The discovery and validation of species-specific venom antibodies to inform scorpion sting diagnosis in Morocco and beyond.

Scorpionism can be defined as the pathological condition which may arise following envenoming (via a sting) by medically significant scorpion species. Scorpionism is incredibly variable and can involve only isolated local symptoms, such as pain and swelling, along a spectrum of severity to a very severe life-threatening disease, with the most severe cases progressing to cardiogenic, neurological, respiratory and/or renal failure, which can result in death (Feola et al., 2020, Khattabi et al., 2011, Santos et al., 2016). It is likley that scorpion-human conflict in the form of accidental stinging events is a problem as old as humanity itself, and methods of ridding the house of scorpions are mentioned in the Ebers pypyrus, a medical text produced in Egypt ~3500 years ago (Cloudsley-Thompson, 1990). However, despite the ancient nature of the problem, scorpionism remains profoundly under researched.

In the North African (NA) region the annual incidence of scorpion sting is estimated to be at least ten times higher, and the mortality rate over twenty-seven times higher (~350,000 stings and 805 deaths) than that of snakebite (463-36,208 bites and 20-29 deaths) (Jenkins et al., 2021). Snakebite is designated a neglected tropical disease (NTD) by the World health Organization (WHO), while conversely, efforts to highlight scorpionism by designating it NTD status, brought forward by Morocco and Benin, were rejected in 2018 (11th NTD STAG report 2018). The reason for this rejection was cited as "(scorpion sting is not) immediately amenable to broad control, elimination or eradication by applying one or more of the five public health strategies adopted by the Department for Control of NTDs". This incident underlines the unmet need for robust research into the epidemiology, pathophysiological and therapeutic/prevention aspects of scorpionism and scorpion sting, especially in the North African region.

Morocco in North Africa should be utilised as a "case study" and region of special interest for the study of the epidemiology, pathophysiological and therapeutic/prevention aspects of scorpionism and scorpion sting. In Morocco, scorpion envenoming is considered the primary cause of poisoning in the country by the Centre Anti-Poison et de Pharmacovigilance du Maroc (CAPM) and a national strategy to tackle scorpionism was instated in 1999, and updated in 2013, to reduce the morbidity and mortality caused by scorpionism in Morocco. This strategy highlights that the issue of scorpionism is considered a priority in the country.

One of the major challenges faced in tackling scorpionism in Morocco is the massively diverse scorpion fauna and challenges in determining which species are stinging people and causing notable disease. 68 scorpion species and subspecies, belonging to 12 genera, make Morocco the country with the highest scorpion diversity in North Africa (Touloun et al., 2024). Three of these genera, Androctonus (11 spp.), Buthus (19 spp.) and Hottentotta (3 spp.), contain species of medical importance (Ward et al., 2018). Androctonus mauritanicus and Buthus occitanus, termed the "black" and "yellow" scorpions respectively in much of the epidemiological literature, are considered the foremost and second most dangerous scorpions in the country. However, this raises some important issues. Buthus occitanus is now known to not reside in the country, and envenomings previously attributed to this species should now be considered to be by any of the 19 Buthus species which are confirmed to reside to Morocco. Furthermore, In Morocco, there are several black scorpions, which superficially appear very similar, capable of causing medically significant disease, including several Androctonus species as well as the unduly neglected Hottentotta gentili, which is rarely noted in the literature as envenoming people, but which shares many of the same niches of A. mauritanicus, and with venom which is almost as toxic.