Studies

Kizer et al. 1985: 45 Lionfish stings (identification: in some cases Pterois volitans; not identified in most cases); aquarium accidents; retrospective study.
Trestrail and Al-Mahasneh 1989: 23 Pterois sp. stings (identified as Pterois sp. 23/23); aquarium accidents; retrospective study.

Case reports

Stock and Bartels 1982: 1 Lionfish sting. Identification: Pterois volitans; aquarium accident.
Auerbach et al. 1987a: 1 Lionfish sting. Identification: Pterois volitans; aquarium accident.

Signs & symptoms

Lionfish venom contains venom components that induce severe pain and cause local tissue necroses.

Local injury: puncture wounds.

Foreign matter, such as remnants of the spine sheath, can remain in the wound and, in addition to causing local toxic effects of the venom and bacterial infections, can lead to poor wound healing and necroses.

Local effects

Local pain 45/45, pain in the entire affected extremity 10/45, local swelling 23/45, paraesthesias locally and/or in the region of the entire affected extremity 7/45, local erythemia or ecchymosis 5/45 (Kizer et al. 1985).
Pain 15/23, swelling 7/23, blisters 2/23 (Trestrail and Al-Mahasneh 1989).

Other signs & symptoms

Systemic signs and symptoms have been described. However, it is not clear to what extent these effects are primary, i.e. caused by systemic action of the venom, or secondary, in association with local signs of envenoming, such as severe pain.

State of anxiety 8/45, nausea or vomiting 6/45, sweating 1/45, respiratory problems 2/45, chest pain 1/45, abdominal pain 1/45, somnolence 1/45, arterial hypotension 1/45, generalised weakness 1/45, facial flushing 1/45, syncope 1/45 (Kizer et al. 1985).
Nausea 5/23, state of anxiety 1/23, disorientation 1/23, headache 1/23 (Trestrail and Al-Mahasneh 1989).

Morbidity

Kizer et al. 1985 (see above): long-term observation of 38/51 patients after a Lionfish sting (35/38) or a Scorpaena guttata sting (3/38). Numbness in the region of the sting for a long period 4/38; bacterial wound infection 4/38; necroses 1/38; tenosynovitis 1/38; scalding after use of the hot water treatment (Kizer et al. 1985).

Case fatality rate

No reported fatalities.

First aid and treatment

Immersion of the affected extremity in water as hot as can be tolerated, especially if it is not possible to get immediate medical assistance (water temperature approx. 45°C; temperature should be checked by a companion or with a healthy extremity in order to avoid burns; duration of treatment if necessary >30 min). The venom of the Pteroinae, which, in addition to the physical injury, is responsible for pain and tissue destruction, is believed to be heat-labile. It is assumed that the hot water treatment may have an inactivating effect on the venom. However, this method is controversial, due to the risk of additional tissue damage. Its efficacy has not yet been documented in a controlled study.

Kizer et al. 1985 (see above): long-term observation of 38/51 patients after a Lionfish sting (35/38) or a Scorpaena guttata sting (3/38). Complete absence of pain shortly after commencing the hot water treatment 30/38. Absence of pain within 24 hours after the sting 38/38.

Symptomatic treatment

Pain: injection of a local anaesthetic without the addition of a vasoconstrictor (lignocaine 1%) directly into and around the wound. Nerve block anaesthesia with lignocaine 1% or preferably bupivacaine because it has a longer duration of action (analogous to Fenner et al. 1989b, Dormon 1985).

Blistering: blisters are opened and emptied with the idea that the contents of the blisters contain substances that can damage tissues (venom components, inflammatory mediators) (Auerbach et al. 1987a).

Injury: removal of foreign matter, wound cleaning and disinfection. Regular wound inspection and dressing changes until the wound has healed fully.

Tetanus prophylaxis. Antibiotic treatment if there is a clinically evident wound infection.

Specific treatment

Because of the similarity of the venoms amongst the scorpaeniform fishes, it is assumed that the "Stonefish antivenom" (CSL, Parkville, Australia) will also be effective in cases of Pteroinae envenoming (Kizer et al. 1985). However, this is neither clinically documented, nor has it been necessary to administer antivenom treatment in the cases of Pteroinae envenoming known to date.