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Echinoderm Envenomation Follow-up

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


Starfish (Asteroidea) and sea urchins (Echinoidea)

Most injuries and envenomations caused by starfish and sea urchins result from inadvertently stepping upon or carelessly handling them. Wading in bare feet in turbid waters, especially at night, should be avoided. While shoes, diving booties, and wet suits may provide some protection, each is easily penetrated by the sharp long spines of the crown-of-thorns starfish and many species of urchin.

The use of thick gloves is recommended if one must handle the crown-of-thorns starfish or any of the sharp-spined sea urchins. This also applies to many sea cucumber species and short-spined sea urchins, particularly the flower urchin (Toxopneustes pileolus), that do not need to produce a puncture wound to envenomate.

Sea cucumbers (Holothuroidea)

The toxins contained in the body wall and white Cuvierian tubules extruded from the anus of some species of sea cucumber may cause significant ocular irritation. Therefore, divers should not clear their masks in close vicinity to a disturbed sea cucumber or touch their eyes after handling sea cucumbers.

Whether significant dermal irritation occurs after contact is debatable (conflicting data are available). Several sources report vigorous inflammatory reactions following direct skin contact with Cuvierian tubules and recommend against touching the white tubules extruded from the anus of some sea cucumbers. Other experts report extensive personal experience and island customs involving direct contact with no adverse effects.



Significant local and systemic effects are possible following echinoderm envenomation from any of the 3 venomous classes, starfish (Asteroidea), sea urchins (Echinoidea), and sea cucumbers (Holothuroidea). However, a clear link between echinoderm envenomation and death (other than subsequent drowning) cannot be found in the literature, despite several anecdotal reports of fatalities.[4, 2, 5, 6] Detailed documentation is sparse, and death must be very rare. This is in contrast to poisoning or intoxication following ingestion of certain echinoderms, which has been well documented to result in severe illness and fatality.


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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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