) were male. most of patients (1842 cases 95.83%) were hospitalized 1-2 days.Conclusion: In this survey, Patients at the emergency units showed signs of local and systemic effects, 36 patients were died. We propose that public awareness and physician readiness combined with the availability of effective antivenom has potential value in reducing complications and lethality in scorpion envenomation.

Hemilipin, a novel Hemiscorpius lepturus venom heterodimeric phospholipase A2, which inhibits angiogenesis in vitro and in vivo

Phospholipases A2 (PLA2) are enzymes which specifically hydrolyze the sn-2 acyl ester bond of phospholipids producing free fatty acids and lysophospholipids. The secreted PLA2 (sPLA2) are the most common types of PLA2 purified from the snake venom, mammalian pancreatic juice and other sources. They display a variety of toxic actions and biological activities, including antitumoral and antiangiogenic effects. In this study, we report the isolation, characterization and the antiangiogenic activity of Hemilipin, a novel sPLA2 extracted from Hemiscorpius lepturus venom, the most dangerous scorpion in Iran. Hemilipin was purified by HPLC and analyzed by MALDI TOF/MS. The primary structure was determined by EDMAN degradation method and the PLA2 activity by titration of fatty acids released from the egg yolk phospholipids. Its antiangiogenic activity was studied in vitro by evaluating effects on apoptosis, Matrigel angiogenesis, migration and adhesion of human umbilical vein endothelial cells (HUVECs) and human pulmonary artery endothelial cells (HPAECs) and in vivo by the chorioallantoic membrane (CAM) assay.Mass spectrometry profile showed that Hemilipin is heterodimeric and the PLA2 test demonstrated its strong hydrolytic activity. N-terminal aminoacid sequence highlighted a significant homology of Hemilipin's small and large subunits with other sPLA2 group III. Hemilipin had no effect on apoptosis, but strongly impacted angiogenesis both in vitro and in vivo. Our results demonstrate that this novel non toxic sPLA2 could be a new tool to disrupt at different steps human angiogenesis.

Hemiscorpius lepturus venom induces expression and production of interluckin-12 in human monocytes.

The objective of this study was to evaluate the capacity of the venom from Hemiscorpius lepturus to induce expression and production of interleukin-12 (IL-12) on isolated human monocytes. For this purpose, isolated human monocytes (250,000-300,000 cells/ml) were exposed to different concentrations of the venom (0.625, 1.25, 2.5, 5, 10 and 20μg/ml) in 96-well plates for varying incubation periods (6, 12, and 24h). The end point of assessment included LDH cytotoxicity assay, measurement of expression of IL-12,p40 mRNA by real-time PCR, and quantification of IL-12 release using sandwich ELISA technique. The results showed that this venom produced concentration- and time of incubation-dependent cytotoxicity. The level of enhancement of expression and production of IL-12 were found significantly higher with lowest concentration and after 6h of incubation. The findings demonstrated that the venom from this scorpion contains active constituents which can direct the immune system to produce IL-12.

A forward to optimization of antivenom therapy: An in vivo study upon the effectiveness of the antivenom against early and delayed nephrotoxicity induced by the venom of the Iranian scorpion Hemiscorpius lepturus in rat

The aim of the present invivo study was to identify the optimal effective dose, the most favorable time and the route of administration of the available polyvalent scorpion antivenom against the toxic effects induced by Hemiscorpius lepturus (H.lepturus) venom in rat. The end point for assessment included measurement of alanin-amino-peptidase (AAP) and N-acetyl-b-d-glucosaminidase (NAG), biochemical urine analysis and histopathological assessment. The results showed that a single subcutaneous 50μg of the venom produced significant increase in the AAP and NAG enzyme activity, urinary biochemical parameters and induced histopathological structural abnormalities in the renal system. The optimal effective co-administered dose of the antivenom was 0.5ml, which when administered 1 and 2h of envenomation by intravenous (IV) and subcutaneous (SC) routes respectively produced significant protection against these toxic effects. Prudently, the significance of these findings need to be assessed in further clinical studies.

Species composition, sex ratio, geographical distribution, seasonal and monthly activity of scorpions and epidemiological features of scorpionism in Zarrin-dasht County, Fars Province, Southern Iran

ObjectiveTo determine the fauna, density, geographical distribution, sex ratio of scorpions and epidemiology of scorpionism in Zarrin-dasht County, south of Iran. MethodsThis descriptive and practical research was done during 2010-2011 for bioecology of scorpions and during 2008-2009 for epidemiology of scorpionism. The specimens of scorpions were captured by rock-rolling, black light and burrow excavation methods. ResultsThe found species and subspecies were as follows: Odontobuthus odonturus (42.1%), Scorpio maurus townsendi (40.1%), Olivierus (Mesobuthus) caucasicus (8.3%), Mesobuthus eupeus kirmanensis (4.4%), Compsobutus matthiesseni (1.6%), Compsobuthus rugosulus (1.2%), Androctonus crassicauda (0.4%), Hemiscorpius lepturus (0.4%), Sassanidotus zarudnyi (0.4%), Mesobuthus eupeus afghanus (0.4%), Mesobuthus eupeus philippovitschi (0.4%) and Mesobuthus eupeus phillipsi (0.4%). Also, the majority of specimens were caught in the summer season (43.3%). Scorpion sting cases were more frequently reported at summer (69%), on feet (52.6%) and in urban areas (54.7%). ConclusionsZarrin-dasht County (with 12 scorpion species and subspecies) has the high level of diversity in scorpion community. Planning prevention, control and treatment programs based on the identified species are suggested.

NMR-based metabonomics survey in rats envenomed by Hemiscorpius lepturus venom.

About 1% of scorpion stings in Iran have been reported in cities and more than 5% in rural areas. The genus Hemiscorpous lepturus belongs to the family Hemiscorpiidae that is endemic in the south-western province of Khoozestan and other parts of western Iran. Although this species is responsible for only 10% of the reported stings, it is also responsible for 95% of mortalities. The heavy cytotoxic and neurotoxic venomous effects of scorpion sting may cause serious disorders such as erythema, purpuric changes, bulla, necrosis and ulcer, either alone or in combination. The toxic effects of H. lepturus venom cause vast changes in both primary and secondary metabolites of the victim, which finally lead to death if not treated early enough. Metabolomics is the systematic study of chemical fingerprints resulting from cytotoxic and pathogenic reactions of cells. We studied the toxic mechanism of H. lepturus venom on metabolome profiling of the victims along with biochemical pathways, organs and physiological detectable effects of this venom by the help of (1)H NMR. Our results showed that pyrimidine, histidine and tyrosine metabolisms, and steroid hormone biosynthesis were the most affected pathways. The major action of the crude venom is on the pancreas, and also on the nerve cells, spleen and mitochondria, causing acute seizures, which resemble the early markers of myocardial injury and seizure disorders.

Assessment of immunogenic characteristics of Hemiscorpius lepturus venom and its cross-reactivity with venoms from Androctonus crassicauda and Mesobuthus eupeus

Hemiscorpius lepturus (H. lepturus), one of the most venomous scorpions in tropical and sub-tropical areas, belongs to the Hemiscorpiidae family. Studies of antibodies in sera against the protein component of the venom from this organism can be of great use for the development of engineered variants of proteins for eventual use in the diagnosis/treatment of, and prevention of reactions to, stings. In the present in vitro study, the proteins of H. lepturus venom, which could specifically activate the production of immunoglobulin G (IgG) in victims accidently exposed to the venom from this scorpion, were evaluated and their cross-reactivity with venoms from two other important scorpion species including Androctonus crassicauda and Mesobuthus eupeus assessed. H. lepturus venom was analyzed with respect to its protein composition and its antigenic properties against antibodies found in sera collected from victims exposed to the venom of this scorpion within a previous 2-month period. The cross-reactivity of the H. lepturus venom with those from A. crassicauda and M. eupeus was assessed using ELISA and immunoblotting. Electrophoretic analysis of the venom of H. lepturus revealed several protein bands with weights of 8–116 KDa. The most frequent IgG-reactive bands in the test sera had weights of 34, 50, and 116 kDa. A weak cross-reactivity H. lepturus of venom with venoms from A. crassicauda and M. eupeus was detected. The results of immunoblotting and ELISA experiments revealed that H. lepturus venom activated the host immune response, leading to the production of a high titer of antibodies. Clearly, a determination of the major immunogenic components of H. lepturus venom could be valuable for future studies and ultimately of great importance for the potential production of recombinant or hypo-venom variants of these proteins.

A camelid antibody candidate for development of a therapeutic agent against Hemiscorpius lepturus envenomation.

Hemiscorpius lepturus scorpionism poses one of the most dangerous health problems in many parts of the world. The common therapy consists of using antivenom antibody fragments derived from a polyclonal immune response raised in horses. However, this immunotherapy creates serious side effects, including anaphylactic shock sometimes even leading to death. Thus, many efforts have been made to introduce new replacement therapeutics that cause less adverse reactions. One of the most attractive approaches to replacing the available therapy is offered by single-domain antibody fragments, or nanobodies (Nbs). We immunized dromedaries with H. lepturus toxin and identified a functional recombinant Nb (referred to as F7Nb) against heminecrolysin (HNc), the major known hemolytic and dermonecrotic fraction of H. lepturus venom. This Nb was retrieved from the immune library by phage display selection. The in vitro neutralization tests indicated that 17.5 nmol of the F7Nb can inhibit 45% of the hemolytic activity of 1 EC100 (7.5 μg/ml) of HNc. The in vivo neutralization tests demonstrated that F7Nb had good antihemolytic and antidermonecrotic effects against HNc in all tested mice. Surprisingly, F7Nb (8.75 nmol) neutralized 1 LD100 of HNc (10 μg) via an intracerebroventricular route or 1 LD100 (80 μg) via a subcutaneous route. All of the control mice died. Hence, this Nb is a potential leading novel candidate for treating H. lepturus scorpionism in the near future.

An in vitro Comparative study upon the Hemolytic, Thrombogenic, Coagulation parameters and Stability properties of the Hemiscorpiuslepturus Venom

Hemi scorpius lepturus belonging to Hemiscorpiidae family is the most venomous of all types of scorpion existing in south west of Iran causing hemoglobinuria and dermal lesions by envenomation. We compare the hemolytic pattern upon time in different domestic animals upon time according to their different sphingomyelin contents. In addition other in vitro hematologic parameters, platelet lysis, coagulation changes and finally preservative factors (temperature, pH, protases) are discussed. The hemolytic activity was inhibited significantly by heating at 100 °C for 60 minutes (26%) and reached 38% via incubation with papain (10U/ml) while retained over a pH range of 4-11. Horses and sheep have the lower (61%) and upper (100%) rate of hemolysis. Calcium and magnesium ions could increase rate of hemolysis and EDTA solution had significantly decresing effect. The venom significantly changed in vitro coagulation factors (PT and APTT) from base line levels and had no effect on platelet lysis. It seems that our venom belongs to metalloproteinases due to potentiation effects of bivalent cations (calcium and magnesium) and ghost cell formation in our study indicatiing hemoglobin efflux.

Epidemiological review of scorpion envenomation in iran.

This epidemiological review was carried out to display the magnitude and the geographic distribution of scorpion envenomation in Iran with focus on the southwestern region of Iran, particularly. The Iranian recognized scorpions belonging to two families, including Buthidae and Scorpionidae. Buthidae family consists of 14 genuses, 26 species, and 18 sub-species, while Scorpionidae family has three genuses and four species. The lack of basic knowledge, including the geographical distribution, clinical manifestations, and specific treatments related to scorpiofauna justifies such multidisciplinary studies. The venom of two endemic Iranian scorpions, including Hemiscorpius lepturus (H. lepturus) and Odonthubuthus doriae (O.doriae) have considered as an effective source of new neurotoxin peptides for the further development of physio-pharmacological probes and designing the clinical trials. Such epidemiological information may improve the determinants of Iranian scorpion stings in order to plan and implement effective public health intervention.

Hemiscorpius lepturus envenomation: Manifestations and management with specific antivenom

Scorpionism is a known significant problem of medical and social importance in many tropical and subtropical regions including the Middle East. In Iran, highest prevalence of scorpion sting about 60% of all the stings has been reported from Khuzestan province. Among the 21,000 cases of reported scorpion stung patients, 12% were caused by H. lepturus, but contributed to 95% of all moralities in scorpion stung patients. The sting of H. lepturus does not produce an immediate pain as does the sting of other scorpions, rather cause delayed swelling that may diffuse and is often accompanied by late necrosis at the sting site suggestive of less significant role of the nervous system stimulation. Since the venom from H. lepturus is cytotoxic in nature and the renal response and blood toxicity are normally simultaneously manifested, it is suggested that the toxin binds to kidney tissue and potentially induce acute renal failure in stung patients. Pharmacokinetic analysis revealed that Intramuscular (i.m) injection of antivenoms is ineffective in neutralizing the action of venoms. Although some reports mention the slow distribution rate of H. lepturus venom following sting, but since the cytotoxic effect of venom from this scorpion is irreversible by antivenom once it occurs, it is recommended to use antivenom through intravascular (i.v) route. Antivenoms of F(ab)2 fraction are the best choice of treatment for their fast extravasation, their ample distribution into the extracellular space, and their prolonged retention time.

The Roles of Some Scorpions,Hemiscorpius lepturusandAndroctonus crassicauda, in a Scorpionism Focus in Ramhormorz, Southwestern Iran

Scorpion stings are a common and important health problem in Iran, particularly in south and southwestern Iran, including the province of Khuzestan. In the area of Khuzestan near the city of Ramhormoz, Hemiscorpius lepturus (Scorpionida: Hemiscorpioiidae) and Androctonus crassicauda (Buthidae) are present. Ramhormoz is in southwestern Iran and is one of the most important foci of the scorpion sting problem. The current study was carried out to gain both epidemiological and medical information about scorpion stings in and around the city of Ramhormoz. In total, 179 people who were admitted to the Emergency Department of Ramhormoz Imam Khomeini Hospital during 2008 and 2009 after being stung by scorpions were monitored. Epidemiological and medical parameters including sex of the victim; the part of the body stung; the month when stung; the biochemical parameters comprising blood sugar (BS), blood urea nitrogen (BUN), and creatinine (CR); hematological parameters including white blood cells (WBC), count blood cells (CBC), red blood cells (RBC), hemoglobin (Hb), hematocrit (HCT), platelet (PLT); and urine analysis including hemoglobinuria were recorded. The current study showed that most of the victims were stung by H. lepturus, while very few were stung by A. crassicaud, but in over half of the cases the species was not known. Stings were most common from May to Aguust. 73% of the victims were female. The limbs were the part of the body most likely to be stung. Hemogobinuria was very common in H. lepturus victims.

High Frequency of Acquired ADAMTS13 Deficiency After Hemolysis in Hemiscorpius Lepturus (Scorpion) Stung Children

To estimate the frequency of acquired ADAMTS13 deficiency in severe cases of Hemiscorpius lepturus stung patients and the frequency of acute kidney injury (AKI) in these patients. Sixty scorpion stung children who were referred with severe hemolysis and hemoglobinuria were studied. None of them had received blood products and no one had a past medical history of renal failure. Plasma levels of ADAMTS13 and ADAMTS13 antibody (IgG) were measured using ELISA. ADAMTS13 was decreased in 91.7% of patients and the anti-ADAMTS13 antibody (Ab) was increased in 98.3%. ADAMTS13 decreased in all of the patients with acute kidney injury and none of those with normal levels of ADAMTS13 developed renal failure; all patients with AKI had also increased levels of ADAMTS13Ab. Acute kidney injury was found in 23.3% and had significant association with severe anemia, thrombocytopenia, pyuria, hematuria and considerable proteinuria (p < 0.001). Disseminated intravascular coagulation (DIC) and Hemolytic uremic syndrome (HUS) developed in 6.7% and 10% respectively. The index findings demonstrate that Hemiscorpius lepturus sting is usually associated with ADAMTS13 deficiency, and increased ADAMTS13 autoantibody. These combined mechanisms may contribute to scorpion sting-induced coagulopathies and may predispose patients to develop DIC and HUS.