eMedicine Specialties > Emergency Medicine > Environmental
Lionfish and Stonefish: Follow-up
Updated: Dec 2, 2008
Follow-up
Deterrence/Prevention
- Most injuries and envenomations caused by Scorpaenidae result from inadvertently stepping on, carelessly handling, or harassing them.
- Most Scorpaena (eg, scorpionfish) and Synanceia (eg, stonefish) species are never seen until a sting occurs because of their excellent camouflage amongst rocks or along the sea bottom.
- Wading in bare feet, particularly at night, should be avoided.
- While shoes, diving booties, gloves, and wetsuits may provide some protection, they are easily penetrated by the stout, sharp spines of stonefish, and it is best to avoid touching the sea bottom or to use a shuffling gait while wading.
- Pterois (eg, lionfish) species are frequently free-swimming or hovering in small caves or crevices for protection.
- Do not provoke or corner these fish, as they may dart forward, resulting in an envenomation.
- Marine aquarists, in particular, must be cautious when cleaning their tanks or attempting to transfer captive lionfish.
Patient Education
- For excellent patient education resources, visit eMedicine's Infections Center, Environmental Exposures and Injuries Center, and Bites and Stings Center. Also, see eMedicine's patient education articles Tetanus, The Bends - Decompression Syndromes, and Stingray Injury.
Miscellaneous
Medicolegal Pitfalls
- Recognize the need for tetanus prophylaxis with marine-acquired injuries. Tetanus has caused death following penetrating marine wounds.
- Recognize the potential for wound contamination and subsequent secondary infection with marine-acquired injuries. Puncture wounds and deep lacerations should not be closed in order to prevent infection following primary closure.
- Failure to identify and address retained foreign bodies with the use of alternative imaging techniques and subsequent referral. In one series of marine animal injuries, nearly 20% were associated with a retained foreign body.
- Take care to prevent thermal injury when using hot-water-immersion techniques, particularly if local or regional anesthesia is used as an adjunct.
- Recognize symptoms of diving-related disorders, in the event of an uncontrolled ascent precipitated by painful envenomation at depth.
Special Concerns
- Erysipelothrix rhusiopathiae
- 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.
- Mycoplasma marinum
- 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.
- Vibrio (vulnificus, parahaemolyticus, damsela) and Aeromonas (parahaemolyticus, alginolyticus) species
- 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.
More on Lionfish and Stonefish |
| Overview: Lionfish and Stonefish |
| Differential Diagnoses & Workup: Lionfish and Stonefish |
| Treatment & Medication: Lionfish and Stonefish |
Follow-up: Lionfish and Stonefish |
| Multimedia: Lionfish and Stonefish |
| References |
| « Previous Page | Next Page » |
References
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.
Aldred B, Erickson T, Lipscomb J. Lionfish envenomations in an urban wilderness. Wilderness Environ Med. Nov 1996;7(4):291-6. [Medline].
Auerbach PS. Marine envenomations. N Engl J Med. Aug 15 1991;325(7):486-93. [Medline].
Auerbach PS. Medical Guide to Hazardous Marine Life. 2nd ed. Flagstaff, Az: Best Pub; 1991:17-19.
Auerbach PS. Wilderness Medicine: Management of Wilderness and Environmental Emergencies. 4th ed. 2001:1492-1497.
Bove AA. Bove and Davis' Diving Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 1997:310-311.
Burnett JW. Aquatic adversaries: stonefish. Cutis. Dec 1998;62(6):269-70. [Medline].
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].
Cunningham, P, Goetz, P. Pisces Guide to Venomous & Toxic Marine Life of the World. Houston, Tex: Pisces Books; 1996:102-114.
Currie BJ. Marine antivenoms. J Toxicol Clin Toxicol. 2003;41(3):301-8. [Medline].
Edmonds C. Dangerous Marine Creatures: Field Guide for Medical Treatment. 2nd ed. 1995:63-68, 75-79, 239-249.
Garyfallou GT, Madden JF. Lionfish envenomation. Ann Emerg Med. Oct 1996;28(4):456-7. [Medline].
Gwee MC, Gopalakrishnakone P, Yuen R, et al. A review of stonefish venoms and toxins. Pharmacol Ther. 1994;64(3):509-28. [Medline].
Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 3rd ed. St Louis, Mo: Mosby; 1996:488-490.
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].
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.
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.
Hodgson WC. Pharmacological action of Australian animal venoms. Clin Exp Pharmacol Physiol. Jan 1997;24(1):10-7. [Medline].
Isbister GK. Venomous fish stings in tropical northern Australia. Am J Emerg Med. Nov 2001;19(7):561-5. [Medline].
Kizer KW. Marine envenomations. J Toxicol Clin Toxicol. 1983-84;21(4-5):527-55. [Medline].
Kizer KW. Scorpaenidae envenomation. A five-year poison center experience. JAMA. 1985;253 (6):807-10. [Medline].
Lyon RM. Stonefish poisoning. Wilderness Environ Med. 2004;15 (4):284-8. [Medline].
Meir J, White J. Clinical Toxicology of Animal Venoms and Poisons. Boca Raton, Fla: CRC Press; 1995:2-5, 141-151.
Patel MR, Wells S. Lionfish envenomation of the hand. J Hand Surg [Am]. May 1993;18(3):523-5. [Medline].
Perkins RA, Morgan SS. Poisoning, envenomation, and trauma from marine creatures. Am Fam Physician. Feb 15 2004;69(4):885-90. [Medline].
Singletary EH, Adam SR, Bodmer JCA. Envenomations. Med Clin North Am. 2005;89(6):1195-1224.
Soppe GG. Marine envenomations and aquatic dermatology. Am Fam Physician. Aug 1989;40(2):97-106. [Medline].
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].
Taylor DM. An analysis of marine animal injuries presenting to emergency departments in Victoria, Australia. Wilderness Environ Med. 2002;13(2:106-12. [Medline].
Trott AT. Wounds and Lacerations: Emergency Care and Closure. 2nd ed. St Louis, Mo: Mosby; 1997:285-295.
Further Reading
Keywords
lionfish envenomations, stonefish envenomations, scorpionfish envenomations, Scorpaenidae, Pterois species, Scorpaena species, Synanceia species, Scorpaenidae envenomations
Follow-up: Lionfish and Stonefish