Penetrating marine envenomation

The major causes of penetrating marine envenoming or injuries are:
1. Venomous fish: stone fish, catfish, scorpion fish, weever fish
2. Sting rays
3. Echinoderms: sea urchins

There are a huge variety of different venomous fish and stingrays throughout the world which are summarised in tables 1 to 3.

Table 1. List of important groups of venomous fish that have been implicated in envenomation.

Group	Distribution	Examples
Stonefish (Synanceia spp.)	Tropical and warm temperate oceans, including central Pacific, Indo-Pacific and east to the African coast	Australian estuarine stonefish (S. trachynis), the Indian stonefish (S. horrida) and the reef stonefish (S. verrucosa)
Scorpionfish (Scorpaenidae)	Worldwide mainly in tropical and temperate oceans	Lionfish (Pterois volitans), soldierfish or cobbler (Gymnapistes marmoratus), sculpin (Scorpaena guttata), red rock cod(S. ergastulorum), bullrout (Notesthes robusta), Fortesque (Centropogon australis)
Weever fish (Trachinidae)	Mediterranean, European coastal areas, Black Sea, Pacific Ocean of the coast of Chile	Greater weever fish (Trachinus draco) and the lesser weever fish (Echiichtis vipera)
Scats (Scatophagidae)	Indo-Pacific Ocean	Silver scat, striped butterfish or spadefish (Selenotoca multifasciata)
Rabbitfish or happy moments (Siganidae)	Tropical Indo-Pacific region	Siganus spp.
Enoplosidae	Australia (temperate waters)	Old wife (Enoplosus armatus)

Table 2. List of the families of catfish that have been implicated in envenomation.

Family	Distribution	Examples
Ariidae	Worldwide	Arius spp.
Bagridae	Asia, Africa, Japan	Pseudobagrus, Liobagrus reini
Clariidae	Indo-Pacific and India	Clarias batrachus
Doradidae	Fresh waters of South America	Pterodoras granulosus, Centrochir crocodili
Heteropheustidae	India	Heteropneustes fossilis
Ictaluridae	America,	Ictalurus and Noturus
Pimelodidae	South America to Mexico	Pimelodus clarias
Plotosidae	Indo-Pacific region including Australia	Plotosus lineatus, Cnidoglanis megastoma, Tandanus bostocki
Siluridae	Africa and Asia

Table 3. Important families of stingrays and their distributions

Family	Common Name	Examples	Distribution
Urolophidae	Round stingrays or stingarees	Urolophus	Worldwide
Dasyatidae	Stingrays or whip rays	Dasyatis, Taeniura, Urogymnus	Worldwide
Potamotrygonidae	River rays	Potamotrygon	South America
Gymnuridae	Butterfly rays	Gymnura	America
Myliobatidae	Bat or devil rays	Aetobatus narinari, Myliobati	Worldwide
Rhinopteridae	Cow-nosed rays	Rhinoptera	Europe and America

TREATMENT

The treatment of marine injuries is similar with minor modifications depending on the size of the wound and the presence of broken off spines.

First aid

Wound site: wash with water
Bleeding: local pressure
Pain: immerse in hot water (45ºC) for a maximum duration of 90 minutes

Hospital treatment

local irrigation of the wound and removal of foreign material/spines
radiography or ultrasound to identify retained spines or foreign bodies
oral or titrated parenteral analgesia and/or local or regional anaesthesia; the latter may assist with exploration of the wound
stonefish antivenom is available for stonefish stings with severe pain or systemic effects
surgical consultation is required for deep injuries, involvement of joints or bones or retained foreign material
thoracic or abdominal stingray injuries should be treated as major trauma with appropriate resuscitation and surgical intervention
prophylactic antibiotics should be considered for large wounds with foreign material or delayed presentation
all penetrating marine injuries must be reviewed every 24 to 48 hours for the first week