Lionfish and Stonefish Envenomation
- Author: Scott A Gallagher, MD, FACEP; Chief Editor: Joe Alcock, MD, MS more...
The family Scorpaenidae represents a large array of fish characterized by the ability to envenomate with various types of specialized spines. This group of fish is responsible for the second most common piscine envenomation, after stingrays.
Unfortunately, this family of fish has a confusing variety of common names, which tends to hinder accurate field identification, classification, and understanding of envenomation. It is helpful to consider the Scorpaenidae family as 3 distinct groups, based upon their venom organ structure and toxicity.
These 3 groups and their representative genera include the following (see the images below):
Injury and envenomation are reported in the natural environment (eg, accidental exposure to waders, divers, fishermen), as well as in the home setting (eg, handling by unwary marine aquarists).
See Deadly Sea Envenomations, a Critical Images slideshow, to help make an accurate diagnosis.
Common to the family Scorpaenidae are 12-13 dorsal spines, 2 pelvic spines, and 3 anal spines. Each spine is associated with a pair of venom glands. A loose integumentary sheath covers each spine. The sheath is pushed down the spine during envenomation, causing compression of the venom glands located at the base of the spines. Venom then travels from the glands through anterolateral depressions in the spines and into the wound, in a manner analogous to that of a stingray envenomation. The pectoral spines, while often ornate and plumelike, are innocuous. The venom toxicity is due to antigenic, heat-labile proteins of high molecular weight. Treatment is based on the proposed heat-labile characteristics of these proteins.
The true number of Scorpaenidae envenomations is unknown. However, there are more than 100 reported cases of captive lionfish (genus Pterois) envenomations in the medical literature, nearly all of which occur on the hands of unwary marine aquarists. Reports from coastal locales commonly involve fisherman, divers, and other water enthusiasts who inadvertently may step on or carelessly handle members of the Scorpaenidae family.
This large family is widespread throughout the tropical, subtropical, and temperate regions. Some species are even found in polar regions. No accurate estimates regarding the international frequency of Scorpaenidae envenomations are available; however, they are not uncommon. While the tropical seas contain the majority of species, the temperate waters of the Indo-Pacific, India, South Africa, Australia, Philippines, China, Japan, and the United States are home to many venomous Scorpaenidae.
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. 1996 Nov. 7(4):291-6. [Medline].
Auerbach PS. Marine envenomations. N Engl J Med. 1991 Aug 15. 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. 1998 Dec. 62(6):269-70. [Medline].
Chan TY, Tam LS, Chan LY. Stonefish sting: an occupational hazard in Hong Kong. Ann Trop Med Parasitol. 1996 Dec. 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. 1996 Oct. 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. 2003 Jul. 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. 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. 1997 Jan. 24(1):10-7. [Medline].
Isbister GK. Venomous fish stings in tropical northern Australia. Am J Emerg Med. 2001 Nov. 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]. 1993 May. 18(3):523-5. [Medline].
Perkins RA, Morgan SS. Poisoning, envenomation, and trauma from marine creatures. Am Fam Physician. 2004 Feb 15. 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. 1989 Aug. 40(2):97-106. [Medline].
Sutherland SK. Antivenom use in Australia. Premedication, adverse reactions and the use of venom detection kits. Med J Aust. 1992 Dec 7-21. 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.