Lionfish envenomation
Background
- Number of camouflaged bottom-dwelling fish fish species within family Scorpaenidae, mostly found in the Indo-Pacific
- Also called zebrafish, firefish, turkeyfish, tastyfish or butterfly-cod
- Fins have spine connected to venom glands which inject venom when agitated
Clinical Features
- Local erythema, ecchymosis, swelling
- Intense, sharp pain
- Australian stonefish can cause systemic toxicity:
- Symptoms peak at 60-90 minutes
- Duration: 1-2 days
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Evaluation
- Clinical diagnosis, no specific testing available
- Consider radiography as retained foreign bodies are common[1]
Management
- Clean wound, update tetanus, remove retained tissue
- One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial [2]
- Immerse extremity in hot water (45 C) for 30-60 minutes
- Stonefish envenomations with severe toxicity can be treated with antivenin obtained through poison control