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FISH STINGS

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Approximately 225 species of marine fishes are known to be venomous. Refer to other managements "STINGRAY INJURIES", "WEEVER FISH" and "VENOMOUS SCORPAENIDAE STINGS" for information on stingrays, scorpion fish, lionfish, stonefish, and weever fish.

Specific Substances

    A) CATFISH
    1) Arabian Gulf catfish
    2) Arius thallasinus: Arabian Gulf catfish
    3) Armoured catfish
    4) Blue catfish
    5) Brown bullhead
    6) Catfish eel
    7) Carolina mudtom
    8) Channel catfish
    9) Cobbler
    10) Eel-tailed catfish
    11) Electric catfish
    12) Estuary catfish
    13) Freshwater catfish
    14) Heteropneustes fossilis: Stinging catfish
    15) Ictalurus catus: White catfish
    16) Ictalurus furcatus: Blue catfish
    17) Ictalurus nebulosus: Brown bullhead
    18) Ictalurus punctatus: Channel catfish
    19) Malapterusus: Electric catfish
    20) Marine catfish
    21) Noturus furiosus: Carolina mudtom
    22) Pimelodus pictus
    23) Plotosus pineatus: Marine catfish
    24) Plotosidae (eel-tailed catfish)
    25) Saltwater catfish
    26) Sea catfish
    27) Siluridae
    28) Stinging catfish
    29) Stonecat
    30) Striped catfish
    31) White catfish
    DOGFISH
    1) Aburazuno
    2) Acanthias Americanus
    3) Acanthias Vulgaris
    4) Aquillat
    5) Cacao-bagre
    6) Dornhund
    7) Ferron
    8) Galhudo
    9) Galludo Melga
    10) Koliuciaia
    11) Shark-catfish
    12) Spinarolo
    13) Spinax Acanthias
    14) Spiny dogfish
    15) Squalus megalops/cubensis
    16) Squalus Suckleyi
    JACKS (FISH)
    1) Caranx ruber
    2) Caranx lugubris
    3) Caranx hippos
    4) Caranx bartholomaei
    5) Carangidae
    6) Hemicaranx amblyrhynchus
    7) Jack almaco
    8) Jack bar
    9) Jack black
    10) Jack bluntnose
    11) Jack crevalle
    12) Jack yellow
    13) Seriola rivoliana
    RABBITFISH
    1) Barhead spinefoot
    2) Barred spinefoot
    3) Bicolored foxface
    4) Blackeye rabbitfish
    5) Black foxface
    6) Blotched foxface
    7) Blue-spotted spinefoot
    8) Brownspotted spinefoot
    9) Dusky spinefoot
    10) Foxface rabbitfish
    11) Golden-lined spinefoot
    12) Gold-spotted spinefoot
    13) Labyrinth spinefoot
    14) Little spinefoot
    15) Magnificent rabbitfish
    16) Marbled spinefoot
    17) Mottled spinefoot
    18) Orange-spotted spinefoot
    19) Peppered spinefoot
    20) Siganidae
    21) Siganus argenteus (Streamlined spinefoot)
    22) Siganus canaliculatus (White-spotted spinefoot)
    23) Siganus corallinus (Blue-spotted spinefoot)
    24) Siganus doliatus (Barred spinefoot)
    25) Siganus fuscescens (Mottled spinefoot)
    26) Siganus guttatus (Orange-spotted spinefoot)
    27) Siganus javus (Streaked spinefoot)
    28) Siganus labyrinthodes (Labyrinth spinefoot)
    29) Siganus lineatus (Golden-lined spinefoot)
    30) Siganus luridus (Dusky spinefoot)
    31) Siganus magnificus (Magnificent rabbitfish)
    32) Signaus niger (Black foxface)
    33) Siganus puelloides (Blackeye rabbitfish)
    34) Siganus punctatissimus (Peppered spinefoot)
    35) Siganus punctatus (Gold-spotted spinefoot)
    36) Siganus randalli (Variegated spinefoot)
    37) Siganus rivulatus (Marbled spinefoot)
    38) Siganus spinus (Little spinefoot)
    39) Siganus stellatus (Brownspotted spinefoot)
    40) Siganus sutor (Shoemaker spinefoot)
    41) Siganus trispilos (Three--blotched rabbitfish)
    42) Siganus unimaculatus (Blotched foxface)
    43) Siganus uspi (Bicolored foxface)
    44) Siganus vermiculatus (Vermiculated spinefoot)
    45) Siganus virgatus (Barhead spinefoot)
    46) Siganus vulpinus (Foxface rabbitfish)
    47) Siganus woodlandi
    48) Shoemaker spinefoot
    49) Spinefoots
    50) Streamlined spinefoot
    51) Streaked spinefoot
    52) Three--blotched rabbitfish
    53) Variegated spinefoot
    54) Vermiculated spinefoot
    55) White-spotted spinefoot
    SCATS
    1) African Scat
    2) Common Scat
    3) Moon Scat
    4) Scatophagidae
    5) Scatophagus
    6) Scatophagus argus (Common Scat)
    7) Scatophagus tetracanthus (African Scat)
    8) Selenotoca multifasciata
    9) Selenotoca papuensis (Moon Scat)
    STARGAZER
    1) Banded stargazer
    2) Bulldog stargazer
    3) Common stargazer
    4) Deepwater stargazer
    5) Freckled stargazer
    6) Giant stargazer
    7) Lancer stargazer
    8) Northern stargazer
    9) Smooth stargazer
    10) Spiny stargazer
    11) Spotted stargazer
    12) Southern stargazer
    13) Uranoscopidae
    SURGEONFISH
    1) Acanthuridae
    2) Doctorfish
    3) Lined surgeonfish
    4) Pacific blue tang surgeonfish
    5) Sohal surgeonfish
    6) Spinetail
    7) Tang
    TOADFISH
    1) Batrachoididae
    2) Blackspotted toadfish
    3) Common toadfish
    4) Dark toadfish
    5) Frilled toadfish
    6) Oyster toadfish
    7) Pale toadfish
    8) Prickly toadfish
    9) Red striped toadfish
    10) Smooth toadfish
    11) Torquigener pleurogramma

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) BACKGROUND: Approximately 225 species of marine fishes are known to be venomous. Refer to other managements "STINGRAY INJURIES", "WEEVER FISH" and "VENOMOUS SCORPAENIDAE STINGS" for information on stingrays, scorpion fish, lionfish, stonefish, and weever fish.
    B) TOXICOLOGY: The venom varies among species. In most cases fish stings cause intense local pain and carry the potential for infection as these are puncture wounds that may contain retained fragments of the sting apparatus and waterborne bacteria. In animal studies, the venom of Plotosus lineatus (plototoxin) produced local tissue destruction and necrosis. It also caused muscular spasm, respiratory distress, neurotoxic, leukopenic, hemolytic, and lethal effects. Edema-forming and hemolytic effects were observed with crinotoxin of Plotosus lineatus. Arius thalassinus had acetylcholine-like and prostaglandin-releasing components.
    C) EPIDEMIOLOGY: A large number of venomous fishes are encountered worldwide. Severe envenomations from poisonous fish are rare.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Patients with mild to moderate toxicity usually report pain. Inflammation, edema, erythema, and tenderness immediately around the wound are common. Wounds may develop infections secondary to the injury. Weakness and paresthesias frequently occur.
    2) SEVERE TOXICITY: Pain, erythema, edema, paleness, paresthesia, tissue necrosis, soft-tissue infections, tenosynovitis of the hands, bursitis, septic arthritis, osteomyelitis, bony cysts, and necrotizing fasciitis have been reported following catfish stings. Patients with severe pain may experience nausea and vomiting. Tachycardia, weakness, hypotension, loss of consciousness, respiratory distress, and unusual sensations (tingling, pricking) have been reported following severe catfish stings. Secondary infection may occur. Septicemic death has been reported. A fisherman died almost immediately after a catfish sting to the left anterior hemithorax that resulted in a perforating wound to the left ventricle.

Laboratory Monitoring

    A) No specific laboratory tests are necessary unless otherwise clinically indicated.
    B) Monitor vital signs following severe envenomations.
    C) Monitor serum electrolytes in patients with significant vomiting.
    D) Soft-tissue radiographs or ultrasound of the sting site may reveal a retained spine or other foreign bodies. Regardless of the findings, direct exploration of the wound should be performed.
    E) Monitor for evidence of infection.

Treatment Overview

    0.4.7) BITES/STINGS
    A) MANAGEMENT OF MILD TO MODERATE TOXICITY
    1) Submerge the injured part in hot water at as high a temperature as the patient can tolerate without injury (less than 113 degrees F or 45 degrees C), for 30 to 90 minutes or more. Control pain with NSAIDs or oral or parenteral opioids. Digital nerve block or local anesthesia should be considered for pain relief in patients who have persistent pain despite an adequate trial of hot water immersion (at least 2 hours). Do NOT use a digital nerve block or local anesthesia administration and immersion in hot water simultaneously as it may lead to significant burns. TETANUS: Administer antitetanus as indicated. ANTIBIOTICS: Wounds may become infected. Antibiotic choice should be guided by culture results.
    B) MANAGEMENT OF SEVERE TOXICITY
    1) ANTIBIOTICS: Some physicians administer antibiotics routinely. If antibiotic prophylaxis is used, VIBRIO species should be covered. Trimethoprim-sulfamethoxazole is appropriate for oral administration, while third generation cephalosporins are best for IV administration. HYPOTENSIVE EPISODE: Administer IV 0.9% saline, add vasopressors, if hypotension persists. Patients with hypotension should be carefully evaluated for evidence of injury to heart, lungs, abdominal organs or vasculature.
    C) PAIN
    1) Submerge the injured part in hot water (less than 113 degrees F or 45 degrees C) at as high a temperature as the patient can tolerate without injury to the skin for 30 to 90 minutes or more. Control pain with NSAIDs or oral or parenteral opioids. Digital nerve block or local anesthesia should be considered for pain relief in patients who have persistent pain despite an adequate trial of hot water immersion (at least 2 hours). Do NOT use a digital nerve block or local anesthesia administration and immersion in hot water simultaneously as it may lead to significant burns.
    D) WOUND CARE
    1) Attempt to remove the spines if they can be seen in the wound.
    2) SEA URCHIN SPINES: The following method has been used to remove sea urchin spines and can be used for fish spines: radiographic localization of the spine is recommended to determine joint disruption or bony penetration to determine the number of spines and degree of serration. Inject a 1.5 mL bolus of subcutaneous lidocaine into each lateral surface of the involved phalanx to produce tumescent local anesthesia. Use the point of a scalpel blade to nick the apex of the edematous wound or site of maximal discoloration or pain to extrude the spine. Culture any liquid discharge as indicated.
    3) Irrigate the wound thoroughly.
    E) AIRWAY MANAGEMENT
    1) Airway management is unlikely to be necessary except in rare cases of severe allergic reactions.
    F) ANTIDOTE
    1) None.
    G) PATIENT DISPOSITION
    1) HOME CRITERIA: Most patients with mild pain and/or trivial wounds can be managed at home with local wound care.
    2) OBSERVATION CRITERIA: Patients with significant pain or wounds that require debridement should be referred to a healthcare facility for evaluation and treatment.
    3) ADMISSION CRITERIA: Patients with wounds that become secondarily infected or skin necrosis should be admitted.
    4) CONSULT CRITERIA: A medical toxicologist or poison center should be consulted on all severe envenomations. Consult a surgeon if skin necrosis develops.
    H) PITFALLS
    1) Pitfalls include inadequate exploration of the wound, failure to provide tetanus prophylaxis, and failure to cover Vibrio species when prescribing antibiotics for wound infections. Patients with wounds to the thorax, abdomen or near major vessels, and those with hypotension should be carefully evaluated for traumatic injury to deep structures.
    I) PHARMACOKINETICS
    1) Absorption occurs rapidly following envenomation.
    J) DIFFERENTIAL DIAGNOSIS
    1) Sea snake envenomation, jelly fish envenomation, stingray injry or dinoflagellate poisoning may be mistaken for a fish sting envenomation.

Range Of Toxicity

    A) TOXICITY: Catfish, dogfish, and sea urchins usually cause just local effects. Penetrating wounds from a barb/barbel may cause severe injury, dependent in part on the depth and location of the injury. Deaths are extremely rare and are secondary to traumatic injury, not envenomation.

Clinical Effects

Summary Of Exposure

    A) BACKGROUND: Approximately 225 species of marine fishes are known to be venomous. Refer to other managements "STINGRAY INJURIES", "WEEVER FISH" and "VENOMOUS SCORPAENIDAE STINGS" for information on stingrays, scorpion fish, lionfish, stonefish, and weever fish.
    B) TOXICOLOGY: The venom varies among species. In most cases fish stings cause intense local pain and carry the potential for infection as these are puncture wounds that may contain retained fragments of the sting apparatus and waterborne bacteria. In animal studies, the venom of Plotosus lineatus (plototoxin) produced local tissue destruction and necrosis. It also caused muscular spasm, respiratory distress, neurotoxic, leukopenic, hemolytic, and lethal effects. Edema-forming and hemolytic effects were observed with crinotoxin of Plotosus lineatus. Arius thalassinus had acetylcholine-like and prostaglandin-releasing components.
    C) EPIDEMIOLOGY: A large number of venomous fishes are encountered worldwide. Severe envenomations from poisonous fish are rare.
    D) WITH POISONING/EXPOSURE
    1) MILD TO MODERATE TOXICITY: Patients with mild to moderate toxicity usually report pain. Inflammation, edema, erythema, and tenderness immediately around the wound are common. Wounds may develop infections secondary to the injury. Weakness and paresthesias frequently occur.
    2) SEVERE TOXICITY: Pain, erythema, edema, paleness, paresthesia, tissue necrosis, soft-tissue infections, tenosynovitis of the hands, bursitis, septic arthritis, osteomyelitis, bony cysts, and necrotizing fasciitis have been reported following catfish stings. Patients with severe pain may experience nausea and vomiting. Tachycardia, weakness, hypotension, loss of consciousness, respiratory distress, and unusual sensations (tingling, pricking) have been reported following severe catfish stings. Secondary infection may occur. Septicemic death has been reported. A fisherman died almost immediately after a catfish sting to the left anterior hemithorax that resulted in a perforating wound to the left ventricle.

Cardiovascular

    3.5.2) CLINICAL EFFECTS
    A) LACERATION OF HEART
    1) WITH POISONING/EXPOSURE
    a) CATFISH
    1) CASE REPORT: A 39-year-old fisherman died almost immediately after a catfish sting to the left anterior hemithorax that resulted in a perforating wound to the left upper chest. Upon autopsy, a laceration to the left ventricle of the heart was found resulting in a severe intrathoracic hemorrhage (Haddad et al, 2008).
    B) TACHYCARDIA
    1) WITH POISONING/EXPOSURE
    a) CATFISH
    1) In one study, 17 cases of injuries by freshwater catfish (10 by stinging catfish and 7 by African catfish) were reviewed. Intense pain, edema, and erythema developed in 7 patients following African catfish envenomation. Severe pain, numbness, dizziness, local edema, and erythema developed in 10 patients following stinging catfish envenomation. Five of the 10 patients developed tachycardia, weakness, arterial hypotension, loss of consciousness, respiratory distress, and unusual sensations (tingling, pricking). All patients recovered following supportive care (Satora et al, 2008).
    2) STINGING CATFISH: The venom can cause tachycardia, weakness, hypotension, dizziness, and respiratory distress (Satora et al, 2005).
    C) HYPOTENSIVE EPISODE
    1) WITH POISONING/EXPOSURE
    a) Hypotension or shock following envenomation in humans is relatively rare.
    b) CATFISH
    1) In one study, 17 cases of injuries by freshwater catfish (10 by stinging catfish and 7 by African catfish) were reviewed. Intense pain, edema, and erythema developed in 7 patients following African catfish envenomation. Severe pain, numbness, dizziness, local edema, and erythema developed in 10 patients following stinging catfish envenomation. Five of the 10 patients developed tachycardia, weakness, arterial hypotension, loss of consciousness, respiratory distress, and unusual sensations (tingling, pricking). All patients recovered following supportive care (Satora et al, 2008).
    2) STINGING CATFISH: The venom can cause tachycardia, weakness, hypotension, dizziness, and respiratory distress (Satora et al, 2005).

Respiratory

    3.6.2) CLINICAL EFFECTS
    A) RESPIRATORY DISTRESS
    1) WITH POISONING/EXPOSURE
    a) CATFISH
    1) In one study, 17 cases of injuries by freshwater catfish (10 by stinging catfish and 7 by African catfish) were reviewed. Intense pain, edema, and erythema developed in 7 patients following African catfish envenomation. Severe pain, numbness, dizziness, local edema, and erythema developed in 10 patients following stinging catfish envenomation. Five of the 10 patients developed tachycardia, weakness, arterial hypotension, loss of consciousness, respiratory distress, and unusual sensations (tingling, pricking). All patients recovered following supportive care (Satora et al, 2008).
    2) STINGING CATFISH: The venom can cause respiratory distress (Satora et al, 2005).

Neurologic

    3.7.2) CLINICAL EFFECTS
    A) PAIN
    1) WITH POISONING/EXPOSURE
    a) Pain is the most common complaint in all fish stings (Rosson & Tolle, 1989).
    1) CATFISH
    a) Intense burning (hot-pin like) or throbbing pain may occur (Huang et al, 2013; Satora, 2009; Satora et al, 2005; Quail et al, 2000; Williamson, 1995; Burnett et al, 1985).
    b) Pain, erythema, edema, paleness, paresthesia, tissue necrosis, soft-tissue infections, tenosynovitis of the hands, bursitis, septic arthritis, osteomyelitis, bony cysts, and necrotizing fasciitis have been reported following catfish stings (Roth & Geller, 2010).
    c) In an 8-year observational study of catfish envenomations along the south western Atlantic coast of Brazil, 127 cases were identified. Puncture wounds occurred in 90% (n=115) of the cases and lacerations in approximately 10% (n=12) of the cases. Intense pain was the primary symptom observed in the acute phase of the envenomation. Inflammation, edema, and erythema were also noted in the acute phase of envenomation. Bacterial and fungal infection, as well as retention of barb fragments in the wound were clinical manifestations noted in the later phase of envenomation (Haddad & Martins, 2006).
    d) CASE REPORT: An adult was stung by a catfish that produced a linear wound about 4 mm long and 1 mm deep. After the sting, there was a scalding sensation spreading from the finger up to the hand and arm. This was followed by involuntary tremor and irregular muscle contraction in the finger and hand. Pain was alleviated by immersion of the sting site in hot water (Patten, 1975).
    e) In one study, 17 cases of injuries by freshwater catfish (10 by stinging catfish and 7 by African catfish) were reviewed. Intense pain, edema, and erythema developed in 7 patients following African catfish envenomation. Severe pain, numbness, dizziness, local edema, and erythema developed in 10 patients following stinging catfish envenomation. Five of the 10 patients developed tachycardia, weakness, arterial hypotension, loss of consciousness, respiratory distress, and unusual sensations (tingling, pricking). All patients recovered following supportive care (Satora et al, 2008).
    2) JACKS
    a) Pain ("bee-like"), lasting for 30 minutes, has been reported.(Williamson, 1995).
    3) SCATS
    a) Severe pain ("electric-shock like") has been reported (Williamson, 1995).
    4) TOADFISH
    a) Severe pain, local edema, and secondary infections have been reported (Williamson, 1995).
    B) PARESTHESIA
    1) WITH POISONING/EXPOSURE
    a) CATFISH: Paresthesia/numbness around the wound is not uncommon (Roth & Geller, 2010; Satora et al, 2008; Scoggin, 1975).
    C) PARALYSIS
    1) WITH POISONING/EXPOSURE
    a) CATFISH: Limb paralysis may be seen with severe catfish stings (Al-Hassan et al, 1985).

Gastrointestinal

    3.8.2) CLINICAL EFFECTS
    A) GASTROINTESTINAL TRACT FINDING
    1) WITH POISONING/EXPOSURE
    a) Patients with severe pain may experience nausea and vomiting following severe envenomations (Auerbach, 1991).
    b) STINGING CATFISH: The venom can cause nausea and vomiting (Satora et al, 2005).

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) SKIN FINDING
    1) WITH POISONING/EXPOSURE
    a) CATFISH
    1) Edema and erythema are seen at the wound site (Satora et al, 2005; Burnett et al, 1985). Skin rashes and intense local pallor of surrounding tissues, with local ischemia and necrosis may occur (Williamson, 1995). The venom of stinging catfish can cause local inflammation with erythema, edema, local hemorrhage, and tissue necrosis (Satora et al, 2005)
    2) Cellulitis, lymphangitis and septicemia may be sequelae after catfish stings (Satora et al, 2008; Burnett et al, 1985).
    3) OBSERVATIONAL STUDY: In an 8-year observational study of catfish envenomations along the south western Atlantic coast of Brazil, 127 cases were identified. Puncture wounds occurred in 90% (n=115) of the cases and lacerations in approximately 10% (n=12) of the cases. Intense pain was the primary symptom observed in the acute phase of the envenomation. Inflammation, edema, and erythema were also noted in the acute phase of envenomation. Bacterial and fungal infection, as well as retention of barb fragments in the wound, were clinical manifestations noted in the later phase of envenomation (Haddad & Martins, 2006).
    4) Erythema, edema, paleness, paresthesia, tissue necrosis, soft-tissue infections, tenosynovitis of the hands, bursitis, septic arthritis, osteomyelitis, bony cysts, and necrotizing fasciitis have been reported following catfish stings (Roth & Geller, 2010).
    5) In one study, 17 cases of injuries by freshwater catfish (10 by stinging catfish and 7 by African catfish) were reviewed. Intense pain, edema, and erythema developed in 7 patients following African catfish envenomation. Severe pain, numbness, dizziness, local edema, and erythema developed in 10 patients following stinging catfish envenomation. Five of the 10 patients developed tachycardia, weakness, arterial hypotension, loss of consciousness, respiratory distress, and unusual sensations (tingling, pricking). All patients recovered following supportive care (Satora et al, 2008).
    6) CASE REPORT: A 52-year-old man experienced immediate and severe pain of his right thumb following skin penetration of a catfish barb. Over the next several days, the patient continued to experience progressive pain, erythema, and swelling radiating to his right arm. He subsequently developed an abscess, requiring drainage, and was treated with IV antibiotics. Laboratory data showed an elevated WBC (13,200/mcL, 80% neutrophils), a C-reactive protein of 4.5 mg/dL (reference range 0 to 1), and a sedimentation rate of 38 mm/hour (reference range 0 to 13). Wound cultures revealed the presence of Proteus vulgaris and Morganella morganii. With continued IV antibiotics, the patient's signs and symptoms improved with normalization of his WBC, and he was discharged with a 10-day course of oral antibiotics. At a 12-month telephone follow-up, the patient indicated that the wound had completely healed without sequelae (Huang et al, 2013).
    b) SPINY DOGFISH
    1) CASE REPORT: Local edema, erythema, and excruciating pain occurred in a 54-year-old fisherman after he was injured near the little finger in his left hand by the spine anterior to the dorsal fin of a spiny dogfish (Squalus cubensis/megalops group). His pain decreased over the next 6 hours without treatment; however, edema with local cutaneous thickening lasted approximately 2 weeks (Haddad & Gadig, 2005).
    B) NECROTIZING FASCIITIS
    1) WITH POISONING/EXPOSURE
    a) CATFISH
    1) Necrotizing fasciitis has been reported following catfish envenomation (Roth & Geller, 2010).
    2) CASE REPORT: Severe pain, erythema, and swelling developed in a 26-year-old man after he suffered a penetrating injury to the dorsal aspect of the right long finger after handling a Pimelodus pictus catfish. Laboratory results revealed a serum WBC count of 11,800 cells/mcL. Despite supportive treatment, including antibiotic therapy, he developed recurrent fevers, worsening erythema and elevated WBC count of 29,800 cells/mcL. A diagnosis of necrotizing fasciitis was considered. An operative debridement revealed significant necrosis of the subcutaneous fat, with normal-appearing extensor retinaculum, paratenon, tendon, fascia, and intrinsic musculature. Multiple biopsy specimens revealed diffuse soft-tissue necrosis suspicious for necrotizing fasciitis. Following daily debridement over the next 2 days, his symptoms gradually improved and he was discharged home on day 11 (Carty et al, 2010).

Musculoskeletal

    3.15.2) CLINICAL EFFECTS
    A) MUSCULOSKELETAL FINDING
    1) WITH POISONING/EXPOSURE
    a) CATFISH
    1) Tenosynovitis of the hands, bursitis, septic arthritis, and osteomyelitis have been reported following catfish stings (Roth & Geller, 2010).
    B) INCREASED MUSCLE TONE
    1) WITH POISONING/EXPOSURE
    a) CATFISH
    1) Painful muscular spasms/fasciculation have been reported following catfish envenomation (Roth & Geller, 2010; Williamson, 1995).
    2) CASE REPORT: An adult was stung by a catfish that produced a linear wound about 4 mm long and 1 mm deep. After the sting, there was a scalding sensation spreading from the finger up to the hand and arm. This was followed by involuntary tremor and irregular muscle contraction in the finger and hand. Pain was alleviated by immersion of the sting site in hot water (Patten, 1975).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) No specific laboratory tests are necessary unless otherwise clinically indicated.
    B) Monitor vital signs following severe envenomations.
    C) Monitor serum electrolytes in patients with significant vomiting.
    D) Soft-tissue radiographs or ultrasound of the sting site may reveal a retained spine or other foreign bodies. Regardless of the findings, direct exploration of the wound should be performed.
    E) Monitor for evidence of infection.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Patient Disposition

    6.3.6) DISPOSITION/BITE-STING EXPOSURE
    6.3.6.1) ADMISSION CRITERIA/BITE-STING
    A) Patients with wounds that become secondarily infected or skin necrosis should be admitted.
    6.3.6.2) HOME CRITERIA/BITE-STING
    A) Most patients with mild pain and/or trivial wounds can be managed at home with local wound care.
    6.3.6.3) CONSULT CRITERIA/BITE-STING
    A) A medical toxicologist or poison center should be consulted on all severe envenomations. Consult a surgeon if skin necrosis develops.
    6.3.6.5) OBSERVATION CRITERIA/BITE-STING
    A) Patients with significant pain or wounds that require debridement should be referred to a healthcare facility for evaluation and treatment.

Monitoring

    A) No specific laboratory tests are necessary unless otherwise clinically indicated.
    B) Monitor vital signs following severe envenomations.
    C) Monitor serum electrolytes in patients with significant vomiting.
    D) Soft-tissue radiographs or ultrasound of the sting site may reveal a retained spine or other foreign bodies. Regardless of the findings, direct exploration of the wound should be performed.
    E) Monitor for evidence of infection.

Abstracts

Case Reports

    A) CATFISH STINGS
    1) CASE REPORT: A 55-year-old man kicked a catfish into the river and 24 hours later reported to the emergency department with the metatarsophalangeal joint of his left great toe being erythematous, warm, and painful to passive motion. Radiographs revealed a bony spine (10 mm by 1 mm) within the metatarsophalangeal joint which was visible only on oblique view. The spine was removed under general anesthesia. The patient was given a 10 day course of oral antibiotic. No infection developed (Zeman, 1989).
    2) OBSERVATIONAL STUDY: In an 8-year observational study of catfish envenomations along the south western Atlantic coast of Brazil, 127 cases were identified. Puncture wounds occurred in 90% (n=115) of the cases and lacerations in approximately 10% (n=12) of the cases. Intense pain was the primary symptom observed in the acute phase of the envenomation. Inflammation, edema, and erythema were also noted in the acute phase of envenomation. Bacterial and fungal infection as well as retention of barb fragments in the wound were clinical manifestations noted in the later phase of envenomation (Haddad & Martins, 2006).
    3) In one study, 17 cases of injuries by freshwater catfish (10 by stinging catfish and 7 by African catfish) were reviewed. Intense pain, edema, and erythema developed in 7 patients following African catfish envenomation. Severe pain, numbness, dizziness, local edema, and erythema developed in 10 patients following stinging catfish envenomation. Five of the 10 patients developed tachycardia, weakness, arterial hypotension, loss of consciousness, respiratory distress, and unusual sensations (tingling, pricking). All patients recovered following supportive care (Satora et al, 2008).

Range Of Toxicity

Summary

    A) TOXICITY: Catfish, dogfish, and sea urchins usually cause just local effects. Penetrating wounds from a barb/barbel may cause severe injury, dependent in part on the depth and location of the injury. Deaths are extremely rare and are secondary to traumatic injury, not envenomation.

Minimum Lethal Exposure

    A) CATFISH: CASE REPORT: A 39-year-old fisherman died almost immediately after a catfish sting to the left anterior hemithorax that resulted in a perforating wound to the left upper chest. Upon autopsy, a laceration to the left ventricle of the heart was found resulting in a severe intrathoracic hemorrhage (Haddad et al, 2008).

Maximum Tolerated Exposure

    A) Stings by a catfish, dogfish, and sea urchins usually cause only local effects.
    B) CASE SERIES
    1) In a case series of fisherman (n=79) from the Israeli Mediterranean Coast, the most common injury reported by fisherman were due to stingrays (n=24; 30.4%) followed by weever fish (n=17; 21.5%), rabbit fish (n=10; 12.7%) and stripped sea catfish (n=8; 10.1%) and the remaining cases were due other fish. Most injuries were due to envenomation (80%) compared to secondary infections (11.5%) or other injuries. Most cases were of moderate (53%) or minor severity (29%) and 9% reported no effect. The remaining 9% of cases were considered severe (ie, loss of a finger, permanent severe scar). Secondary infections and an injury by a stingray (Dasyatis pastinaca) produced the greatest pain and toxicity resulting in 3 cases of hospitalization for over 10 days. No deaths occurred (Gweta et al, 2008).

Pharmacology Toxicology

Toxicologic Mechanism

    A) The venoms of fishes vary considerably in their chemistry and pharmacology. The venom components of marine fishes have not been purified or characterized.
    B) CATFISH
    1) In animal studies, the venom of Plotosus lineatus (plototoxin) produced local tissue destruction and necrosis. It also caused muscular spasm, respiratory distress, neurotoxic, leukopenic, hemolytic, and lethal effects. The venom is water-soluble, vasoconstrictor protein. It is heat-labile and freezing did not destroy the venom. Edema-forming and hemolytic effects were observed with crinotoxin of Plotosus lineatus. Arius thalassinus had acetylcholine-like and prostaglandin-releasing components (Williamson, 1995).
    2) CATFISH VENOM: contains at least 2 to 8 mouse-lethal fractions and 2 dermonecrotic fractions (Burnett et al, 1985).

References

General Bibliography

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