Stonefish Envenomations of the Hand – A Local Marine Hazard: A Series of 8 Cases and Review of the Literature

Abstract

Introduction: The Singapore shoreline has changed significantly in recent years, but the stonefish (Synanceia sp.) continues to inhabit our native waters and human envenomation still occurs regularly. In this paper, we document their clinical course, review our management experience and propose a treatment algorithm. Clinical Picture: Envenomation is associated with appreciable local morbidity, excruciating pain and gross oedema of the affected limb. Severe systemic morbidity and deaths have been reported in the literature but are very rare. Treatment: Prompt first aid with immersion in hot water (45ºC) inactivates the venom. Supplementary analgesia, tetanus prophylaxis and broad-spectrum antibiotics are recommended. Specific antivenom is available and indicated for severe envenomations with systemic symptoms. Complicated puncture wounds and retained spines require surgical debridement. Outcome: Eight cases of stonefish envenomations to the hand were treated over the last 1.25 years (October 2001 to January 2003). Length of hospital stay averaged 3.9 days. There were no deaths or significant systemic morbidity, but 1 case required surgical debridement for local necrosis. Complete resolution of swelling, with return to full function, occurred on average by 8.2 days. Conclusions: Prompt recognition of envenomation, early first aid and hot water soaks result in rapid relief of pain and symptoms. Our local experience suggests that the majority of stonefish envenomations do not result in significant or protracted morbidity and require only supportive management. Systemic morbidity and mortalities are rare.