Lionfish and Stonefish Envenomation Differential Diagnoses

Updated: Jan 13, 2017
  • Author: Scott A Gallagher, MD, FACEP; Chief Editor: Joe Alcock, MD, MS  more...
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DDx

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

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

It appears as a well-demarcated cellulitis characterized by erythema, edema, and warmth.

Erythromycin, cephalexin, and penicillin VK are all referenced as appropriate first-line treatment.

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

While dissemination is rare, local debridement, adequate drainage, and a prolonged antibiotic course (doxycycline, clotrimazole) are essential to proper 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 the loss of a limb or death.

Vibrio vulnificus septicemia has a 20-50% mortality rate, depending on the source referenced.

Aeromonas infections may be similarly severe and may clinically resemble clostridial gangrene.

Sepsis with these organisms typically requires intensive care support and antimicrobial therapy, based on sensitivity results.

Initial antibiotic therapy is parenteral, broad-spectrum antibiotics, such as an aminoglycoside or third-generation cephalosporin.

Differential Diagnoses