Lionfish envenomation

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Background

Lionfish.jpg
  • 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
  • The fish have alternating brown, to orange and white stripes or spots.
  • They are common to home aquariums & account for the majority of spiny fish related calls to the poison control center in the U.S.[1]
  • Fins have spine connected to venom glands which inject venom when agitated

Clinical Features

Edema and erythema in the right hand of a patient two hours after puncture in the middle finger.
Edema and erythema on the index and medium fingers of the right hand after sting to index finger.
  • Local erythema, ecchymosis, swelling, & variable skin changes (e.g. pallor vs. erythema vs. cyanosis) [2]
  • Intense, sharp pain
  • Symptoms peak at 60-90 minutes
  • Duration: 1-2 days
  • Lesions can progress to hemorrhagic bullae with necrosis.
  • Systemic effects are similar to stonefish.

Differential Diagnosis

Marine toxins, envenomations, and bites

Evaluation

  • Clinical diagnosis, no specific testing available
  • Consider radiography as retained foreign bodies are common[3]

Management

  • Clean wound, update tetanus, remove retained tissue
  • One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial [4]
  • Immerse extremity in hot water (45 C) for 30-60 minutes

Disposition

Patients should be observed for 6-12 hours.

See Also

References

  1. Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 9 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf
  2. Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 9 of 9. ACEP Now.https://www.acepnow.com/wp-content/uploads/2021/08/ACEP_August-2021.pdf
  3. *Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.
  4. *Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.