LIONFISH ENVENOMATION: CLINICAL ASPECT AND MANAGEMENT
09/02/2018Lionfish envenomation: clinical aspect and management
Şamil Aktaş, Bengüsu Mirasoğlu
Department of Underwater and Hyperbaric Medicine, Faculty of Medicine,Istanbul University, 34093, Çapa, Istanbul, TURKEY
Abstract
Lionfish (Pterois spp.) which is native to Indo-Pacific region has been invading the Turkish coastal region and propagating rapidly as a Lessepsian species in the last years. Envenomation is expected to be encountered more frequently by divers due to its noteworthy appearance and by fishermen due to its novelty in the region. Lionfish sting is mostly seen at hands and results in pain, local edema, erythema and heat at site. Sometimes, cyanosis, pallor, vesicles and tissue necrosis can occur. The systemic signs and symptoms are rare and can be hypo/hypertension, nausea, abdominal pain, fever, dyspnea, convulsions, fainting, paralysis and cardiac failure. Death related to envenomation has not been reported although itis possible. The primary approach in the management of lion fish envenomation is removal of the remaining spines and immersion of the stung part in hot (35-40°C) water. Bleeding should be controlled if present and wound should be cleaned and disinfected. Analgesics are almost always necessary. Tetanus prophylaxis is required for all cases and antibiotics can be administered in case of infection. Imaging techniques can be used to search remaining spine fragments. Lionfish envenomation can be avoided generally by raising awareness and using protective gloves during hunting and cleaning of the fish.
Keywords: Lionfish, Pterois volitans, Pterois miles, venomous fish
References
Auerbach, P.S., McKinney, H.E., Rees, R.S., Heggers, J.P. (1987) Analysis of vesicle fluid following the sting of the lionfish Pterois volitans. Toxicon 25(12): 1350-1353.
Atkinson, P.R.T., Boyle, A., Hartin, D., McAuley, D. (2006) Is hot water immersion an effective treatment for marine envenomation? Emerg Med J 23(7): 503-508.
Church, J.E., Hodgson, W.C. (2002) Adrenergic and cholinergic activity contributes to the cardiovascular effects of lionfish (Pterois volitans) venom. Toxicon 40: 787-779.
Church, J.E., Moldrich, R.X., Beart, P.M., Hodgson, W.C. (2003) Modulation of intracellular Ca2+ levels by Scorpaenidae venoms. Toxicon 41: 679-689.
Cohen, A.S., Olek, A.J. (1989) An extract of lionfish (Pterois volitans) spine tissue contains acetylcholine and a toxin that affects neuromuscular transmission. Toxicon 27:1367-1376.
de Haro, L., Pommier, P. (2003) Envenomation: a real risk of keeping exotic house pets. Vet Hum Toxicol. 45(4): 214-6.
Diaz, J.H. (2014) Skin and soft tissue infections following marine injuries and exposures in travellers. J Travel Med. 21(3): 207-213.
Diaz, J.H. (2015) Marine Scorpaenidae Envenomation in Travelers: Epidemiology, Management, and Prevention. J Travel Med. 22(4): 251-258.
Diaz, J.H., Lopez, F.A. (2015) Skin, soft tissue and systemic bacterial infections following aquatic injuries and exposures. Am J Med Sci. 349(3): 269-275.
Garyfallou, G.T., Madden, J.F. (1996) Lionfish envenomation. Ann Emerg Med. 28(4): 456-457.
Golani, D., Sonin, O. (1992) New records of the Red Sea fishes, Pterois miles (Scorpaenidae) and Pteragogus pelycus (Labridae) from the eastern Mediterranean Sea. Jpn. J. Ichthyol. 39(2): 167-169.
Haddad, V.Jr., Stolf, H.O., Risk, J.Y., França, F.O., Cardoso, J.L. (2015) Report of 15 injuries caused by lionfish (Pterois volitans) in aquarist in Brazil: a critical assessment of the severity of envenomations. J Venom Anim Toxins Incl Trop
Dis 20-21: 8.
Patel, M.R., Wells, S. (1993) Lionfish envenomation of the hand. J Hand Surg Am 18: 523-525.
Resiere, D., Cerland, L., De Haro, L., Valentino, R., Criquet-Hayot, A., Chabartier, C., Kaidomar, S., Brouste, Y., Mégarbane, B., Mehdaoui, H. (2016) Envenomation by the invasive Pterois volitans species (lionfish) in the
French West Indies–a two-year prospective study in Martinique. Clin Toxicol (Phila). 54(4): 313-318.
Schaper, A., Desel, H., Ebbecke, M., de Haro, L., Deters, M., Hentschel, H., Hermans-Clausen, M., Langers, C. (2009) Bites and stings by exotic pets in Europe: An 11 year analysis of 404 cases from Northeastern Germany and Southeastern France. Clinical Toxicology 47: 39-43.
Turan, C., Ergüden, D., Gürlek, M., Yağlıoğlu, D., Uyan, A., Uygur, N. (2014) First record of the Indo-Pacific lionfish Pterois miles (Bennett, 1828) (Osteichthyes: Scorpaenidae) for the Turkish marine waters. J. Black Sea/Medit.
Environ. 20(2): 158˗163.
Turan, C., Öztürk, B. (2015) First record of the lionfish Pterois miles (Bennett 1828) from the Aegean Sea. J. Black Sea/Medit. Environ. 21(3): 334˗338.
Vetrano, S.J., Lebowitz, J.B., Marcus, S. (2002) Lionfish envenomation. J Emerg Med. 23(4): 379-382.