History
Immediately excruciating and incapacitating localized pain follows a sting from members of the Synanceia (stonefish) genus.
This pain may spread to involve the entire limb and regional lymph nodes, peaking at around 60-90 minutes and lasting up to 12 hours if untreated.
Mild subsequent pain may persist for days to weeks.
Less severe, although extremely painful, symptoms are seen following envenomation with members of the Scorpaena (scorpionfish) and Pterois (lionfish) genera.
Physical Examination
The severity of envenomation depends upon multiple factors including the offending species, the number of stings, and the age and underlying health of the victim. Scorpaenidae stings are progressively more severe from Pterois (lionfish) to Scorpaena (scorpionfish) to Synanceia (stonefish).
Puncture wound
See the image below.
A 45-year-old diver was taking photographs in Australia at a depth of 60 feet. He suddenly noticed an excruciating pain in his left foot after resting his foot on a large stonefish. Photo courtesy John Williamson, MD and Surf Lifesaving Queensland.
Classic envenomation reveals one or more puncture wounds, each discolored by a surrounding ring of bluish cyanotic tissue.
Subsequent edema, erythema, and warmth may involve the entire limb, although it rarely results in tissue necrosis in the absence of secondary infection (in marked contrast to stingray envenomation injuries).
Vesicle formation, particularly of the hands, may be followed by rapid tissue sloughing, cellulitis, and surrounding hypesthesia.
Systemic effects may be present (eg, nausea, muscle weakness, dyspnea, hypotension).
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Lionfish (Pterois volitans) have long, slender spines with small venom glands, and they have the least potent sting of the Scorpaenidae family. Courtesy Dee Scarr.
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Scorpionfish (genus Scorpaena) have shorter, thicker spines with larger venom glands than lionfish do, and they have a more potent sting. Courtesy Dee Scarr.
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Stonefish (genus Synanceia) have short, stout spines with highly developed venom glands, and they have a potentially fatal sting. Courtesy Paul S. Auerbach, MD.
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Members of the genera Scorpaena, such as these scorpionfish, and Synanceia, such as the stonefish, usually are found well camouflaged on the sandy bottom of the sea or amongst rocks. Shoes or booties may provide some protection; however, it is best to avoid touching the sea bottom or to use a shuffling gait while wading. Courtesy Dee Scarr.
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Members of the genus Pterois, such as this lionfish, are usually free-swimming or hovering in small caves or crevices for protection. Provoking these fish by handling or cornering them may result in a painful envenomation. Courtesy Dee Scarr.
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In defense of the animals, envenomations and injury generally occur in response to a perceived threat, usually handling or stepping on the animals. Photo by Scott A Gallagher, MD.
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A 45-year-old diver was taking photographs in Australia at a depth of 60 feet. He suddenly noticed an excruciating pain in his left foot after resting his foot on a large stonefish. Photo courtesy John Williamson, MD and Surf Lifesaving Queensland.
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Top, Brown rockfish of the Scorpaenidae family. Lateral view of the left pelvic spine in articulation with the pelvic girdle. Middle, Anterior view of left pelvic spine (proximal portion) of the brown rockfish. Bottom, Lionfish spine.
