Is stonefish Synanceia verrucosa envenomation potentially lethal?

Stonefish sting lethality in man has been scarcely documented since the middle of the 20th century. We report three clinical cases, including one fatality, emphasizing the cardiovascular toxicity of the Synanceia verrucosa venom, and its potentially lethal effects. All clinical data have been recently collected in New Caledonia and French Polynesia.

Rhabdomyolysis during envenomation by Physalia sp envenomation in New Caldonia.

We report the first case of rhabdomyolysis following envenomation by a Physalia sp in New Caledonia. Systemic envenomation by this marine hydrozoan is well known, including myalgia as a commonly reported clinical feature. Nonetheless, a related increase in muscle enzymes, featuring rhabdomyolysis, has not previously been described. In this case report, we describe a patient with rhabdomyolysis and acute renal failure. Rhabdomyolysis should be checked in case of systemic physalia envenomation.

[Characterization of poisoning by the coconut crab, Birgus latro, in New Caledonia: aspects of clinical and toxicological features and treatment in 23 cases]. / Caractérisation des intoxications par le crabe de cocotier Birgus latro L. en Nouvelle-Calédonie : données cliniques, toxinologiques et thérapeutiques, à partir de vingt-trois cas.

We report 23 cases of poisoning, 4 fatal, due to ingestion of coconut crab, Birgus latro, in New Caledonia. Clinical and biological features of this poisoning are characterized, and the toxin complex is described. We suggest a treatment strategy based on digoxin-specific antibody fragments for patients in a life-threatening condition.

First successful curative use of digoxin-specific Fab antibody fragments in a life-threatening coconut crab (Birgus latro L.) poisoning.

We wish to report the first curative use of digoxin-specific Fab antibody fragments in a coconut crab Birgus latro L. poisoning in New Caledonia. The female patient, aged sixty-three with a previous history of cardiovascular and metabolic dysfunctions, showed marked first-degree atrio-ventricular block and several atrial pauses, and was given 760 mg of digoxin-specific Fab antibody fragments. Shortly after the perfusion her electrocardiogram returned to close to normal with only slight first-degree atrio-ventricular block and no more atrial pauses. Neriifolin LC-MS/MS tests performed on the patient's serum and urine samples confirmed cardenolide poisoning. Another, younger patient, with high neriifolin levels in her serum and urine samples only experienced gastro-intestinal symptoms and was discharged without specific treatment. The consumption of coconut crab in New Caledonia should be avoided even though the first of the two cases reported suggests that digoxin-specific Fab antibody fragments can be effective in the treatment of life-threatening poisoning caused by the ingestion of this crustacean.

Double lethal coconut crab (Birgus latro L.) poisoning.

We report a double lethal coconut crab Birgus latro L. poisoning in New Caledonia. Both patients died after showing gastro-intestinal symptoms, major bradycardia with marked low blood pressure, and finally asystolia. Both had significative hyperkaliemia, suggesting a digitaline-like substance intoxication. Traditional knowledge in the Loyalty Islands relates coconut crab toxicity to the consumption of the Cerbera manghas fruit by the crustacean. Elsewhere previous descriptions of human poisoning with the kernel of fruits of trees belonging to the genus Cerbera, known to contain cardiotoxic cardenolides, appear to be very similar to our cases. Cardenolides assays were performed on patient's serum samples, fruit kernel and on the crustacean guts, which lead us to suppose these two fatal cases were the result of a neriifolin intoxication, this toxin having been transmitted through the coconut crab.

[Acute circulatory failure following a stonefish envenomation in New Caledonia: case report]. / Envenimation par poisson-pierre: une observation d'inefficacité circulatoire en Nouvelle-Calédonie.

The purpose of this report is to describe a case of severe systemic envenomation with cardiac arrest following a sting by the stonefish Synanceia verrucosa. Although the exact mechanism underlying cardiac arrest is debatable, cardiovascular toxicity of stonefish venom appears to have been involved. This case supports the life-threatening potential of this type of accident, a much-debated topic in recent years.