Conidae Clinical Presentation

Updated: Mar 06, 2017
  • Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Joe Alcock, MD, MS  more...
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A detailed history is essential, when possible, to determine the time of the incident. A typical incident involves walking, swimming, and/or diving in temperate to tropical waters with accidental contact with a cone shell or incorrect handling of a hazardous specimen. If possible, the type of cone should be identified.

Symptoms include the following:

  • Sharp burning or stinging sensation at time of envenomation
  • Local numbness and paresthesias
  • Perioral paresthesias
  • Generalized paresthesias
  • Nausea
  • Blurred vision and diplopia
  • Malaise
  • Generalized weakness
  • Dysphagia
  • Areflexia
  • Aphonia
  • Paralysis
  • Apnea
  • Pruritus
  • Headache


A patient with a cone shell envenomation may manifest an array of symptoms.

Vital signs should include pulse oximetry.

The envenomed area may become swollen and pale or cyanotic.

A pulmonary examination should assess for hypoxia and respiratory failure and/or respiratory arrest.

A cardiac examination should assess for ectopy and tachycardia.

A detailed neurologic examination should assess for the following:

  • Level of consciousness
  • Visual acuity
  • Motor examination
  • Deep tendon reflexes (decreased/absent)

Repetitive vital signs and cardiopulmonary and/or neurologic examination are imperative.



The following may lead to envenomation:

  • Careless or unknowledgeable handling of a hazardous specimen
  • Unsuspecting scuba divers carrying live cone shells in a wet suit, unsecured specimen bag, or buoyancy control device
  • Accidental contact while walking, swimming, and/or diving in shallow, tropical waters
  • Increased opportunities for exposure (eg, in aquarium keepers and handlers)