Lionfish envenomation: clinical aspect and management

Lionfish (Pterois spp.) which is native to Indo-Pacific region has been invading the Turkish coastal region and propagating rapidly as a Lessepsian species in the last years. Envenomation is expected to be encountered more frequently by divers due to its noteworthy appearance and by fishermen due to its novelty in the region. Lionfish sting is mostly seen at hands and results in pain, local edema, erythema and heat at site. Sometimes, cyanosis, pallor, vesicles and tissue necrosis can occur. The systemic signs and symptoms are rare and can be hypo/hypertension, nausea, abdominal pain, fever, dyspnea, convulsions, fainting, paralysis and cardiac failure. Death related to envenomation has not been reported although it is possible. The primary approach in the management of lion fish envenomation is removal of the remaining spines and immersion of the stung part in hot (35-40°C) water. Bleeding should be controlled if present and wound should be cleaned and disinfected. Analgesics are almost always necessary. Tetanus prophylaxis is required for all cases and antibiotics can be administered in case of infection. Imaging techniques can be used to search remaining spine fragments. Lionfish envenomation can be avoided generally by raising awareness and using protective gloves during hunting and cleaning of the fish.