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ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesView all Images (5)
Potentially life-threatening emergency
Stonefish spine puncture - Marine Exposures
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Other Resources UpToDate PubMed
Potentially life-threatening emergency

Stonefish spine puncture - Marine Exposures

Print Images (5)
Contributors: Vidal Haddad Jr, MD, MS, PhD, Robert Norris MD, Joanne Feldman MD, MS
Other Resources UpToDate PubMed

Synopsis

Stonefish include several species of venomous fish belonging to the large Scorpaenidae family. There are a great number of fish in this family that are venomous, but the three most important genera are Pterois (lionfish), Scorpaena (scorpionfish), and Synanceja (stonefish). Lionfish typically have long, relatively slender rays of fins with the smallest venom glands and produce the weakest venom. Scorpionfish have shorter but sturdier rays of fins and larger venom glands. Stonefish have the shortest and strongest rays and the largest venom glands and can deliver a much larger dose of far more powerful venom to a victim. Each ray is covered with a loose integumentary sheath. During envenomation, the sheath is pushed down the spine causing compression of the venom glands located at the base of the spines. Venom then travels through grooves in the spines and into the wound.

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.

Codes

ICD10CM:
T63.591A – Toxic effect of contact with other venomous fish, accidental, initial encounter

SNOMEDCT:
241822000 – Poisoning by venomous fish

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Marine animal bites
Envenomation

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Therapy

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References

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Last Updated: 02/19/2010
Copyright © 2018 VisualDx®. All rights reserved.
Potentially life-threatening emergency
Stonefish spine puncture - Marine Exposures
Print 5 Images
View all Images (5)
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Stonefish spine puncture (General) : Cyanosis, Dusky color, Edema, Marine puncture wound, Marine sting, Scuba diving/snorkeling/ocean swimming, Skin warm to touch, Limb pain, Painful skin lesion
Organism image of Stonefish spine puncture
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