Middle East DVEP - Armed Forces Pest Management Board

scorpions frequently rest in shoes or clothing.There is a broad array of scorpions in the Middle East. The two most widely distributedspecies of medical importance are the yellow scorpion, Leiurus quinquestriatus, and theblack scorpion, Androctonus crassicauda. A list of species reported from the Middle Eastis provided in Appendix A.5.Most stings are inflicted on the lower extremities or the arms and hands. During thePersian Gulf War, most stings occurred during the daytime, when scorpions were resting.However, among indigenous populations, stings are more often inflicted at night,especially between the hours of 2100 and 0100, when scorpions are most actively huntingfor prey. In Iran, the most dangerous scorpion, Hemioscorpion lepturus, is more oftenencountered in winter. However, in Jordan, most scorpion stings occur in the hot season,peaking in August.Scorpions can sting multiple times, and when trapped, as with a person in a sleeping bag,will readily do so, as long as the victim is active. Common places where stings areencountered by military personnel include the boots and under or around piled clothing.Scorpion stings broadly affect nearly all body tissues, and they present a mixture ofhemolytic, neurotoxic or cardiotoxic effects. All stings should be considered potentiallydangerous. The severity of scorpion stings can be categorized as follows: 1) patients withpain but no systemic findings; 2) those who in addition to pain have one or two mildsystemic manifestations, such as local muscle spasm, dry mouth, increased salivation, orrunny nose; 3) those who have more severe systemic manifestations but no centralnervous system manifestation or general paralysis; and 4) those who have severe systemicreactions, including CNS involvement, such as confusion, convulsions, and coma, with orwithout general paralysis. Victims also develop uncoordinated eye movements, penileswelling, or cyanosis. The most severe manifestations occur in children, who are moresusceptible to the effects of venom because of their small body mass. Those with type 1,2, or 3 manifestations can be managed by attempting to slow the spread of the venom byapplying ice and supporting the patient with fluids and antihistamines. However, thosewith type 4 manifestations require intensive medical treatment, especially during the first24 hours following the sting. Antivenin therapy is important for severe cases. For thistreatment to be effective, the stinging scorpion must be captured so it can be properlyidentified.To prevent scorpion stings, military personnel should be instructed to empty boots beforeattempting to put them on, carefully inspect clothing left on the ground before dressing,and keep sleeping bags tightly rolled when not in use.11. Simuliidae (black flies, buffalo gnats, turkey gnats). Black flies are small (3 to 5mm), usually dark, stout-bodied, hump-backed flies with short wings. Despite theirappearance, black flies are strong flyers that are capable of dispersing many km from theirbreeding sites. Only females suck blood. They can emerge in large numbers and beserious pests of both livestock and humans. Black flies bite during the day and in theopen. Simulium damnosum tends to have a bimodal pattern of activity, with peaks ofactivity around 0900 h in the morning and 1700 h in the afternoon, but in shaded areasbiting is more evenly distributed throughout the day. The arms, legs and face are common140