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Lionfish and Stonefish: Follow-up

Author: Scott A Gallagher, MD, FACEP, Chairman, Department of Emergency Medicine, Aspen Valley Hospital; Senior Clinical Instructor, Department of Surgery, School of Medicine, University of Colorado Health Sciences Center
Contributor Information and Disclosures

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

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

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Treatment & Medication: Lionfish and Stonefish
Follow-up: Lionfish and Stonefish
Multimedia: Lionfish and Stonefish
References
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Further Reading

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Keywords

lionfish envenomations, stonefish envenomations, scorpionfish envenomations, Scorpaenidae, Pterois species, Scorpaena species, Synanceia species, Scorpaenidae envenomations

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Contributor Information and Disclosures

Author

Scott A Gallagher, MD, FACEP, Chairman, 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.

Medical Editor

Robert L Norris, MD, Associate 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.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & 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.

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
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.

CME Editor

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

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: eMedicine.com, Inc. Consulting fee Consulting

 
 
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