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Marine Envenomations
Presentation
After coming into contact with marine life, the patient may seek medical attention because of local pain, swelling, or skin discoloration. While more common in coastal areas, envenomation can also occur from handling animals kept in saltwater aquaria. Marine animal envenomations can be divided into two major categories: macropenetration and micropenetration. Macropenetration occurs after contact with spiny fish or mollusks and is due to stingers and spines that leave visible tissue defects ( Fig. 143.1 ). Micropenetration occurs from contact with cnidaria that contain nematocysts ( Figs. 143.2–143.4 ), cellular spring-loaded harpoons designed for venom delivery underneath the epidermis. Management is fundamentally different. Exact identification of the animal is generally not necessary.
Envenomations that cause severe systemic symptoms such as Irukandji syndrome, seizures, and paralysis as well as poisoning due to ingestion of seafood (e.g., ciguatera, paralytic/neurotoxic/amnesic shellfish poisoning) are beyond the scope of this chapter and will not be discussed here.
Macropenetration
This injury typically occurs in individuals who wade through shallow water. Stingrays have a dorsal reflex that results in whiplike propulsion of the tail and typically leads to lower extremity injuries. Anglers are at risk for upper extremity injuries during attempted removal of a stingray from fishing lines. Other animals (scorpionfish, stonefish, catfish, sea urchin, etc.) possess dorsal (and some species pectoral) spines that penetrate the plantar aspect of the patient’s foot. In addition to the penetrating injury, injected venom often contains hyaluronidase, arachidonic acid, and serotonin, leading to pain out of proportion to the visible injury (see Fig. 143.1 ).
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