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