International Journal of Bioinformatics and Biomedical Engineering

Vol. 1, No. 2, 2015, pp. 147-152

http://www.aiscience.org/journal/ijbbe

Scorpion Sting in Different Regions of Sudan:

Epidemiological and Clinical Survey among
University Students
Nahla O. M. Ali1, *, Nuha O. M. Ali2
1
Department of Parasitology, Faculty of Veterinary Medicine, University of Khartoum, Khartoum, Sudan
2
Medical Oncology section, King Faisal Specialist Hospital and Research Centre, Jeddah, Kingdom of Saudi Arabia

Abstract
In this study, a survey was conducted among first class students of the faculty of veterinary medicine at the University of
Khartoum in respect to being stung by scorpions. Data were collected from 200 students in a questionnaire, which includes
information on age, sex, location, time of the day and activity when got stung, site of sting, symptoms and treatment. The
collected data were analyzed and presented in this communication. The highest cases were reported from Darfur region (36%),
followed by Khartoum and Gezira (16%). While, the lowest cases were reported from River Nile and White Nile (4%). 32% of
cases were male, while 68% were females students. The average age of the cases ranges from 17–19 years, and most of them
got stung in childhood at age of 7 years. Some cases have been got stung several times at different age. The time of the day at
which cases got stung varied from early morning, afternoon to night. The activity of the most cases when got stung, was either
outdoor activity or at sleeping time. A range of different clinical symptoms were reported by the different cases. The treatment
adopted by all cases varied between traditional and medical ones. The significance of the above results is discussed in the light
of existing literature.

Keywords
Scorpion Stings, Epidemiological, Clinical, University Students, Survey, Khartoum, Sudan

Received: July 15, 2015 / Accepted: August 7, 2015 / Published online: August 17, 2015
@ 2015 The Authors. Published by American Institute of Science. This Open Access article is under the CC BY-NC license.
http://creativecommons.org/licenses/by-nc/4.0/

SSs are relatively common in the Northern and Western

1. Introduction regions of our country, and the most common subspecies
Scorpion sting resulting in envenomation is a life-threatening responsible for stings are the Leiurus quinquestriatus
emergency and causes serious health problems in tropical and (Abushama, 1961). This scorpion is found in dry
subtropical regions. Scorpion sting (SS) cases are particularly habitats/desert areas on different substrate types (but not in
common in the central and west regions of Sudan due to sand dunes). The species hide in small natural burrows or
geographical location, climate and the socioeconomic under stones etc (Cloudsley-Thompson, 1961); this is one of
structure. There are 1500 subspecies of scorpions worldwide, the world most dangerous scorpion, with very potent venom.
with 50 subspecies having venom dangerous for humans. In This species are medical important, and cause several deaths
South America, North Africa, and the Middle East, the each year. The reported lethal dose (LD) is of the value of
Leiurus quinquestriatus, Androctonus crassicauda, and 0.16-0.50 mg/kg of body weight. A previous study showed
Buthus occitonus subspecies are dangerous (Yılmaz et al., that only localized reactions occur in 97% of the victims, but
2013). the venom can be potentially lethal in children because the
severity of the symptoms is weight-dependent. However,

* Corresponding author
E-mail address: dr_nahla2004@yahoo.com (N. O. M. Ali)
148 Nahla O. M. Ali and Nuha O. M. Ali: Scorpion Sting in Different Regions of Sudan: Epidemiological and Clinical Survey
among University Students

antivenin is available for this species, but should be used v.16.0 software package. Descriptive data were expressed as
only for severe cases. frequency and percentage. Intergroup differences were
Scorpion venom shows variability by subspecies and has a analyzed using chi-square or Fisher test, depending on the
features of the data. A p value below 0.05 was considered
complex structure composed of neurotoxic proteins, salts,
statistically significant.
acidic proteins, and organic compounds, thereby having
neurologic, cardiovascular, hematologic, and renal side Table 1. Abroug’s classification.
effects, in addition to local effects such as redness, pain,
Grade Signsandsymptoms
burning, and swelling (Ismail et al., 1994). Mortality due to GradeI Pain and/or paresthesia at the scorpion sting site.
SSs is associated with cardiac dysfunction and pulmonary Fever, chills, excessive sweating, nausea-vomiting,
GradeII
edema (Razi and Malekanrad, 2008). The clinical picture diarrhea, hypertension and priapism.
GradeIII Cardiovascular, respiratory, and/or neurologic symptoms.
depends on the anatomical location of the sting and the
victim’s age, weight and health status (Tuuri and Reynolds,
2011; de Roodt et al., 2003). Although SSs are more 3. Results
common in adults and males, mortality is higher in children
(Celis et al., 2007; Gueron et al., 1992). Among the 200 students who participated in this survey, 25
(12.5%) were stung by scorpion at sometime of their life,
The aim of this study was to present the epidemiologic and 68% (n=17) were females and 32% (n=8) were males. The
clinical features of 25 cases that have had scorpion sting mean age of the students was 18.48 years. Statistical analysis
among the first class students of the faculty of Veterinary showed a non-significant difference between genders in
Medicine, University of Khartoum. terms of SSs (p>0.005). Cases distribution according to age
and sex is shown in Table 2.
2. Materials and Methods Table 2. The distribution of the scorpion sting cases according to age and
sex.
Study area:
Female Male Total
In the current survey, demographic and clinical data were Age group (year)
n % n % n %
mainly collected from Central Sudan (Khartoum, Gezira, 2-7 11 44 3 12 14 56
Sennar, and White Nile states), Eastern Sudan (Kassala and 8 - 13 4 16 2 8 6 24
14 - 19 2 8 3 12 5 20
Gedariff states), Western Sudan (North Darfur, West Darfur, Total 17 68 8 32 25 100
East Darfur and South Darfur) and Northern Sudan (River
Nile/Berber). More than half of the students have been stung at age of 7
years or below (56%), 24% of them were in the age group 8
Population size and Sampling techniques: to13 years and 20% of them were in the age group14 to19
The estimated population size of Sudan is approaching 40 years.
million. This study retrospectively analyzed the As shown in Table 3, the place of residence was rural region
epidemiologic and demographic features of 25 university in 11(44%) cases and urban in 14 (56%). The distribution of
students out of the class (n=200) who exposed to SS between the first year students according to the regions of Sudan as
January 1998 and January 2015. A questionnaire was filled well as the estimated population in each region of Sudan is
by all students enrolled in this study after the purpose of the illustrated in Figure 1 and Figure 2, respectively. The
survey was explained and that no any biological materials distribution of cases according to their region is shown in
will be taken from them neither any medicine will be given Figure 3 and Figure 4. There was no significant difference
to them during the study. The guidance of the parents of between SS incidents in terms of place of residence
some students were sought to fill the forms, when the SS (p>0.005). The majority of victims were stung by scorpions
occurred in the childhood. The age, sex, place of the incident, while they were at active work (afternoon) (40%) or at night
sting location on body, color of the scorpion, systemic (sleep) (28%) in bed. Eight (32%) cases were stung by a
symptoms, and treatment received, all were included in the scorpion in the morning while putting on their own clothes
form. (Table 3). The location of scorpion sting varies from one case
The clinical severity of the reported symptoms of each case to another. Most of the cases had sting either at fingers (32%)
was evaluated according to Abroug’s classification (Table1). or toes (36%). In respect to the clinical signs, most of the
cases have shown pain (96%) and swelling (92) at the site of
Statistical analysis:
the sting. While 80% have shown excessive sweating, 76%
Statistical analyses of the study data were performed with the chills after the scorpion sting. None of the case has neither
help of the Statistical Package for the Social Sciences (SPSS)
 International Journal of Bioinformatics and Biomedical Engineering Vol. 1, No. 2, 2015, pp. 147-152 149

cardiovascular nor neurologic symptoms. Only 3 cases (12%) have nausea or vomiting.
have respiratory problems. Nearly half of the cases (48%)

Table 3. Demographic and epidemiological data.

n 10
Region
Urban 14 56
Rural 11 44
Color of scorpion
Yellow 13 52
Black 2 8
Activity when got stung
working 10 40
sleeping 7 28
putting on their own clothes 8 32
Location of scorpion sting
Fingers 8 32
Toes 9 36
Ankle 5 20
Back 2 8
Thigh 1 4
Clinical sign
1. Pain and/or paresthesia at the scorpion sting site 24 96
2. Fever 2 2.48
3. Nausea – vomiting 12 48
4. Excessive sweating 20 80
5. Chills 19 76
6. Hypertension 5 20
7. Swelling 23 92
8. Itching 6 24
9. Cardiovascular 0 0
10. respiratory 3 12
11. neurologic 0 0

Figure 1. The distribution of the first year students according to the regions of Sudan.
150 Nahla O. M. Ali and Nuha O. M. Ali: Scorpion Sting in Different Regions of Sudan: Epidemiological and Clinical Survey
among University Students

Figure 2. The estimated population in each region of Sudan. A person for each1kilometer.

Figure 3. The distribution of the scorpion stings among the first year students according to the regions of Sudan.

Figure 4. The geographical distribution of the scorpion sting cases according to the Sudan states.
 International Journal of Bioinformatics and Biomedical Engineering Vol. 1, No. 2, 2015, pp. 147-152 151

As shown in Table 4, the comparison of clinical symptoms hyaluronidases, histamine, and other chemicals (Bawaskar
and Bawaskar, 2012).
between male and female was also analyzed. The two cases
of fever were reported only in female students (100%). The Different scorpions have different venoms. These venoms
pain, swelling and the respiratory signs were distributed in may cause local as well as systemic effects in the first hours.
more or less the same percentage among cases; 65.2 to 66.7% Pain, heat, edema, and hematoma are commonly observed
of female students and 33.3 to 34.8% of male cases, while, locally (GradeI). Systemically, hypotension or hypertension,
itching are equally distributed among students (50:50). The respiratory failure, cardiovascular toxicity, hemolysis, renal
sweating and the chills were both have a similar pattern of failure, and haemorrhages at various sites may be observed
distribution. Of the 12 cases that expressed nausea, 7 (58.3%) (Abroug et al., 1999).
were females and 5 (41.7%) were males, while 3 of the 5 The finding that most of the cases in Khartoum state were
cases that expressed hypertension were females. There was from Omdurman locality is in consistent with the previous
no significant difference between sex of the stung students in study of Mahmoud (1998), that the majority of patients were
terms of clinical signs (p>0.005).
from Omdurman, namely Ombadda.
Table 4. The distribution of the clinical symptoms according to the sex. In this study, all the reported cases from Kassala, River Nile
Female Male Total (Berber), Gezira and White Nile states are only female
Symptom
n % n % n % students. While, in Khartoum state, same number of students
Pain 16 66.7 8 33.3 24 96 were reported for both sex. Overall, females predominate,
Fever 2 100 0 0 2 8
Nausea–vomiting 7 58.3 5 41.7 12 48 and 68% of the cases were below ten years of age. 84% of
Excessivesweating 14 70 6 30 20 80 them had one sting of which 75% had been caused by yellow
Chills 12 63.2 7 36.8 19 76 scorpion. However, 16% of cases had several stings on their
Hypertension 3 60 2 40 5 20
Swelling 15 65.2 8 34.8 23 92 life. Of the symptoms, local pain was very frequent while
Itching 3 50 3 50 6 24 hypertension and shocks were quite common. Half of the
Cardiovascular 0 0 0 0 0 0 cases received traditional treatment or home management.
respiratory 2 66.7 1 33.3 3 12
neurologic 0 0 0 0 0 0
Very few cases received medical treatment in the form of
antiscorpion antivenin.
The time of scorpion sting in some cases is during night or
4. Discussion
early morning, this may be due to the fact that the scorpion is
Scorpions are distributed worldwide, but dangerous SSs are a nocturnal animal with an endogenous rhythm synchronised
common in North Africa, Middle East, India, South America, primarily by alternating light and darkness (Abushama,
southern United States, and Mexico. These dangerous SSs 1961). Most of the cases have SS during the summer (64%)
are great problem in some parts of the world with fatalities in and very few during winter (4%). This finding is similar to a
children especially younger ones. In Sudan, Leiurus previous study in Saudia Arabia (Jarrar and Al-Rowaily,
quinquestriatus (Ehrenberg, 1928) or yellow scorpion is 2008). The ratio between the cases reported during the day
responsible of most of the reported stings in this survey. This time (diurnal) to that during the night (nocturnal) is 3:2. The
species is distributed in Africa (Algeria, Chad, Egypt, Majority of the cases had sting in the exposed limbs,
Ethiopia, Libya, Mali, Niger, Somalia, Sudan and Tunisia) especially the lower limbs (toes).
and Asia (Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi
Previous study has shown that the scorpion stings (SSs) in
Arabia, Syria, Turkey, United Arab Emirates and Yemen).
Sudan usually have a mild course. Approximately 94% of the
Scorpions live in jungles, deserts, and rocky areas; they incidents take place at night in homes in the countryside;
become active at night and feed on insects and sometimes 88% of cases do not require hospital admission (Mahmoud,
small rodents (Abushama, 1964; Abushama, 1968; Altıntaş et 1998).
al., 2002). They possess a wide range of colors, ranging from
This study addresses an important clinical question, however,
straw color to yellow, from light brown to black.
it has some limitations, and for example, the population is
The clinical representation of SS poisoning depends on the consisted from a convenience sample (students). Therefore it
subspecies, age, size, venom amount, and feeding is difficult to extrapolate the obtained results to the general
characteristics of the scorpion as well as seasonal conditions population of any region of Sudan. It should be carried out
(White, 2010). The scorpion venom is a water-soluble in the actual population of each region. Another important
antigenic complex mixture of neurotoxin, cardiotoxin, limitation is that some cases occurred in the childhood which
nephrotoxin, hemolysins, phosphodiesterases, phospholipase, makes it difficult to collect accurate data especially on
152 Nahla O. M. Ali and Nuha O. M. Ali: Scorpion Sting in Different Regions of Sudan: Epidemiological and Clinical Survey
among University Students

clinical symptoms. Certainly, there will be some missing [9] Cloudsley - Thompson J L. (1961). Observations on the
information. biology of the scorpion Leiurus quinquestriatus in the Sudan.
Ent. Month. Mag., vol.97: 153-155.
In conclusion, this survey confirms the prevalence of
[10] De Roodt A R, Garcia S I, Salomon O D, Segre L, Dolab J A,
scorpion stings (SSs) in Sudan of mild symptoms and Funes R F, et al. Epidemiological and clinical aspects of
without any mortality, suggesting that the type of scorpion scorpionism by Tityus trivittatus in Argentina. Toxicon 2003;
venom is weak and is not dangerous like others in different 41: 971-7.
countries. [11] Gueron M, Ilia R, Sofer S. The cardiovascular system after
scorpion envenomation. A review. J Toxicol Clin Toxicol
1992; 30: 245-58.
References [12] Ismail M, Abd-Elsalam M A, al-Ahaidib M S. Androctonus
crassicauda (Olivier), a dangerous and unduly neglected
[1] Abroug F, Nouira S, Saguiga H. Envenomations
scorpion-I. Pharmacological and clinical studies. Toxicon
scorpionniques: avences chimiques, physiopathologiques et
1994; 32: 1599-618.
therapeutiquis. Monograph1994:1-68.
[13] Jarrar B M and Al-Rowaily M A. Epidemiological aspects of
[2] Abroug F, ElAtrous S, Nouira S, Haguiga H, Touzi N,
scorpion stings in Al-Jouf Province, Saudi Arabia. Ann Saudi
Bouchoucha S. Serotherapy in scorpion envenomation: a
Med. 2008 May-Jun; 28(3): 183-7.
randomised controlled trial. Lancet.1999 Sep11;354(9182):
906-9. [14] Mahmoud E S M. (1998). Pattern of Scorpion Stings in
Sudanese Children. Clinical M D, Faculty of Medicine,
[3] Abushama F T. (1961). Some Aspects of The Biology of
University of Khartoum.
Leiurus quinquestriatus (H and E): A Common Scorpion
Species in the Central Sudan. M.Sc. Faculty of Science, [15] Razi E and Malekanrad E. Asymmetric pulmonary edema
University of Khartoum. after scorpion sting: a case report. Rev Inst Med Trop Sao
Paulo 2008; 50: 347-50.
[4] Abushama F T. (1964). On the behaviour and sensory
physiology of the scorpion Leirus quinquestriatus. Animal [16] Tuuri R E and Reynolds S. Scorpion envenomation and
behaviour, vol.12:140-153. antivenom therapy. Pediatr Emerg Care 2011; 27: 667-75.
[5] Abushama F T. (1968). Observations on the mating behaviour [17] White J. Venomous animals: clinical toxinology. EXS. 2010;
and birth of Leiurus quinquestriatus (H. & E.), a common 100: 233-91.
scorpion species in the Central Sudan. Rev. Zool. Bit. Afr.,
vol.77: 37-43. [18] Yılmaz F, Arslan E D, Demir A, Kavalci C, Durdu T, Yılmaz
M S, Yel C, Akbulut S. (2013). Epidemiologic and clinical
[6] Altıntaş K. Tıbbi parazitoloji MN Medikal Nobel 2002: 364-7. characteristics and outcomes of scorpion sting in the
southeastern region of Turkey. Ulus Travma Acil Cerr Derg
[7] Bawaskar H S and Bawaskar P H. Scorpion sting: update. J
2013; 19(5): 417-422.
Assoc Physicians India 2012; 60: 46-55.

[8] Celis A, Gaxiola-Robles R, Sevilla-Godinez E, Orozco

Valerio Mde J, Armas J. Trends in mortality from scorpion
stings in Mexico, 1979-2003. Rev Panam Salud Publica 2007;
21: 373-80.