Envenomation by Trachinus draco and Pain Management.

We report a case of a 42-y-old female patient who sustained a sting to the neck from a Trachinus draco fish. She subsequently developed complications including arytenoid membrane edema secondary to either the local anesthetic agent administered to the wound or the dracotoxin itself. The patient was examined in the emergency department after the sting. Local anesthesia with lidocaine was administered to the areas of injury at another hospital before presenting to our hospital emergency department. The patient reported that her pain partially decreased but hoarseness developed and she had difficulty breathing after the local anesthetic was administered. Laryngeal examination by our hospital's otolaryngologist revealed edema of the patient's right arytenoid membrane without evidence of vocal cord swelling. Computed tomography of the neck revealed edema in the right arytenoid membrane on the side of the neck where the local anesthetic had been injected. The patient, who was given supplementary treatment, was discharged without any complications on the seventh day of hospitalization. The principle treatment for these types of stings includes immersion in hot water, analgesic therapy, and observation for signs of local and systemic envenomation. We recommend using caution when injecting local anesthetic agents in the neck because of underlying vital structures.

Anaphylaxis induced by Thalassophryne nattereri venom in mice is an IgE/IgG1-mediated, IL-4-dependent phenomenon.

We hypothesized that beyond the Thalassophryne nattereri venoms ability to induce in mice a strong specific-Th2 response with high levels of specific IgE/IgG1, it would be able to trigger anaphylaxis in sensitized individuals. To investigate whether the venom is capable of inducing an allergic reaction in mice and characterize soluble and cellular mediators involved in this process, BALB/c female mice were sensitized intraperitoneally with decreasing-dose of venom at weekly intervals for 4 weeks and challenged by intraperitoneal, oral or epicutaneous routes with venom 2 weeks later. Our data show that sensitized-mice challenged by all routes showed intense symptoms of anaphylaxis, dependent on the anaphylactic IgG1 and IgE antibodies and mast cells. The late-phase reaction developed after initial symptoms was characterized by the influx of eosinophils, dependent on IL-5, IL-17A and eotaxin produced by Th2 cells in inflamed lungs and skin draining lymph-nodes. Using C57BL/6 deficient mice we demonstrated that IL-4 KO mice failed to develop anaphylactic symptoms or local Th2 inflammation, producing low levels of IgG1 and increased levels of IgG2a. Together our results demonstrated that the venom of T. nattereri has allergenic proteins that can trigger an allergic process, a phenomenon IgE-IgG1 dependent, IL-4-mediated and negatively regulated by IFN-γ.

Aquatic antagonists: stingray injury update.

Stingrays cause more sting-related injuries than any other fish. Their venom and mechanism of injury lead to painful, poor-healing wounds that often become infected. Stingray injuries are further complicated by retained barbs and foreign bodies, which also may lead to considerable morbidity. Most stingray injuries can be treated with hot water immersion, wound debridement, and prophylactic antibiotics, while some may require more extensive treatment and surgical intervention at a tertiary care center. Educating patients about avoidance strategies, such as wading through water with a shuffling gait and wearing protective leg guards, may help decrease stingray injuries.

The clinical effects of the venomous Lessepsian migrant fish Plotosus lineatus (Thunberg, 1787) in the Southeastern Mediterranean Sea.

CONTEXT: Plotosus lineatus is a venomous fish that has migrated from the Indo-Pacific region to the Mediterranean Sea (Lessepsian migrant). Its presence in the Mediterranean Sea was first recorded in 2002 and was observed in growing schools. Its spines contain toxins with lytic, hemolytic and edematous activities. OBJECTIVE: To characterize the injuries caused by Plotosus lineatus in the Southeastern Mediterranean Sea. METHODS: A prospective observational case series of consultations provided by a national Poison Center pertaining to Plotosus lineatus from 2007 to 2016. Demographic and clinical data and method of fish identification were retrieved from the medical toxicological records, and described. RESULTS: Eighty four cases were included; the main findings are: median age 35 (range 3-80) years, 91.7% males, 51.2% fishermen, 78.6% palm injuries, 94% and 4.8% were mildly and moderately injured, respectively. Main local manifestations included pain, puncture wound, swelling, and erythema (90.5%, 70.2%, 33.3%, and 16.7%, respectively). Systemic signs were minor and infrequent (≤7.1%), including hypertension, tachycardia, vomiting, chills, and weakness. Management included wound disinfection, immersion in hot water, tetanus prophylaxis, and analgesics. No patient required hospital admission. The fish was identified mostly by the victim with the aid of the Poison Center (mainly by typical description, and a picture), and some by marine biologists. CONCLUSIONS: Plotosus lineatus is a new fish in the Southeastern Mediterranean Sea. It affects fishermen handling fishing nets, and beach hikers stepping on or holding it. Injuries caused by its spines usually result in minor effects; pain may be intense. Treatment includes disinfection, analgesics, and antitetanus and antibiotics as needed. No lethal cases were recorded, unlike exposure of animals to the venom of the Indo-Pacific species; reason is unclear. Our series illustrates the consequences of manmade disruption of ecosystem resulting in invasion of toxic species to a new environment, affecting human health.

[Partial finger amputation after weever sting and second-degree burn].

The greater weever (Trachinus draco) is the only venomous fish in Denmark, and if stung by the weever the venom may cause symptoms such as pain, headache, nausea, dizziness and in severe cases systemic allergic reaction or tissue necrosis. The venom is heat-labile and should therefore be treated with warm water to the afflicted area. We report a case of a patient who was stung in the second finger and because of the treatment, he got a second-degree burn, that may have enhanced the effect of the venom, thus resulting in partial finger amputation.

[Management of bluespotted stingray injuries in Djibouti from July 2008 to July 2009]. / Prise en charge des piqûres de raies pastenagues à Djibouti de juillet 2008 à juillet 2009.

Although stingray injuries have always been frequent in the Republic of Djibouti, it was not until July 2008 that the Bouffard Hospital developed a standardised management protocol. The purpose of this report is to describe that protocol and evaluate its impact on the outcome of stingray injuries based on a prospective study for the period between July 2008 and July 2009. During the study period, 12 stingray stings were treated. The treatment protocol that is based on a multidisciplinary approach involving the intensivist, anaesthesiologist, and surgeon achieved wound healing within one month. This outcome contrasts with previous publications that have generally described longer healing times with frequent infectious complications.

Stonefish envenomation with acute carpal tunnel syndrome.

Stonefish envenomation is a common marine sting. Although stonefish injuries are commonly sustained during maritime activities, this local delicacy can also be considered a regional occupational hazard for chefs. The availability and consumption of stonefish in local restaurants has increased the risk of acute carpal tunnel syndrome after a stonefish injury. This case report describes acute carpal tunnel syndrome following stonefish envenomation. An excellent recovery was achieved after surgical decompression of the carpal tunnel syndrome. Standard management of stonefish injuries should therefore take into account the possibility that this orthopaedic emergency may complicate the injury.

Severe sequelae after stonefish envenomation.

More tourists are visiting the idyllic waters of the South Pacific each year. They share the shallow waters with the native wildlife, including the venomous stonefish. Although the injection of its venom has been reported to have occasional fatal neuromuscular and cardiovascular sequelae, severe tissue necrosis at the injection site has not been described. We present a case of stonefish injury that describes serious localised sequelae of stonefish envenomation

Hand wound caused by an active sting with a toxin spine of a catfish (Heteropneustes fossilis)--a case report.

A case of a 33-years-old aquarist admitted to the Clinic with a painful wound caused by a Stinging Catfish (Heteropneustes fossilis) was presented. While cleaning the aquarium the fish actively stung him in the hand. After irrigating and debriding of the wound the patient was given tetanus anatoxin and antibiotic course. The opioid analgesia and local anesthesia had to be provided to relieve the pain. The follow up after 2 weeks showed healed wound of the hand and the patient had no subjective complaints. There is an urgent need for a bill about venomous and poisonous animals which will be allowed to be kept at home. The registration of venomous and poisonous animals in the Regional Poison Control Centers should be compulsory. There is a need for initiating educational activity among people who keep dangerous animals at home as their pets.

[Dangerous aquaria]. / Niebezpieczne akwaria.

World trends for a home breeding of exotic freshwater and marine fishes did not miss Poland. There are almost all species of aquarium fishes available in Polish pet shops, but there is not enough information about threat given to customers. In some fish, there are masses of one-cell glands, mainly serous, in the proximity of the spines. In others, those one-cell glands may be grouped in larger aggregates of cells called venom glands, that may form organs resembling multicellular glands of terrestrial animals. They are usually located around the spines or hard rays of the fins. Even if covered with a connective tissue sheath, the aggregates of the venom cells do not have any common outlet; they are not, therefore, proper multicellular glands. The venom glands of the catfish are covered with a thin sheath and they release their contents when the fin ray is pressed. Spines are derived from fin rays. When the spine penetrates the body of its prey, it presses its base against the cells, squashes them and squeezes the venomous contents into the wound. Catfish, lionfish and stonefish have the venom glands producing secretion which could be dangerous. The eels and morays blood is also dangerous, as well as slime of reduced squamae. Poison information centers noted several cases of fishes' stings in Poland.

[Poisonous animals registration in Poland]. / Rejestracja zwierzat jadowitych w Polsce.

The Act on Nature Conservation of 16.04.2004 (Official Journal, 2004, No 92, item 880) imposes on private individuals the duty to register some animals. The data collected by Kraków municipal authorities and delivered to the Poison Information Centre (Colleglum Medicum, Jagiellonian University) indicate that there are following species in private hands in the city and its surroundings: 11 individuals of Naja naja, 2--Hydrodynates gigas and 55-- Dendrobates spp. According to these information the employees of the PIC elaborated the advice on the treatment of specific animals' poisoning. In the period May 2003 - May 2004 (before the above Act came into force) there were 143 individuals from Brachypelma genus and 3 scorpions (Pandinus imperator) registered in Krakow. These species produce venoms which take local effect. According to art. 64 (1) of the above Act it is compulsory to register amphibians, reptiles, birds and mammals. However, it would be desirable to introduce the duty to register also dangerous species of invertebrates and fishes. It would provide the complete list of poisonous animals kept in private hands. Thus, it would be possible to estimate any possible threats and to elaborate adequate treatment in case of specific animals' poisoning.

Pattern of stingray injuries reported to Texas poison centers from 1998 to 2004.

This study examined the relationship between selected factors and all human exposures involving stingray injuries reported to Texas poison centers. Cases were obtained retrospectively from calls to poison centers in Texas and included all reported human exposures involving stingray injuries from 1998 to 2004. The distribution of cases was determined for a variety of demographic and clinical parameters. A total of 153 cases were identified. The reported stingray injury penetrance increased during the 7-year period. Of the cases with a known patient age, 2% were <6 years, 25% were 6-19 years and 73% were >19 years. The stingray injuries occurred in public areas in 54% of the cases. In 61% of cases, the management site was reported not to be a health care facility. Of the cases with a known clinical outcome, none involved no effects and 53% involved minor effects. The highest proportion of stingray injuries occurred during the summer months, particularly August. In 60% of the cases, the calls originated from counties along the coast. This information can be used to identify those portions of the population most in need of education regarding the prevention and treatment of stingray injuries.

[Aquatic animals of medical importance in Brazil]. / Animais aquáticos de importância médica no Brasil.

The injuries caused by venomous and poisonous aquatic animals may provoke important morbidity in the victim. The cnidarians (jellyfishes, especially cubomedusas and Portuguese-Man-of-War) caused nearly 25% of 236 accidents by marine animals, while sea urchins were responsible for about 50% and catfish, stingrays and scorpionfish nearly 25%). In freshwater, stingrays and catfish cause injuries with a very similar mechanism to the poisoning and the effects of the toxins of marine species. In a series of about 200 injuries observed among freshwater fishermen, nearly 40% were caused by freshwater catfish, 5% freshwater stingrays and 55% by traumatogenic fish, such as piranhas and traíras. The author presents the aquatic animals that cause injuries to humans in Brazil, the clinical aspects of the envenoming and the first measures for the control of the severe pain observed mainly in the accidents caused by cnidarians and venomous fishes.

[Cardiotoxicity of vertebrates venoms]. / Kardiotoksyczne dzialanie jadów kregowców.

Vertebrate species (fish, amphibians and reptiles) with cardiotoxic venoms properties are described in the paper. A regulatory problems related to breeding of venomous animals are also included.