eMedicine Specialties > Emergency Medicine > Environmental

Conidae: Differential Diagnoses & Workup

Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Coauthor(s): William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
Contributor Information and Disclosures

Updated: Apr 30, 2009

Differential Diagnoses

Anaphylaxis
Snake Envenomations, Sea
Coelenterate and Jellyfish Envenomations
Submersion Injury, Near Drowning
Decompression Sickness
Toxicity, Ciguatera
Dysbarism
Toxicity, Shellfish
Hyperventilation Syndrome
Lionfish and Stonefish
Octopus Envenomations

Workup

Laboratory Studies

  • No assay for cone toxins are currently commercially available.
  • No specific laboratory abnormality is described for cone shell envenomation.
  • In acutely ill individuals, obtain blood for complete blood count, electrolytes, and coagulation studies if indicated.
  • Measure arterial blood gas levels.

Imaging Studies

  • After the airway is secure, imaging studies may aid evaluations for retained stingray barbs, foreign bodies, or other possible causes of local symptoms. Radular teeth are small enough to probably be missed on plain radiography.
  • Imaging studies may also be obtained for evaluation of endotracheal tube placement.

More on Conidae

Overview: Conidae
Differential Diagnoses & Workup: Conidae
Treatment & Medication: Conidae
Follow-up: Conidae
References

References

  1. Yuan DD, Liu L, Shao XX, Peng C, Chi CW, Guo ZY. Isolation and cloning of a conotoxin with a novel cysteine pattern from Conus caracteristicus. Peptides. Sep 2008;29(9):1521-5. [Medline].

  2. Duda TF Jr. Differentiation of venoms of predatory marine gastropods: divergence of orthologous toxin genes of closely related Conus species with different dietary specializations. J Mol Evol. Sep 2008;67(3):315-21. [Medline].

  3. Han TS, Teichert RW, Olivera BM, Bulaj G. Conus venoms- a rich source of peptide-based therapeutics. Current Pharmaceutical Design. 2008;14(24):2462-79. [Medline].

  4. Ekberg J, Craik DJ, Adams DJ. Conotoxin modulation of voltage-gated sodium channels. Int J Biochem Cell Biol. 2008;40(11):2363-8. [Medline].

  5. Atanassoff PG, Hartmannsgruber MW, Thrasher J, Wermeling D, Longton W, Gaeta R, et al. Ziconotide, a new N-type calcium channel blocker, administered intrathecally for acute postoperative pain. Reg Anesth Pain Med. May-Jun 2000;25(3):274-8. [Medline].

  6. Auerbach PS. Marine envenomations. N Engl J Med. Aug 15 1991;325(7):486-93. [Medline].

  7. Brown CK, Shepherd SM. Marine trauma, envenomations, and intoxications. Emerg Med Clin North Am. May 1992;10(2):385-408. [Medline].

  8. Cox B. Calcium channel blockers and pain therapy. Curr Rev Pain. 2000;4(6):488-98. [Medline].

  9. Cruz LJ, White J. Clinical toxicology of Conus snail stings. In: Handbook of Clinical Toxicology of Animal Venoms and Poisons. CRC Press; 1995:117-128.

  10. Dutertre S, Lewis RJ. Toxin insights into nicotinic acetylcholine receptors. Biochem Pharmacol. Sep 14 2006;72(6):661-70. [Medline].

  11. Hahin R, Wang GK, Shapiro BI, Strichartz G. Alterations in sodium channel gating produced by the venom of the marine mollusc Conus striatus. Toxicon. 1991;29(2):245-59. [Medline].

  12. Hawdon GM, Winkel KD. Venomous marine creatures. Aust Fam Physician. Dec 1997;26(12):1369-74. [Medline].

  13. Heinemann SH, Leipold E. Conotoxins of the O-superfamily affecting voltage-gated sodium channels. Cell Mol Life Sci. Jun 2007;64(11):1329-40. [Medline].

  14. Jain KK. An evaluation of intrathecal ziconotide for the treatment of chronic pain. Expert Opin Investig Drugs. Oct 2000;9(10):2403-10. [Medline].

  15. Jin AH, Brandstaetter H, Nevin ST, Tan CC, Clark RJ, Adams DJ, et al. Structure of alpha-conotoxin BuIA: influences of disulfide connectivity on structural dynamics. BMC Struct Biol. 2007;7:28. [Medline].

  16. Kobayashi J, Nakamura H, Hirata Y, Ohizumi Y. Effect of venoms from Conidae on skeletal, cardiac and smooth muscles. Toxicon. 1982;20(5):823-30. [Medline].

  17. Livett BG, Sandall DW, Keays D, Down J, Gayler KR, Satkunanathan N, et al. Therapeutic applications of conotoxins that target the neuronal nicotinic acetylcholine receptor. Toxicon. Dec 1 2006;48(7):810-29. [Medline].

  18. McIntosh JM, Jones RM. Cone venom--from accidental stings to deliberate injection. Toxicon. Oct 2001;39(10):1447-51. [Medline].

  19. Miljanich GP. Ziconotide: neuronal calcium channel blocker for treating severe chronic pain. Curr Med Chem. Dec 2004;11(23):3029-40. [Medline].

  20. Norton RS, Olivera BM. Conotoxins down under. Toxicon. Dec 1 2006;48(7):780-98. [Medline].

  21. Olivera BM. Conotoxins and other biologically active peptides in Conus venoms. Toxicon. 1990;28:256.

  22. Olivera BM, Rivier J, Clark C, Ramilo CA, Corpuz GP, Abogadie FC, et al. Diversity of Conus neuropeptides. Science. Jul 20 1990;249(4966):257-63. [Medline].

  23. Pi C, Liu J, Peng C, Liu Y, Jiang X, Zhao Y, et al. Diversity and evolution of conotoxins based on gene expression profiling of Conus litteratus. Genomics. Dec 2006;88(6):809-19. [Medline].

  24. Rauck RL, Wallace MS, Leong MS, Minehart M, Webster LR, Charapata SG, et al. A randomized, double-blind, placebo-controlled study of intrathecal ziconotide in adults with severe chronic pain. J Pain Symptom Manage. May 2006;31(5):393-406. [Medline].

  25. Sharpe IA, Gehrmann J, Loughnan ML, Thomas L, Adams DA, Atkins A, et al. Two new classes of conopeptides inhibit the alpha1-adrenoceptor and noradrenaline transporter. Nat Neurosci. Sep 2001;4(9):902-7. [Medline].

  26. Teichert RW, Jacobsen R, Terlau H, Yoshikami D, Olivera BM. Discovery and characterization of the short kappaA-conotoxins: a novel subfamily of excitatory conotoxins. Toxicon. Mar 1 2007;49(3):318-28. [Medline].

Further Reading

Keywords

cone shell toxin, cone shell envenomation, cone shell sting, Conidae family, cone shell venom, conotoxin, conus, mollusca envenomation, conotoxin peptides, Conus geographicus, Conus geographus, C geographus, C geographicus, ziconotide, Conus aulicus, C aulicus, Conus gloria-maris, Conus gloriamaris, C gloriamaris, C gloria-maris, Conus marmoreus, C marmoreus, Conus omaria, C omaria, Conus striatus, C striatus, Conus tulipa, C tulipa, Conus textile, C textile, Mollusca, mollusk, mollusc, oligopeptide toxin, radula, radular sheath, cone shell poisoning

Contributor Information and Disclosures

Author

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine
Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Coauthor(s)

William H Shoff, MD, DTM&H, Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania
William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Glaxo Smith Kline Consulting fee Consulting; Glaxo Smith Kline Honoraria Speaking and teaching

Medical Editor

Samuel M Keim, MD, Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine
Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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