Severe sequelae after stonefish envenomation

Marine Envenomation in Okinawa: Overview and Treatment Concept

Okinawa prefecture is a popular tourist destination due to its beaches and reefs. The reefs host a large variety of animals, including a number of venomous species. Because of the popularity of the reefs and marine activities, people are frequently in close contact with dangerous venomous species and, thus, are exposed to potential envenomation. Commonly encountered venomous animals throughout Okinawa include the invertebrate cone snail, sea urchin, crown-of-thorns starfish, blue-ringed octopus, box jellyfish, and fire coral. The vertebrates include the stonefish, lionfish, sea snake, and moray eel. Treatment for marine envenomation can involve first aid, hot water immersion, antivenom, supportive care, regional anesthesia, and pharmaceutical administration. Information on venomous animals, their toxins, and treatment should be well understood by prehospital care providers and physicians practicing in the prefecture.

[Protracted Course with Finger Amputation Following Stonefish Envenomation]

Eine 53-jährige Frau stellte sich 2,5 Wochen, nachdem sie sich auf Mauritius eine Steinfischstichverletzung am rechten Kleinfinger zugezogen hatte, in unserer Notfallambulanz vor. Sie hatte im Urlaub beim Schwimmen am Meeresufer versehentlich auf einen im Sand vergrabenen Steinfisch gegriffen (Abb. 1). Sofort war es neben massiven Schmerzen am gesamten Arm zu einer Rötung am Kleinfinger und einer Schwellung der Hand gekommen. Nach notfallmäßigem Transport in das nächste Krankenhaus wurde der Patientin dort aufgrund einer starken systemischen Reaktion ein Antidot im Rahmen eines kurzzeitigen intensivmedizinischen Aufenthaltes verabreicht. Bei Blasenbildung wurde eine oberflächliche Wundrevision und eine Kompartmentspaltung palmar an der rechten Hand am Folgetag durchgeführt. Die Narben ließen allerdings auf eine nur minimale Eröffnung der Stichwunde und der Intermetakarpalräume schließen. Eine Antibiotikatherapie erfolgte während des 4-tägigen Krankenhausaufenthaltes mittels Ampicillin/Sulbactam intravenös, welche bei Entlassung oralisiert und bis zur Vorstellung in unserer Klinik fortgesetzt wurde.

The Geographic Distribution, Venom Components, Pathology and Treatments of Stonefish (Synanceia spp.) Venom

Stonefish are regarded as one of the most venomous fish in the world. Research on stonefish venom has chiefly focused on the in vitro and in vivo neurological, cardiovascular, cytotoxic and nociceptive effects of the venom. The last literature review on stonefish venom was published over a decade ago, and much has changed in the field since. In this review, we have generated a global map of the current distribution of all stonefish (Synanceia) species, presented a table of clinical case reports and provided up-to-date information about the development of polyspecific stonefish antivenom. We have also presented an overview of recent advancements in the biomolecular composition of stonefish venom, including the analysis of transcriptomic and proteomic data from Synanceia horrida venom gland. Moreover, this review highlights the need for further research on the composition and properties of stonefish venom, which may reveal novel molecules for drug discovery, development or other novel physiological uses.

Clinical characteristics of stonefish "Oni-daruma-okoze" envenomation in Japan

Aim

Stonefish, known in Japan as "Oni-daruma-okoze" (Synanceia verrucosa Block et Schneider), inhabit the waters surrounding the Okinawa/Amami districts. By far, habubites have been limited to these areas mainly due to climatic conditions. Due to changes promoted by global warming and increasing tourism, concerns regarding the potential for stonefish envenomation as well as jellyfish stings on the main island of Japan are increasing. However, few studies of stonefish envenomation have been reported in Japan. The current study aimed to comprehensively examine for the first time the clinical characteristics of stonefish envenomation in Japan.

Methods

We administered retrospective questionnaire surveys between January 2013 and December 2017 to determine patient characteristics, treatment, and clinical outcomes of stonefish envenomation. We compared patient characteristics between tourists and non-tourists.

Results

Over the 5-year study period, 15 patients were identified from four hospitals. More than 70% of stonefish envenomation cases occurred in the northern part of Okinawa Main Island. All patients recovered well, including four patients with severe stonefish envenomation. In two severe cases, the length of hospitalization was more than 1 week (8-9 days). Antivenom was not given. There were no significant differences between tourists and non-tourists with regard to baseline characteristics.

Conclusions

During a 5-year period, 15 cases of stonefish envenomation occurred in Japan. The patients recovered well without treatment with antivenom.

Stonefish envenomation

As more Americans travel in greater numbers in search of exotic destinations, they may encounter dangerous marine life that hide in reefs and shallow marine waters. In this case report, we describe a case of stonefish envenomation and provide a review of the literature on management and prevention.