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Echinoderm Envenomation Differential Diagnoses

  • Author: Scott A Gallagher, MD, FACEP; Chief Editor: Joe Alcock, MD, MS  more...
Updated: Oct 27, 2015

Diagnostic ConsiderationsErysipelothrix rhusiopathiaeMycoplasma marinumVibrio (V vulnificus, V parahaemolyticus) and Aeromonas (A parahaemolyticus, A damsela, A alginolyticus)

Secondary skin infection with Erysipelothrix rhusiopathiae as a result of small abrasions and lacerations acquired while handling marine animals, particularly fish and shellfish, is known as fish handler's disease.

Fish handler's disease appears as a well-demarcated cellulitis that is characterized by erythema, edema, and warmth. Erythromycin, cephalexin, and penicillin VK are referenced as appropriate first-line treatment.

Chronic suppurative and granulomatous lesions may result from wound contamination with seawater containing M marinum.

While dissemination is rare, local debridement, adequate drainage, and prolonged antibiotic therapy (eg, doxycycline, co-trimoxazole) are essential to proper wound therapy.

The most serious marine infections, while rare, result from infection with Vibrio and Aeromonas species. Necrotizing fasciitis, cellulitis, myositis, gas gangrene, and sepsis may result in loss of limb and life.

Vibrio vulnificus sepsis has a 20-50% mortality rate, depending on the source referenced. Aeromonas species infection may be equally severe, clinically resembling clostridial gas gangrene.

Sepsis from these organisms typically requires intensive care support and antimicrobial therapy based on sensitivity results. Initial antibiotic therapy should consist of parenteral broad-spectrum antibiotics, such as an aminoglycoside and third-generation cephalosporin.

Differential Diagnoses

Contributor Information and Disclosures

Scott A Gallagher, MD, FACEP Department of Emergency Medicine, Aspen Valley Hospital; Senior Clinical Instructor, Department of Surgery, School of Medicine, University of Colorado Health Sciences Center

Scott A Gallagher, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

James Steven Walker, DO, MS Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine

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, American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Robert L Norris, MD Professor, Department of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, International Society of Toxinology, American Medical Association, California Medical Association, Wilderness Medical Society

Disclosure: Nothing to disclose.

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Echinoderm envenomations. Close-up of brittle star arm. Although spiny, members belonging to this class (Ophiuroidea) generally are considered harmless. Of the phylum Echinodermata, only starfish (class Asteroidea), sea urchins (class Echinoidea), and sea cucumbers (class Holothuroidea) are capable of envenomation. Photo courtesy of Scott A. Gallagher, MD.
Echinoderm envenomations. Unlike most starfish that are typically pentamerous, the crown-of-thorns starfish (Acanthaster planci) may have as many as 23 arms and a body disc up to 60 cm in diameter. Photo courtesy of Dee Scarr.
Echinoderm envenomations. Detail of the crown-of-thorns starfish (Acanthaster planci) spines, which may grow to 6 cm in length. Photo courtesy of Dee Scarr.
Echinoderm envenomations. Detail of the crown-of-thorns starfish (Acanthaster planci). Photo courtesy of Scott A. Gallagher, MD.
Echinoderm envenomations. The common and toxic sea cucumber, Bohadschia argus, with extruded Cuvierian tubules. Contact with these sticky white tentaclelike organs or their free-floating fragments may result in intense skin or ocular irritation. Photo courtesy of Paul S. Auerbach, MD.
Echinoderm envenomations. Long-spined sea urchins, such as this Diadema species, inflict an acutely painful penetrating injury that may be accompanied by systemic symptoms and chronic wound sequelae. Photo courtesy of Dee Scarr.
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