Stonefish spine puncture - Marine Exposures
The stonefish is the most venomous fish known. They live in shallow waters and are so well camouflaged in both shape and color that they look like a rock. Sometimes they burrow in the sand and mud and remain there, motionless, for hours waiting for small fish or other prey. Stonefish grow up to 50 cm (18 inches) long. They have 13 spines on their back, which become erect when the fish is disturbed. Each spine contains 5–10 mg of venom. Stonefish only inhabit the tropical waters of Indo-Pacific region; there are no stonefish in the waters around the United States.
Stonefish venom is myotoxic and can cause paralysis of cardiac, involuntary, and skeletal muscles.
Stonefish envenomation typically occurs when an unsuspecting swimmer steps on the fish. The most important symptom is immediate, severe, sharp, local pain that can radiate throughout the affected limb. The pain is excruciating and may come in waves. The pain can be so severe that the victim can become delirious or unconscious or even hallucinate. If still in the water, the victim may drown.
If untreated, the pain worsens over the next 1–2 hours and typically persists for 6–12 hours, though an ache can last for weeks as has been observed generally in injuries caused by Scorpaenidae. Pain is most severe in stonefish envenomation, however. In fact, pain coupled with the myotoxic effect of the venom can provoke paralysis. The pain typically spreads to the lymph nodes.
The wound area is initially ischemic and then cyanotic. Subsequent erythema, edema, and warmth may involve the affected limb but is initially restricted to the point of the sting. Vesicles may form followed by tissue sloughing with surrounding cellulitis; this is more common in lionfish envenomation. Necrotic ulceration may occur but is not common. The intensity of the sting depends on the size of the fish, the number of spines penetrating the skin, and other factors, such as body weight and health of the victim.
Stonefish envenomation can cause heart failure, hypotension, syncope, pulmonary edema, and paralysis of the chest muscles. Bradycardia, irregular heart rate, and asystole are common dysrhythmias. Delirium, incoordination, paralysis, and seizures may occur. Stonefish venom can kill a human within 6–8 hours.
Late local complications include paresthesias, bacterial secondary infection, ulceration, granuloma formation, or fibrous soft tissue defects.
T63.591A – Toxic effect of contact with other venomous fish, accidental, initial encounter
241822000 – Poisoning by venomous fish