Deadliest scorpion?

[Johnn]

Here is that case report of 18 children ranging from 2 years old - 14 years old envenomated by Leiurus hebraeus.

Mild envenomations - 6
Moderate envenomations - 11
Severe envenomations - 1 (admitted 24 hours after sting)



All 18 children survived.

Free open access:

https://journals.sagepub.com/doi/10.1191/096032700666836486

Screenshots from a unrelated report:
View attachment 435256
View attachment 435257


Of course this is just one case report, and is only posted to show the variability of scorpion envenomations even in children. But presume nothing, your pet H. tamulus, L. quinquestriatus, P. transvaalicus, etc is packing a loaded chamber.

Yeah I agree LQs aren't that bad. Same with p transvaalicus. But I assume the h tamulus to be packing a serious punch.

 

[Outpost31Survivor]

Yeah I agree LQs aren't that bad. Same with p transvaalicus. But I assume the h tamulus to be packing a serious punch.

No, both P. transvaalicus and L. quinquestriatus can both cause very serious envenomations even life threatening stings in children and adults both that is why they can never be written off as "aren't that bad". Scorpion envenomations are wholly unpredictable is my point. Scorpions can control the amount of venom and the amount of neurotoxic proteins and peptides they use in their venom when they sting humans. Their stinging apparatus is like a phaser from Star Trek. They have a stun setting that is loaded with a high concentration pain-inducing K+ salts and they have a kill setting with a higher quantity of neurotoxic proteins and peptides. But yes, statistically speaking scorpion stings are a much more serious and grave matter for children. Even children can survive and walk away with mild stings from medically significant scorpions and adults can even become a fatal statistic due to severe progressive respiratory and cardiovascular morbidity that leads to death instead of recovery.

Read the captions attached to the images below carefully:

 

[ForTW]

This is why i think the question is wierd including two factors. The deadliest scorpion is the one causing the most fatalities therefor must encounter humans.

Including the amount of venom injected is just gambling. Dry stings? Double stings?
Or just the full, potential sting?

Hard to predict what you really get at the end.

 

[Outpost31Survivor]

This is why i think the question is wierd including two factors. The deadliest scorpion is the one causing the most fatalities therefor must encounter humans.

Including the amount of venom injected is just gambling. Dry stings? Double stings?
Or just the full, potential sting?

Hard to predict what you really get at the end.

You are a 100% absolutely correct:

Androctonus mauritanicus: deadliest scorpion Morocco

Androctonus australis: deadliest scorpion North Africa

Leiurus quinquestriatus (?): deadliest scorpion Egypt & Sudan (or maybe A. australis)

Androctonus crassicauda (possibly Leiurus too): deadliest scorpion Middle East & Turkey (the latter may involve a new described species though?)

Hemiscorpius lepturus: deadliest scorpion Iran

Hottentotta tamulus: deadliest scorpion India subcontinent

Parabuthus granulatus: deadliest scorpion southern Africa

Tityus serrulatus: deadliest scorpion Brazil

Centruroides noxius (?): deadliest scorpion Mexico

 

[Outpost31Survivor]

Two free access case reports on Hottentotta tamulus envenomations, I highly recommend reading through both of them thoroughly.


Blistering skin lesion: A new observation of Hottentotta tamulus (white scorpion) sting

Pirasath Selladurai, Prasanth A Sagayanathan, and Thirunavukarasu Kumanan
Additional article information
Abstract
White scorpion (Hottentotta tamulus) stings are an emerging health hazard in northern Sri Lanka and are increasingly recognized particularly during the last decade. The stings are usually harmless; however, fatal cardiovascular sequelae ensues following severe envenomation. It is often difficult to identify this miniature creature and its site of sting due to its nature of habitat and nonspecific local symptoms that develop after the sting. Here, we report a patient who had developed a blistering skin lesion soon after the sting which is not reported in the literature to date by the sting of this particular species. Recognizing it would help the clinicians of this subcontinent to consider scorpion sting as a differential diagnosis for the above presentation in the future.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393814/#!po=2.08333


Scorpion sting envenomation presenting with pulmonary edema in adults: a report of seven cases from Nepal.

U. Bhadani, M. Tripathi, +1 author R. Pandey

Medicine

Indian journal of medical sciences
Scorpion sting is a common problem in villages of Eastern Nepal. The life-threatening complications of myocarditis and pulmonary edema is known in red scorpion in India but not reported in Nepal. This condition requires urgent attention and ICU care from few hours to days. Delay in recognition and the hypoxemia increase the morbidity and mortality. Illiteracy, ignorance, poverty, traditional faith healers trying treatment in remote areas, lack of transport in difficult terrains and the non availability of ventilation facility in nearby hospital, add to delay in appropriate treatment. Seven young adult patients admitted in a span of two years with history of scorpion sting presenting with pulmonary edema required ICU care. They were successfully managed with the positive pressure ventilation with PEEP, cardiac support with inotropes and fluid balance. Magnitude of problem, clinical presentation and management done is emphasized.

https://www.semanticscholar.org/pap...athi/cdd161384cd40442d8351b0de8928e1d62dd44d4

 

[Outpost31Survivor]

Here is an old German sting report that I translated myself using Google, regarding the stings of a few Buthids. If his B.o sting was by a genuine one from France (not considered dangerous) or by a B.o. from North Africa before the revisions (potentially very dangerous) is not known.

"I have already been stung by A. australis, H. jayakari, Euscorpius italicus, and Buthus occitanus and only had the normal bee sting symptoms, i.e. a slightly painful pull at the sting point. But the sting of Tamulus was awesome. In 2004 I was stabbed in the index finger of my right hand by a juvenile animal (3-4 cm KL), I have never experienced such pain, for about 12 hours ... The finger was twice as swollen and I was up the right side of the arm paralyzed up to the neck for 24 hours ... The poison was yellowish, similar to Poecilotheria. Weighs about 80 kg, think with children or something that would have turned out pretty bad. The "Red Scorpion" is one of the most notorious scorpions in India and there is not a single village that has not reported any deaths of this kind."


Medically significant scorpion envenomations are highly variable and strictly statistically speaking there is a high chance of mild to moderate envenomations of healthy adults. But life threatening severe envenomations are a crucial time-limiting urgent medical emergency. The hobbyists that have been stung by the highly venomous scorpions should count themselves fortunate and participation in any irrational high risk taking behavior like handling of medsig scorpions or intentionally being envenomated by medsig requires strong discouragement (most notably species that are responsible for human fatalities).

An adult male in U.A.E. suffered a mild evenomation from an adult Hottentotta jayakari early last July 2022:

"Good day. My husband is working in the UAE. He was sting by this scorpion about 40 minutes ago. Is this scorpion venomous? His finger is a bit swollen and he says it's a burning pain.

Thank you so much
. he is on his way to a clinic in Dibba. His finger is just swollen and he says it's very painful. That is the only symptoms so far.

I needed to hear that, thank you. I am a bit stress about it. Yes, he is busy searching for a medical centre. It's been an hour now and still only swelling and extreme pain. I will keep you posted. Thank you so very much.

I would feel better after his been to the medical centre. His got a bit of a sweat but heart rate and breathing still fine.

they checked his vitals , it's fine. They are giving him an injection for pain and inflammation, then he can go. So relieved . Thank you so much for all your information and help. I am very grateful"

Confirmed envenomation by Hottentotta jayakari of an adult male working in U.A.E. Positive photo ID. Incident report: "he was in his living quarters, he picked up his laundry to put into the washing machine when he felt the stung and then saw the scorpion."

Symptoms included: swelling, pain, burning, and sweating.

Reported to medical center approximately one hour after sting. His vitals were checked and found fine. He was treated with an injection for pain and inflammation and immediately released. They also gave him a tetanus shot.

Iran had recently added H. jayakari to their list of medically significant scorpions due to extensive medical treatment in children and one pediatric case of bone marrow infection.

European breeder had been stung six times by H. jayakari and all resulted in mild envenomations:

 

[Royal Rover]

I’m not a scorpion expert, but have been reading about them since I was a secondary school student. I think this topic resembles that of the deadliest snakes. We never put the inland taipan ahead of the black mamba or king cobra because toxicity isn’t the sole factor to consider, but venom delivery efficiency, yield per bite or sting (as you mentioned) & general temperament of that particular species. L.q. is nowhere near the top. To me, A.c. or A.a. comes in my mind for its large size, venom yield & temperament. The H.t. I’ve seen is sensitive but alright.

This is why i think the question is wierd including two factors. The deadliest scorpion is the one causing the most fatalities therefor must encounter humans.

Including the amount of venom injected is just gambling. Dry stings? Double stings?
Or just the full, potential sting?

Hard to predict what you really get at the end.

Um… I think this is an issue of definitions. Similar topics have been discussed over & over again in other animal realms, for instance serpents.

The deadliest could purely mean the most toxic to humans, thus having the highest chance of killing a person if it successfully inflicts a bite or sting. This title belongs to the inland taipan in the world of snakes.

It could also be defined as having the highest mortality rate on humans which results from a myriad of factors, including general temperament, venom onset, potency (to humans, not theoretical murine data) & yield per strike, alongside delivery efficiency (fang or sting sizes). This is why the black mamba, king cobra & costal taipan are considered the deadliest.

The deadliest could also mean causing the highest fatalities, as you mentioned, which heavily depends on the species’ proximity to human habitation. Humans have the highest chance to come across one, hence taking a strike from it. Some species with lower mortality rates cause higher no. of deaths annually. This is why the deadliest belong to the lancehead, puff adder & saw-scaled viper.

To me, “the most dangerous” combines all of the above factors. That’s why whenever people arise this issue it’s always debatable.

 

[Outpost31Survivor]

I’m not a scorpion expert, but have been reading about them since I was a secondary school student. I think this topic resembles that of the deadliest snakes. We never put the inland taipan ahead of the black mamba or king cobra because toxicity isn’t the sole factor to consider, but venom delivery efficiency, yield per bite or sting (as you mentioned) & general temperament of that particular species. L.q. is nowhere near the top. To me, A.c. or A.a. comes in my mind for its large size, venom yield & temperament. The H.t. I’ve seen is sensitive but alright.

A. australis and A. mauritanicus (Moricco) dominate the Maghreb region of North Africa in stings and fatalities. Not sure about Egypt and Sudan possibly Leiurus quinquestriatus possibly an Androctonus species.

Androctonus crassicauda, Leiurus spp., and Hemiscorpius lepturus (Iran) literally dominate the whole Middle East in fatalities including the Arabian peninsula.

There is evidence that Leiurus has a lower fatality rate than the three aforementioned synanthropic Androctonus species probably related to yield per a strike. In my experience, I have observed Leiurus deliver a lightning quick strike and usually flees immediately. And I remember in my earliest years of keeping hot scorpions, I tailed an Androctonus australis with my tongs and it would not let go of them. It straightened perfectly straight as a board positioned as a upside down "Y" crucified and was attempting to dig its stinger in to my metal tongs while a sizeable drop of milky venom rolled down my tongs. I surmise it may also be related to temperment.

@Royal Rover

Androctonus crassicauda (Olivier), a dangerous and unduly neglected scorpion—I. Pharmacological and clinical studies

Abstract

Androctonus crassicauda venom has an i.v. LD50 in mice of 0.32±0.02 mg/kg, which makes the scorpion among the most toxic species in the world. Fifty-one non-fatal and one fatal cases of scorpion sting were presented. Pain and tenderness were very common following the sting. Generalized erythema occurred in 20–25% of all infants and children below the age of 5 years. Severe CNS manifestations including seizures, unconsciousness and marked irritability occurred mainly in infants and young children, while hypertension occurred in the majority of victims below the age of 11 years. Two pregnant victims were treated with antivenom with no bad consequences on mothers or foetuses. The fatal case described was inadequately treated with antivenom and presented a rare situation of intracranial coagulation in the basal cisterns or low in the cranial subarachnoid space. The victim developed moderate hydrocephalus of the communicating type with clear ventricular CSF and strongly xanthocromic fluid from lumbar puncture. The effects of A. crassicauda venom on isolated hearts, atria and anaesthetized rat blood pressure appeared to be mediated largely through stimulation of the autonomic nervous system with predominance of sympathetic stimulation and release of tissue catecholamines. Electrocardiograms recorded simultaneously with blood pressure changes showed evidence of ectopic foci during the hypertensive phase and ischaemia, inferior wall infarction and different degrees of heart block during the late hypotensive phase. Androctonus crassicauda venom was unique in following a three-compartment open model comprising a central compartment ‘blood’, a rapidly equilibrating ‘shallow’ tissue compartment and a slowly equilibrating ‘deep’ tissue compartment. The overall elimination half-life, t1/2 beta, was 24 hr, indicating that the venom has the slowest elimination among all known scorpion venoms. The long stay of the venom in the body might explain the increased risk of toxicity and the good potential for treatment with serotherapy even hours after the sting.

https://pubmed.ncbi.nlm.nih.gov/7725329/

Toxicological and epidemiological studies of scorpion sting cases and morphological characterization of scorpions (Leiurus quinquestriatus and Androctonus crassicauda) in Luxor, Egypt

Results
A total of 110 cases of scorpion stings were reviewed, males 81 (72.9%) and females 30 (27.1%), with a mean age of 31.9 ± 17.9 years. Localized pain was the most frequent presenting complaint (89 80.2%), vomiting was the commonest clinical symptom (90.9%). All scorpion stings were due to the most endemic species in North Africa, Leiurus quinquestriatus & Androctonus crassicauda. Death rate among cases was (5.5%) all were Abroug’s Grade III. Cardiac dysrhythmia and subsequent pulmonary edema were the commonest cause of death. Clinical manifestations were more sever in Leiurus quinquestriatus stings while death rate was more in Androctonus crassicauda stings.

Mortality from A. crassicauda was more than caused by L. quinquestriatus... While the sting cases caused by L. quinquestriatus had a little pain and other local manifestations giving the time for the venom to progress in the body silently and produce late sever systemic manifestations and complications...

Leiurus quinquestriatusis scorpion species are more toxic than Androctonus crassicauda, while late presentation of manifestation in Androctonus crassicauda sting cases responsible for bad prognosis and high mortality among such cases.


https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click on image to zoom&p=PMC3&id=6479097_ga1.jpg

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479097/#!po=0.595238

 

[Johnn]

I’m not a scorpion expert, but have been reading about them since I was a secondary school student. I think this topic resembles that of the deadliest snakes. We never put the inland taipan ahead of the black mamba or king cobra because toxicity isn’t the sole factor to consider, but venom delivery efficiency, yield per bite or sting (as you mentioned) & general temperament of that particular species. L.q. is nowhere near the top. To me, A.c. or A.a. comes in my mind for its large size, venom yield & temperament. The H.t. I’ve seen is sensitive but alright.


Um… I think this is an issue of definitions. Similar topics have been discussed over & over again in other animal realms, for instance serpents.

The deadliest could purely mean the most toxic to humans, thus having the highest chance of killing a person if it successfully inflicts a bite or sting. This title belongs to the inland taipan in the world of snakes.

It could also be defined as having the highest mortality rate on humans which results from a myriad of factors, including general temperament, venom onset, potency (to humans, not theoretical murine data) & yield per strike, alongside delivery efficiency (fang or sting sizes). This is why the black mamba, king cobra & costal taipan are considered the deadliest.

The deadliest could also mean causing the highest fatalities, as you mentioned, which heavily depends on the species’ proximity to human habitation. Humans have the highest chance to come across one, hence taking a strike from it. Some species with lower mortality rates cause higher no. of deaths annually. This is why the deadliest belong to the lancehead, puff adder & saw-scaled viper.

To me, “the most dangerous” combines all of the above factors. That’s why whenever people arise this issue it’s always debatable.

Yeah maybe I should have been more clear. As far as what I meant, I was saying if you got stung, what scorpions has the highest mortality rate. So aggression and closeness to people wouldn't be considered, just quantity and potency of venom. I am personally rooting for the Indian red scorpions or hemiscorpius lepturus. I know that hemiscorpius lepturus is the last scorpions I'd wanna be stung by. Even I wouldn't handle one of those guys. I am getting some loxosceles laetas and I might handle them but definitely won't get them to bite me

 

[Outpost31Survivor]

Yeah maybe I should have been more clear. As far as what I meant, I was saying if you got stung, what scorpions has the highest mortality rate. So aggression and closeness to people wouldn't be considered, just quantity and potency of venom. I am personally rooting for the Indian red scorpions or hemiscorpius lepturus. I know that hemiscorpius lepturus is the last scorpions I'd wanna be stung by. Even I wouldn't handle one of those guys. I am getting some loxosceles laetas and I might handle them but definitely won't get them to bite me

It is tough. LD50s only offer a look through a glass, darkly. Two factors that should weigh in is mortality rates. But also mortality rates of age groups between 20 years old and under 50 years old. What can be a lethal yield to children and the elderly usually is not a lethal yield to adults. Not a perfect measure bearing the fact the medical significant scorpion hotspots in the whole world the ones that provide better equipped medical facilities with better emergency response staff whom are better trained to treat severe scorpion envenomations will have a greater reduction of mortalities than vice versa.

EDIT: also greater reduced delayment between severe envenomation and hospital admittance.

 

[Johnn]

It is tough. LD50s only offer a look through a glass, darkly. Two factors that should weigh in is mortality rates. But also mortality rates of age groups between 20 years old and under 50 years old. What can be a lethal yield to children and the elderly usually is not a lethal yield to adults. Not a perfect measure bearing the fact the medical significant scorpion hotspots in the whole world the ones that provide better equipped medical facilities with better emergency response staff whom are better trained to treat severe scorpion envenomations will have a greater reduction of mortalities than vice versa.

EDIT: also greater reduced delayment between severe envenomation and hospital admittance.

Yeah. I'm also meaning deadliest when untreated

 

[Outpost31Survivor]

Yeah. I'm also meaning deadliest when untreated

Under this standard you can not overlook H. lepturus and H. tamulus and their higher mortality rates though a huge percentage are pediatric fatalities but also delayed treatment and poorly equipped, poorly trained emergency care for severe scorpion envenomations also were big contributing factors. But outside of these two:

Leiurus abdullahbayrami?
Androctononus australis?
Androctonus crassicauda?
Androctonus liouvillei?
Androctonus mauritanicus?
Tityus serrulatus? Or other Tityus sp.?
Parabuthus granulatus?

Well, since we are speaking of untreated envenomations that now includes Mexico with species such as C. infamatus, C. suffusus, C. noxius, C. limpidus, etc due to high rate of sting incidences that were causing human fatalities in the hundreds annually. An estimated 82% of the victims were five years and younger, and an estimated 94% were nine years and younger. Now with improved medical care and availability and wider availability of higher grade antivenom has significantly reduced human fatalities but there still remains a high rate of sting incidences in Mexico.

You know what is frightening about severe envenomations from Parabuthus granulatus, P. maximus, and P. transvaalicus? Their venom has neuromuscular toxicity which can lead to severe acute flaccid paralysis and deaths caused by these scorpions involve respiratory and/or cardiac failure.

Here is a sting report of a P. granulatus envenomation that occurred over five years ago:

Our first visit to Kgalagadi this week sadly ended after just one day in the park. On Monday evening at about 7:30pm after a shower at Twee Rivieren rest camp my husband was stung on the foot by the infamous Parabuthus Granularis Scorpion. After much confusion he was taken to Askham by the Rangers and left there. They could not help him and he eventually arrived by Ambulance at Upington medi Clinc at 3am in the morning, totally paralyzed and just escaping death. He has been in ICU for the last 3 days and is slowly getting better. The scorpion was taken with him and also stayed in ICU much to the fascination of all the hospital staff. I took the scorpion back to Kgalagadi and released it back into the main park this morning. While my husband was being discharged from Medi-Clinc at the same time. I just want this post to serve as a reminder for everyone to PLEASE wear proper shoes around camp especially children. This amazing creature is small but lethal. Had it been a child they would have died.

 

[Royal Rover]

A. australis and A. mauritanicus (Moricco) dominate the Maghreb region of North Africa in stings and fatalities. Not sure about Egypt and Sudan possibly Leiurus quinquestriatus possibly an Androctonus species.

Androctonus crassicauda, Leiurus spp., and Hemiscorpius lepturus (Iran) literally dominate the whole Middle East in fatalities including the Arabian peninsula.

There is evidence that Leiurus has a lower fatality rate than the three aforementioned synanthropic Androctonus species probably related to yield per a strike. In my experience, I have observed Leiurus deliver a lightning quick strike and usually flees immediately. And I remember in my earliest years of keeping hot scorpions, I tailed an Androctonus australis with my tongs and it would not let go of them. It straightened perfectly straight as a board positioned as a upside down "Y" crucified and was attempting to dig its stinger in to my metal tongs while a sizeable drop of milky venom rolled down my tongs. I surmise it may also be related to temperment.

I always appreciate academic discussion with science-based info like what you've been providing.

I agree that proximity & general temperament may result in the annual number of stings a particular species inflicts to humans. To me, those A. members indeed are generally more sensitive.
Besides, I think it also depends on the threat display of the animal which is exactly why vipers dominate leagues of almost all continents' most frequent biters because their warning signs are subtle compared with elapids'. People may easily miss out the signals. I'm not sure if that's also the case for scorpions. I'm indeed digging into your info.

Yeah maybe I should have been more clear. As far as what I meant, I was saying if you got stung, what scorpions has the highest mortality rate. So aggression and closeness to people wouldn't be considered, just quantity and potency of venom. I am personally rooting for the Indian red scorpions or hemiscorpius lepturus. I know that hemiscorpius lepturus is the last scorpions I'd wanna be stung by. Even I wouldn't handle one of those guys. I am getting some loxosceles laetas and I might handle them but definitely won't get them to bite me

I see.

H.i. indeed has a cocktail of toxins. I think we also have to consider temperament even if we assume the species inflicts a successful sting because dry sting may result. Some species may not be that willing to inject a fatal dose upon every strike, thus lowering its mortality rate.

That's why I go for A.a. for its potency, yield & general manners. Like I mentioned, delivery efficiency also matters. Those fat-tailed scorpions have a robust apparatus to sting deep into a wound for the venom to take quick action.

LD50 statistics are good references, but sometimes there's a discrepancy between venom effects on rodents and on humans. Rapid onset also significantly boosts one's mortality rate after a sting due to insufficient time for hospitalization.

You know what is frightening about severe envenomations from Parabuthus granulatus, P. maximus, and P. transvaalicus? Their venom has neuromuscular toxicity which can lead to severe acute flaccid paralysis and deaths caused by these scorpions involve respiratory and/or cardiac failure.

Here is a sting report of a P. granulatus envenomation that occurred over five years ago:

Parabuthus has always been overlooked by my peers for their lower potency according to murine LD50 data. I didn't know much about the toxicology before your reply. Definitely gonna check it out even more.

 

[darkness975]

The deadliest scorpion is the one that stung you.

 

[Outpost31Survivor]

Parabuthus has always been overlooked by my peers for their lower potency according to murine LD50 data. I didn't know much about the toxicology before your reply. Definitely gonna check it out even more.

They did a epidemiological survey of 184 Parabuthus transvaalicus envenomations in Zimbabwe and found:

Mild envenomations: 63%
Moderate envenomations: 27%
Severe envenomations: 10%

All victims in this case report survived. But yes, no one should overlook the medical importance of Parabuthus especially the species responsible for human fatalities. They have large venom glands and can yield a copious amount of venom per a sting that has no regard to those LD50 results. LD50s doesn't really hold much water anyways. Severe envenomations by Parabuthus is terrifying with the aforementioned severe acute flaccid paralysis plus another sympton is severe hyperaethesia where any body contact can cause excruciating pain shooting through the victim's body at the point of contact even if it is a soft cloth or even soft running water, etc. And severe envenomations can have slow recoveries.

Here is an excellent video on a severe Parabuthus transvaalicus envenomation and the symptons its neuromuscular toxicity can produce. Please bear in mind this was also an older gentleman and therefore more susceptible to severe envenomations. He also shares how he learned to love and respect this animal.

 

[Outpost31Survivor]

In Turkey, a 30 year old male (noted smoker otherwise healthy) suffered an agonizing moderate non-life threatening envenomation from Leiurus abdullahbayrami. The medical importance of Leiurus abdullahbayrami is associated with severe and fatal cases among children in Turkey and Syria.

Case report

A 30-year-old male was stung by a scorpion in south-eastern Anatolia (c/o Küplüce in Kilis Province, close to the Syrian border) on 06. September 2014 at 9:30 p.m. in the tip of the right thumb. Afterwards, the scorpion was caught and was brought to the laboratory for identification, where it was confirmed to be an adult L. abdullahbayrami female, which is now deposited in the collection of the Natural History Museum Vienna. The event took place at night, approximately 12 kilometres away from the nearest hospital. The habitat was typical for this scorpion species and has been documented before (Yağmur et al. 2009). Within 20 minutes, the person was brought to the emergency department in Kilis.

Upon arrival, the patient complained of severe local pain spreading from his right thumb. He was very calm and showed no sign of abnormal blood pressure and pulse. The patient was a smoker and there is no history of hypertension or cardiac diseases in the recent family tree. It is worth mentioning that this scorpion specimen was previously inadvertently damaged by turning a stone.

After arrival of the ambulance at 9:55 p.m., the medical team decided to monitor the patient and not immediately administer antivenom. However, one litre of sodium chloride was intravenously applied as an infusion and antihistamine was administered. Additionally, in order to reduce the pain, an initial mild painkiller was dispensed in the envenomation area. A full blood count, liver function, electrolyte blood levels and other routine laboratory tests were conducted and all showed normal values after 25 minutes of envenomation. After approximately one hour, the acute pain radiated from the fingertip to the wrist. The area where the aculeus penetrated the skin started to redden. Up to this point, severe pain would sporadically set in and last for approximately four minutes at a time. The patient tried to stay as calm as possible and hold his thumb straight using his muscular strength to avoid additional pain caused by bending the finger or moving it quickly around. Additionally, every few minutes, seizures went down to the feet. After one hour, considering the more or less good condition of the patient, the medical team maintained their decision not to inject antivenom. Nevertheless, the pain was incredibly powerful. The patient held the railings of the bed tightly and his body was shaking because of the relapsing seizures. After two hours, the critical climax had been reached. The patient described this moment as the most painful minutes in his life. The skin of his arm began to contract and the first growth of pimples and small blisters became visible. Any contact of the skin initiated nearly unbearable pain and any active muscle movement in the thumb itself and the hand was impossible. After three hours, the medical team decided to administer new painkillers. They decided to evaluate the patient’s condition every ten minutes to decide if antivenom would be used or not. After reaching this peak, the pain declined. At the end of the six hour observation and treatment period the patient was discharged with no further therapy or medication. The pain was still present, and vertical movement of the arm was not possible. During the following night, the patient was not able to sleep, any slow movement of the arm caused pain. In the morning of the next day (around 14 hours after the sting), a pharmacy was visited and some Ibuprofen Atid 800 mg was bought. After two tablets, the pain reached a bearable level, however numbness in the thumb remained and moving the arm caused pain. The stung area remained hypersensitive and touching the thumb resulted in paresthesia, which gradually resolved over two days. After ten days, another blood test was conducted and it showed more or less normal values.

In conclusion, the initial sting caused mild pain and progressed to a hardly bearable one within three hours. The pain originated in the thumb of the right hand and progressed to the shoulder of the patient. Almost all systemic scorpion envenomation produce pain at the site of the sting and several other symptoms can follow. After the alpha and other toxins, the excess can cause adrenergic, cholinergic effects, sympathetic and parasympathetic effects respectively, and neuromuscular excitation (Isbister & Bawaskar 2014). In this case, only sympathetic effects occurred and only some of the classic effects were seen, i.e. irritability, agitation and seizures. The patient suffered pain, but no cardiovascular effects, arrhythmias, hypotension, multi-organ failure or respiratory failure (Yağmur et al. 2015).

Since the sting was by the most venomous species known to science, the patient was very lucky that a stone, and not his thumb, was the first encounter with the culprit. Some plausible explanations might be that (i) the specimen previously lost some of its venom during the first encounter with a stone, (ii) the scorpion had recently used its venom stinging some other animals and was therefore exhausted, (ii) the species’ venom is more toxic to mice than humans, or (iii) some combination of these. Another possible explanation for this is that the toxic sting contained only a so-called prevenom, highly painful and toxic but with a different mixture of ingredients than a normal sting (Inceoglu et al. 2003). This study did not scrutinize to what extent the venom of L. abdullahbayrami is deadly or not and, therefore, does not portray the real potential power of the venom. However, it constitutes an important starting point and stimulus for exciting future reports. Further research should quantify the true effects and the whole clinical spectrum of the scorpion sting.

(PDF) The case history of a toxic sting of a Leiurus abdullahbayrami scorpion in Turkey

PDF | Scorpion stings are very common in Turkey. Nevertheless, they are not well documented in the literature and were never reported for the recently... | Find, read and cite all the research you need on ResearchGate

www.researchgate.net

 

[ScorpionEvo687]

I don't even own any scorpions or other inverts quite yet, but from what online research I've done it seems to be pretty close between the H. tamulus (Indian red scorpion) that you mentioned and the L. quinquestriatus (Deathstalker scorpion). Both very venomous as far as scorpions are concerned and definitely not to be messed with. Not for beginners.

After having thought on it some more, I'm gonna go H. tamulus for "most dangerous" and L. quinquestriatus (or another Leiurus sp.) "most toxic". Could be wrong on that, but if I had to take a guess H. tamulus probably has the highest number of casualties w/ Leiurus sp. having the strongest venom according to LD50 ratings.

 

[Outpost31Survivor]

After having thought on it some more, I'm gonna go H. tamulus for "most dangerous" and L. quinquestriatus (or another Leiurus sp.) "most toxic". Could be wrong on that, but if I had to take a guess H. tamulus probably has the highest number of casualties w/ Leiurus sp. having the strongest venom according to LD50 ratings.

That is a very common opinion though alot of factors are coming into play. Mice are poor substitutes for humans in acute toxicity tests and the scorpion hobby puts too much investment in them.

Tityus obscurus: LD50 3.13 mg/kg - 12.136 mg/kg

Here is a free access case report on three fatalities caused by Tityus obscurus envenomations and a epidemiological report on France and French territories featuring Tityus obscurus.

Background: More than 1500 scorpion species exist worldwide, with a few scorpion species potentially lethal to humans. About 1 million stings annually result in >3000 deaths, but the incidence and mortality vary greatly by species and location. Physicians working internationally must recognize that resulting toxidromes vary significantly by region. Over the past few decades, South America has reported relatively few deaths and low case mortality rates from envenomations. In Guyana, a small tropical country on its northeast coast, they have been extremely rare. A sudden fatal case cluster suggests an extension of the black scorpion's habitat, an increase in venom toxicity, or both. Case reports: During a 12-month period, Guyana experienced 3 deaths, including 1 adult, from black scorpion (Tityus obscurus) envenomation. The 30-year-old man and 2 young children experienced the same symptom complex, initially appearing well except for pain at the sting site. They soon developed persistent emesis and leukocytosis. All were flown from remote jungle areas to the only public tertiary care hospital where they received maximal available medical support. They gradually developed profound cardiopulmonary failure requiring ventilation and, eventually, dysrhythmias. None had hyperglycemia or pancreatitis, and they had no neurologic abnormalities until developing progressive obtundation immediately before intubation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Scorpion envenomation symptoms, outcomes, and treatment are geographically specific. Patients benefit when clinicians recognize the worldwide variations in grading systems and treatment options, which we discuss and compare to our patients.

https://www.researchgate.net/public..._Fatalities_in_Guyana_and_a_Literature_Review

Abstract: Sixty-seven scorpion species have been described in France and its territories, where they have been found to be heterogeneously distributed. Indeed, only one species can be found on Réunion Island, while 38 species exist in French Guiana. The number of stings is also heterogenous, with up to 90 stings per 100,000 inhabitants occurring annually. Scorpion species can frequently be determined through simple visual factors, including species of medical importance (i.e., Buthus, Centruroides and Tityus). Scorpion venom is composed of local enzymes and peptides with a cysteine-stabilized α/β motif (NaTxs, Ktxs, Calcines), which allow for venom diffusion and the prey’s incapacitation, respectively. Harmful scorpion species are limited to Centruroides pococki in the French West Indies, which can induce severe envenoming, and the Tityus obscurus and Tityus silvestris in French Guiana, which can cause fatalities in children and can induce severe envenoming, respectively. Envenomation by one of these scorpions requires hospital monitoring as long as systemic symptoms persist. Typical management includes the use of a lidocaine patch, pain killers, and local antiseptic. In the case of heart failure, the use of dobutamine can improve survival, and pregnant women must consult an obstetrician because of the elevated risk of preterm birth or stillbirth. France does not have scorpion antivenom, as scorpion stings are generally not fatal.

https://www.mdpi.com/2072-6651/14/10/719

 

[Johnn]

After having thought on it some more, I'm gonna go H. tamulus for "most dangerous" and L. quinquestriatus (or another Leiurus sp.) "most toxic". Could be wrong on that, but if I had to take a guess H. tamulus probably has the highest number of casualties w/ Leiurus sp. having the strongest venom according to LD50 ratings.

I agree. It's like phoneutria spiders and atrax robustus. Phoneutria has the most toxic venom but atrax robustus has the most lethal bite. Yet phoneutria is often falsely believed to be the deadliest because of it's venom potency.

 

[ScorpionEvo687]

I agree. It's like phoneutria spiders and atrax robustus. Phoneutria has the most toxic venom but atrax robustus has the most lethal bite. Yet phoneutria is often falsely believed to be the deadliest because of it's venom potency.

I think from LD50 tests the Hexophthalma sp. Six Eyed Sand Spiders are the most venomous in the world but there's been very few recorded, or even suspected, deaths from the bites of them. Seems they probably don't encounter people as often, or just aren't as prone to bite.