Studies

Kizer et al. 1985: 6 Scorpaena guttata stings (identified); aquarium accidents; retrospective study.

Case reports

USA (California)
Halstead 1951: 1 Scorpaena guttata sting. Identification: criteria not specified.
Abdun-Nur et al. 1981: 1 Scorpaena guttata sting. Identification: criteria not specified.

Signs & symptoms

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

Local injury: puncture injuries.

Foreign matter, such as remnants of sting integument, can remain in the wound and, in addition to causing local toxic effects and bacterial infections, can cause poor wound healing and necroses.

Local effects

Local pain 6/6, pain in the entire affected extremity 1/6, local swelling 4/6, paraesthesias locally and/or in the region of the entire affected extremity 2/6, local erythema or ecchymosis 3/6 (Kizer et al. 1985).

Systemic 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 2/6, nausea or vomiting 2/6, sweating 1/6, generalised weakness 1/6, syncope 1/6 (Kizer et al. 1985).

Morbidity

Wound infections, necroses.

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 Scorpaenidae, 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 Pteroinae 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 Lionfish envenoming (Kizer et al. 1985). However, this is neither clinically documented, nor has it been necessary, apart from accidents with Stonefishes, to administer antivenom treatment in the cases of scorpaeniform envenoming known to date.