A diver's guide to subaquatic envenomation in the Mediterranean.

INTRODUCTION: Between 40,000 and 50,000 divers and swimmers are envenomated each year and diving as a hobby is becoming increasingly popular. In the Mediterranean, envenomation is most often by Weever fish, Scorpion fish and jellyfish but coral and sea urchins may also be venomous. ENVENOMATION: Most stings cause local inflammation, oedema and pain. The severity of pain varies with the venom and the amount injected. In severe cases, stings may be life-threatening due to cardiogenic or anaphylactic shock or penetration of vital structures. MANAGEMENT: Most cases of envenomation are preventable with a combination of measures including the avoidance of contact through good buoyancy control, the wearing of body-suits, and by maintaining visual awareness. Immediate management is to return to the surface, elevate and wash the site of injury. Immersion in hot water followed by simple analgesics for pain relief has been shown to be more effective than other methods. More severe cases should be identified by symptoms including confusion and heavy bleeding and referred to qualified medical care. CONCLUSION: Envenomation by subaquatic species is common and preventable yet the dissemination of the appropriate knowledge is limited. This knowledge summary provides pertinent information aimed at divers in preventing and managing such injuries.

Marine Envenomation.

Venomous aquatic animals are hazardous to swimmers, surfers, divers, and fishermen. Exposures include mild stings, bites, abrasions, and lacerations. Severe envenomations can be life threatening. This article reviews common marine envenomations, exploring causative species, clinical presentation, and current treatment recommendations. Recommendations are included for cnidaria, sponges, bristle worms, crown-of-thorns starfish, sea urchins, venomous fish, stingrays, cone snails, stonefish, blue-ringed octopus, and sea snakes. Immediate and long-term treatment options and management of common sequelae are reviewed. Antivenom administration, treatment of anaphylaxis, and surgical indications are discussed.

Cone shell envenomation: epidemiology, pharmacology and medical care.

The marine environment presents much danger, specifically in regards to the numerous venomous inhabitants within tropical and subtropical waters. The toxins from one such group of venomous marine snails, commonly referred to as 'cone snails', have been well documented in causing human fatalities. Yet information regarding medical treatment for cone snail envenomation is limited and poorly accessible. To correct this, medical and scientific expertise and literary review on Conus provide a basic and comprehensive directive focused on the medical treatment and post-mortem investigative analysis of cone snail envenomation. We emphasize what we expect to be the most lethal feeding group of Conus and provide a brief background to the epidemiology of their stings. We describe the venom apparatus of Conus and its utility of rapid venom delivery. We have compiled the documented incidences of Conus envenomation to offer thorough reference of known signs and symptoms - this too drawing on personal experiences in the field. We have also made available a brief background to the biochemistry and pharmacology of Conus venoms to highlight their complex nature.

[Problems caused by poisonous tropical marine animals]. / Myrkyllisten trooppisten mereneläivien aiheuttamat ongelmat.

A Finnish physician encounters problems caused by tropical marine animals either during her/his own travelling or while treating travelers who have returned home. Certain species of medusae and cone shells as well as the stings by some fish species are life-threateningly poisonous. A person stung or bitten by any of the most dangerous species must immediately be admitted to the hospital. Foreign material remaining in tissues after stings by echinoderms and spiky fish may cause problems months after the actual injury. The injuries become easily infected, and antimicrobial drug therapy must thus cover gram-negative rod-shaped bacteria as well.

Seafood intoxication by tetrodotoxin: first case in Europe.

BACKGROUND: Tetrodotoxin is considered the most lethal toxin in the marine environment. Prior cases of intoxication previously described correspond to consumption of tetrodotoxin in tropical or subtropical regions of Asia or the Pacific Islands. OBJECTIVES: We present the first European case of tetrodotoxin intoxication in a patient who ingested part of a trumpet shellfish (Charonia sauliae) from the Atlantic Ocean in Southern Europe. CASE REPORT: Our patient suffered general paralysis, including the respiratory muscles, a few minutes after the consumption of a few grams of C. sauliae. Intubation and mechanical ventilation were necessary for 52 h after the intoxication. The corresponding electrophysiologic studies showed complete non-excitability, with no recordable sensory or motor nerve conduction. We detected the presence of tetrodotoxin in the mollusk and the patient's blood and urine by means of high-performance liquid chromatography-mass spectrometry analysis technique. A previous bioassay showed extremely high quantities of the toxin in the mollusk. CONCLUSIONS: This case alerts us to the possibility of a very harmful biotoxin in European coastal waters. This now should be included in the differential diagnosis of similar cases in Europe, and we must be vigilant for its possible presence in Europe.

Report of a human accident caused by Conus regius (Gastropoda, Conidae).

Conus regius is a venomous mollusc in the Conidae family, which includes species responsible for severe or even fatal accidents affecting human beings. This is the first report on a clinical case involving this species. It consisted a puncture in the right hand of a diver who presented paresthesia and movement difficulty in the whole limb. The manifestations disappeared after around twelve hours, without sequelae.

Report of a human accident caused by Conus regius (Gastropoda, Conidae) / Relato de um acidente em ser humano causado por Conus regius (Gastropoda, Conidae)

Conus regius is a venomous mollusc in the Conidae family, which includes species responsible for severe or even fatal accidents affecting human beings. This is the first report on a clinical case involving this species. It consisted a puncture in the right hand of a diver who presented paresthesia and movement difficulty in the whole limb. The manifestations disappeared after around twelve hours, without sequelae.

Conus regius é um molusco venenoso da família Conidae, que inclui espécies responsáveis por acidentes graves ou mesmo fatais em humanos. Os autores relatam pela primeira vez um caso clínico envolvendo a espécie, que inclui uma punctura na mão direita de um mergulhador submarino, que apresentou parestesias e dificuldade de movimentação do membro todo. O quadro desapareceu em cerca de doze horas, sem seqüelas.

Venomous mollusks: the risks of human accidents by conus snails (gastropoda: conidae) in Brazil.

Mollusks of the genus Conus present a venomous apparatus composed of radulae, a chitin structure linked to glands, which injects potent neurotoxic peptides, causing serious human envenomation and even death, associated with the blockage of certain receptors and muscular paralysis. No reported envenomation has occurred in Brazil, but certain populations are at risk of accidents.

[The man and the sea: marine phytoplancton and public health]. / El hombre y el mar: fitoplancton marino y salud pública.

The progressive, world-wide emergence of the natural phenomenon "red tide" normally ignored because of the exceptionality or exotic nature of its sanitary and medical formation, is a risk already present in Spain and Europe, with a certain repetition and under some of the ethiological and clinical forms which were previously unknown to us. Today under the conventional denomination of "Harmful Algae Blooms" (HABs) they have given rise to an extensive investigation, to much bibliography and an almost universal sanitary legislation, as well as a preventive preoccupation of the some states which have become aware that this is a potential and practically unavoidable risk. In this work the basic facts of HABs, their eco-epidemiology and the knowledge of toxic syndroms produced by the marine phytoplancton, represented by some Dinoflagellates and Diatomeas, and Cyanobacteria, are reviewed.

[Neurological manifestations of fish, mollusk and shellfish poisoning]. / Manifestations neurologiques des intoxications par les poissons, mollusques et crustacés.

Sea-food poisoning is observed in several areas of the world. Intoxication results from ingestion of fresh fish, mollusks, or shellfish contaminated by toxins produced by microorganisms (dinoflagellates). Neurological manifestations are sometimes associated with signs and may be life-threatening. We describe here the principle toxins, their geographic distribution, clinical manifestations, therapeutic management, and possible prevention measures.

Marine envenomations. Part 2--Other marine envenomations.

BACKGROUND: Australian waters contain a variety of venomous creatures, including jellyfish, stinging fish, blue-ringed octopus, sea snakes, cone snails and stingrays. OBJECTIVE: Part 2 of this article focusses on common marine envenomations other than jellyfish stings. DISCUSSION: Even though mortality from these envenomations is low, there is a high level of morbidity especially with stonefish and other stinging fish envenomations. Some envenomations, however, are serious enough to require antivenom treatment and deaths still occasionally occur.

The toxicology of Octopus maculosa: the blue-ringed octopus.

The biotoxicology of the Australian blue-ringed octopus is detailed with the view of introducing it as a remedy into the homoeopathic Materia Medica and stimulating the second step of proving this venom.

Envenenamiento por contacto con caracol Conus / Poisoning by contact with Conus snail

De los caracoles, la familia Conidae o en forma de cono son los únicos que se sabe que pueden producir picaduras venenosas mortales. Se localizan en todos los mares tropicales del mundo en sustratos arenosos y rocosos. Es importante tener precaución al manipular cualquier caracol en forma de cono. No existe un antídoto conocido, el tratamiento médico es sintomático. Se muestra el manejo médico conocido que ha tenido éxito en evitar un desenlace fatal

Acute liver damage with characteristic apoptotic hepatocytes by ingestion of Aplysia kurodai, a sea hare.

A case of acute liver damage by ingestion of Aplysia kurodai, a sea hare is reported. A 40-year-old man, complaining of vomiting and pyrexia after eating a sea hare, was admitted. Laboratory data showed mild liver damage with sustained elevations of aminotransferases. Microscopic findings in the liver biopsy specimen revealed characteristic apoptotic hepatocytes accompanied by mitotic hepatocytes. It is suggested that bioactive substances in the sea hare might induce such apoptosis of hepatocytes in the liver.

Venomous marine creatures.

BACKGROUND: Many venomous marine creatures inhabit Australian waters, causing significant morbidity and occasional fatalities. No antivenom is available for most of these creatures. Little is known about the venom or syndromes produced by many of these creatures. OBJECTIVE: This article discusses the features of envenomation by some of the more commonly encountered venomous marine creatures, and the recommended first aid and medical management of such envenomations. DISCUSSION: The information contained within this article is intended to provide the reader with an overview of some of the more common marine envenomations, and hopefully with the knowledge to effectively manage such problems.

Intoxicaçöes e envenenamentos por moluscos / Intoxications and poisonings by mollusks

Säo apresentadas informaçöes sobre intoxicaçöes provocadas no homem, pela ingestäo de alguns moluscos como alimentos. Säo discutidos aspectos etiológicos, sua sintomatologia e evoluçäo. Säo também discutidos os envenenamentos provocados pela peçonha de alguns moluscos, a maneira de inoculaçäo, os sinais e sintomas, conseqüências e evoluçäo. Há algumas espécies destes moluscos que vivem no litoral do Brasil