Lionfish and Stonefish Envenomation Differential Diagnoses

  • Author: Scott A Gallagher, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 3, 2011
 
 

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

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

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

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

Disclosure: Nothing to disclose.

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, and American Osteopathic Association

Disclosure: Nothing to disclose.

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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Williamson, JA, Fenner, PJ, Burnett, JW. Venomous and Poisonous Marine Animals: Medical and Biological Handbook. Sydney, Australia: U New South Wales P. 1996: 106-117, 374-387, 418-422.

  2. Aldred B, Erickson T, Lipscomb J. Lionfish envenomations in an urban wilderness. Wilderness Environ Med. Nov 1996;7(4):291-6. [Medline].

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

  4. Auerbach PS. Medical Guide to Hazardous Marine Life. 2nd ed. Flagstaff, Az: Best Pub; 1991:17-19.

  5. Auerbach PS. Wilderness Medicine: Management of Wilderness and Environmental Emergencies. 4th ed. 2001:1492-1497.

  6. Bove AA. Bove and Davis' Diving Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 1997:310-311.

  7. Burnett JW. Aquatic adversaries: stonefish. Cutis. Dec 1998;62(6):269-70. [Medline].

  8. Chan TY, Tam LS, Chan LY. Stonefish sting: an occupational hazard in Hong Kong. Ann Trop Med Parasitol. Dec 1996;90(6):675-6. [Medline].

  9. Cunningham, P, Goetz, P. Pisces Guide to Venomous & Toxic Marine Life of the World. Houston, Tex: Pisces Books; 1996:102-114.

  10. Currie BJ. Marine antivenoms. J Toxicol Clin Toxicol. 2003;41(3):301-8. [Medline].

  11. Edmonds C. Dangerous Marine Creatures: Field Guide for Medical Treatment. 2nd ed. 1995:63-68, 75-79, 239-249.

  12. Garyfallou GT, Madden JF. Lionfish envenomation. Ann Emerg Med. Oct 1996;28(4):456-7. [Medline].

  13. Gwee MC, Gopalakrishnakone P, Yuen R, et al. A review of stonefish venoms and toxins. Pharmacol Ther. 1994;64(3):509-28. [Medline].

  14. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 3rd ed. St Louis, Mo: Mosby; 1996:488-490.

  15. Haddad V Jr. Injuries caused by scorpionfishes (Scorpaena plumieri Bloch, 1789 and Scorpaena brasiliensis Cuvier, 1829) in the Southwestern Atlantic Ocean (Brazilian coast): epidemiologic, clinic and therapeutic aspects of 23 stings in humans. Toxicon. Jul 2003;42(1):79-83. [Medline].

  16. Halstead BW, Auerbach PS. Dangerous Aquatic Animals of the World: A Color Atlas: With Prevention, First Aid, and Treatment. St Louis, Mo: Mosby; 1992:85-88.

  17. Hare JA, Whitfield PE. An integrated assessment of the introduction of lionfish (Pterois volitans/miles) to the western Atlantic Ocean. In: NOAA Technical Memorandum NOS NCCOS 2. Silver Spring, Md: NOAA/NOS/NCCOS; 2003:21.

  18. Hodgson WC. Pharmacological action of Australian animal venoms. Clin Exp Pharmacol Physiol. Jan 1997;24(1):10-7. [Medline].

  19. Isbister GK. Venomous fish stings in tropical northern Australia. Am J Emerg Med. Nov 2001;19(7):561-5. [Medline].

  20. Kizer KW. Marine envenomations. J Toxicol Clin Toxicol. 1983-84;21(4-5):527-55. [Medline].

  21. Kizer KW. Scorpaenidae envenomation. A five-year poison center experience. JAMA. 1985;253 (6):807-10. [Medline].

  22. Lyon RM. Stonefish poisoning. Wilderness Environ Med. 2004;15 (4):284-8. [Medline].

  23. Meir J, White J. Clinical Toxicology of Animal Venoms and Poisons. Boca Raton, Fla: CRC Press; 1995:2-5, 141-151.

  24. Patel MR, Wells S. Lionfish envenomation of the hand. J Hand Surg [Am]. May 1993;18(3):523-5. [Medline].

  25. Perkins RA, Morgan SS. Poisoning, envenomation, and trauma from marine creatures. Am Fam Physician. Feb 15 2004;69(4):885-90. [Medline].

  26. Singletary EH, Adam SR, Bodmer JCA. Envenomations. Med Clin North Am. 2005;89(6):1195-1224.

  27. Soppe GG. Marine envenomations and aquatic dermatology. Am Fam Physician. Aug 1989;40(2):97-106. [Medline].

  28. Sutherland SK. Antivenom use in Australia. Premedication, adverse reactions and the use of venom detection kits. Med J Aust. Dec 7-21 1992;157(11-12):734-9. [Medline].

  29. Taylor DM. An analysis of marine animal injuries presenting to emergency departments in Victoria, Australia. Wilderness Environ Med. 2002;13(2:106-12. [Medline].

  30. Trott AT. Wounds and Lacerations: Emergency Care and Closure. 2nd ed. St Louis, Mo: Mosby; 1997:285-295.

 
Previous
Next
 
Lionfish (Pterois volitans) have long, slender spines with small venom glands, and they have the least potent sting of the Scorpaenidae family. Courtesy Dee Scarr.
Scorpionfish (genus Scorpaena) have shorter, thicker spines with larger venom glands than lionfish do, and they have a more potent sting. Courtesy Dee Scarr.
Stonefish (genus Synanceia) have short, stout spines with highly developed venom glands, and they have a potentially fatal sting. Courtesy Paul S. Auerbach, MD.
Members of the genera Scorpaena, such as these scorpionfish, and Synanceia, such as the stonefish, usually are found well camouflaged on the sandy bottom of the sea or amongst rocks. Shoes or booties may provide some protection; however, it is best to avoid touching the sea bottom or to use a shuffling gait while wading. Courtesy Dee Scarr.
Members of the genus Pterois, such as this lionfish, are usually free-swimming or hovering in small caves or crevices for protection. Provoking these fish by handling or cornering them may result in a painful envenomation. Courtesy Dee Scarr.
In defense of the animals, envenomations and injury generally occur in response to a perceived threat, usually handling or stepping on the animals. Photo by Scott A Gallagher, MD.
A 45-year-old diver was taking photographs in Australia at a depth of 60 feet. He suddenly noticed an excruciating pain in his left foot after resting his foot on a large stonefish. Photo courtesy John Williamson, MD and Surf Lifesaving Queensland.
Top, Brown rockfish of the Scorpaenidae family. Lateral view of the left pelvic spine in articulation with the pelvic girdle. Middle, Anterior view of left pelvic spine (proximal portion) of the brown rockfish. Bottom, Lionfish spine.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.