Marine envenomations from corals, sea urchins, fish, or stingrays
- Geoffrey K Isbister, MD
Geoffrey K Isbister, MD
- Professor, Clinical Toxicology Research Group
- University of Newcastle, Australia
- Section Editors
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Stephen J Traub, MD
Stephen J Traub, MD
- Section Editor — Toxicology
- Associate Professor of Emergency Medicine
- Mayo Medical School
- Michele M Burns, MD, MPH
Michele M Burns, MD, MPH
- Section Editor — Pediatric Toxicology
- Assistant Professor of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Marine injuries due to corals, sea urchins, fish spines, and stingrays will be reviewed here.
Jellyfish and Portuguese man-of-war stings and marine toxins, such as ciguatera, scombroid, and shellfish poisoning, are discussed separately. (See "Jellyfish stings" and "Overview of shellfish and pufferfish poisoning".)
EPIDEMIOLOGY AND CLINICAL MANIFESTATIONS
The mode of envenomations by coral, sea urchins, venomous fish, and stingrays vary by animal. These envenomations are painful. The degree of pain is largely determined by the amount of venom injected and the animal encountered.
The puncture wounds associated with marine envenomations often have retained foreign bodies and are frequently contaminated. Most wounds are superficial although stingrays can cause deep penetrating injuries.
Coral — Coral are cnidarians, like jellyfish, and members of the class Anthozoa . Coral stings and lacerations are common among snorkelers, surfers, and scuba divers who touch, step, or fall onto coral .
- Hodge D. Bites and stings. In: Textbook of Pediatric Emergency Medicine, 6th ed, Fleisher GR, Ludwig S (Eds), Lippincott, Williams, and Wilkins, Philadelphia 2010. p.671.
- Haddad V Jr, Lupi O, Lonza JP, Tyring SK. Tropical dermatology: marine and aquatic dermatology. J Am Acad Dermatol 2009; 61:733.
- Taylor KS, Zoltan TB, Achar SA. Medical illnesses and injuries encountered during surfing. Curr Sports Med Rep 2006; 5:262.
- Morocco A. Sea urchin envenomation. Clin Toxicol (Phila) 2005; 43:119.
- Perkins RA, Morgan SS. Poisoning, envenomation, and trauma from marine creatures. Am Fam Physician 2004; 69:885.
- Isbister GK. Marine envenomation and poisoning. In: Medical Toxicology, 3rd ed, Dart RC (Ed), Lippincott Williams & Wilkins, Philadelphia 2004. p.1621.
- Das SK, Johnson MB, Cohly HH. Catfish stings in Mississippi. South Med J 1995; 88:809.
- Isbister GK. Venomous fish stings in tropical northern Australia. Am J Emerg Med 2001; 19:561.
- Lehmann DF, Hardy JC. Stonefish envenomation. N Engl J Med 1993; 329:510.
- Aldred B, Erickson T, Lipscomb J. Lionfish envenomations in an urban wilderness. Wilderness Environ Med 1996; 7:291.
- Kizer KW, McKinney HE, Auerbach PS. Scorpaenidae envenomation. A five-year poison center experience. JAMA 1985; 253:807.
- Briars GL, Gordon GS. Envenomation by the lesser weever fish. Br J Gen Pract 1992; 42:213.
- Evans RJ, Davies RS. Stingray injury. J Accid Emerg Med 1996; 13:224.
- Clark RF, Girard RH, Rao D, et al. Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases. J Emerg Med 2007; 33:33.
- Fernandez I, Valladolid G, Varon J, Sternbach G. Encounters with venomous sea-life. J Emerg Med 2011; 40:103.
- Snyder CC. Animal bite wounds. Hand Clin 1989; 5:571.
- Auerbach PS. Envenomation by aquatic vertebrates. In: Wilderness Medicine, 6th ed, Elsevier, Philadelphia 2007. p.1732.
- Derr C, O'Connor BJ, Macleod SL. Laceration of the popliteal artery and compartment syndrome resulting from stingray envenomation. Am J Emerg Med 2007; 25:96.
- Reid HA. Epidemiology of sea-snake bites. J Trop Med Hyg 1975; 78:106.
- Kularatne SA, Hettiarachchi R, Dalpathadu J, et al. Enhydrina schistosa (Elapidae: Hydrophiinae) the most dangerous sea snake in Sri Lanka: three case studies of severe envenoming. Toxicon 2014; 77:78.
- Johnston C, Ryan NM, Isbister GK. Sea snake envenoming in Australia causes myotoxicity, local effects and non-specific systemic effects (ASP-24). Clin Toxicol 2016; 54:501.
- Fulde GW, Smith F. Sea snake envenomation at Bondi. Med J Aust 1984; 141:44.
- Warrell DA. Guidelines for the management of snake-bites. World Health Organization, Regional Office for South-East Asia, 2010. http://www.searo.who.int/LinkFiles/BCT_snake_bite_guidelines.pdf (Accessed on March 13, 2012).
- Fegan D, Andresen D. Conus geographus envenomation. Lancet 1997; 349:1672.
- Norton RS, Olivera BM. Conotoxins down under. Toxicon 2006; 48:780.
- Ridenour N. Prevention key to managing swimmer's itch. Nurse Pract 2003; 28:54.
- Parasites - cercarial dermatitis (also known as swimmer's itch) www.cdc.gov/parasites/swimmersitch/faqs.html (Accessed on April 05, 2012).
- Burnett JW, Calton GJ, Morgan RJ. Dermatitis due to stinging sponges. Cutis 1987; 39:476.
- Weinstein S, Dart R, Staples A, White J. Envenomations: an overview of clinical toxinology for the primary care physician. Am Fam Physician 2009; 80:793.
- Burnett JW, Burnett MG. Sea urchins. Cutis 1999; 64:21.
- Wada T, Soma T, Gaman K, et al. Sea urchin spine arthritis of the hand. J Hand Surg Am 2008; 33:398.
- Guyot-Drouot MH, Rouneau D, Rolland JM, et al. Arthritis, tenosynovitis, fasciitis, and bursitis due to sea urchin spines. A series of 12 cases in Réunion Island. Joint Bone Spine 2000; 67:94.
- Dahl WJ, Jebson P, Louis DS. Sea urchin injuries to the hand: a case report and review of the literature. Iowa Orthop J 2010; 30:153.
- Sjøberg T, de Weerd L. The usefulness of a skin biopsy punch to remove sea urchin spines. ANZ J Surg 2010; 80:383.
- Böer A, Ochsendorf FR, Beier C, Kaufmann R. Effective removal of sea-urchin spines by erbium: YAG laser ablation. Br J Dermatol 2001; 145:169.
- Fenner PJ, Williamson JA, Skinner RA. Fatal and non-fatal stingray envenomation. Med J Aust 1989; 151:621.
- Diaz JH. The evaluation, management, and prevention of stingray injuries in travelers. J Travel Med 2008; 15:102.
- Gomez JM, Fajardo R, Patiño JF, Arias CA. Necrotizing fasciitis due to Vibrio alginolyticus in an immunocompetent patient. J Clin Microbiol 2003; 41:3427.
- Currie BJ. Marine antivenoms. J Toxicol Clin Toxicol 2003; 41:301.
- Sutherland SK. Antivenom use in Australia. Premedication, adverse reactions and the use of venom detection kits. Med J Aust 1992; 157:734.
- EPIDEMIOLOGY AND CLINICAL MANIFESTATIONS
- Sea urchins
- Venomous fish
- DIFFERENTIAL DIAGNOSIS
- Jellyfish and sea anemone stings
- Blue-ringed octopus (Hapalochlaena maculosa)
- Sea snake envenomation
- Cone snail
- Marine skin lesions
- - Swimmer’s itch
- - Seabather’s eruption
- - Stinging sponge dermatitis
- Pain control
- Local wound care
- Antibiotic therapy
- Stonefish antivenom
- SUMMARY AND RECOMMENDATIONS