North American scorpion species of public health importance with a reappraisal of historical epidemiology.

Scorpionism is a severe threat to public health in North America. Historically, few species of Centruroides have been considered to be the offending taxa, but we know now that their diversity is greater and our knowledge incomplete. Current distribution maps are inadequate for some species. Epidemiologic studies are sporadic and local, and a complete synthesis for North America is missing. We analyze historical and recent knowledge about the identity, distribution and epidemiology of species of medical importance in North America. PubMed, Google Scholar, the National Collection of Arachnids, and results of recent field work were consulted in the preparation of our analysis. We recognized 21 species and one subspecies of medically important scorpions in need of precise geographical delimitation. All these species are found in Mexico, which is clearly a hotspot for scorpionism. Although mortality has been steadily decreasing, deaths still occur, and morbidity remains high. Mortality is most common at age classes of 0-10 years and >50. Morbidity is highest in age class 15-50 years, including the most economically active segment of the population. The season of the highest incidence of scorpion sting peaks between spring and summer but there appears to be a second, lower peak at the end of the summer. Although the systematics of the genus Centruroides has advanced considerably, our knowledge of its diversity remains fragmentary. There is a disconnection between the actual distribution of the scorpions and the incidence maps constructed from scorpion sting records. Despite a historically robust knowledge of the distribution of well-known species, most recently described species are known from only a few localities. Some of the epidemiological parameters are consistent among studies reported herein.