A 10-year retrospective review of stonefish sting injury in Hong Kong

Abstract

Background: Stonefish sting injury is one of the common marine stings in Hong Kong. It is commonly sustained during maritime activities, and it could be regarded as occupational hazard for chefs or domestic hazard for family. Its envenomation could lead to significant local symptoms (pain or swelling) and serious complications, including infection and compartment syndrome. Objectives: This study is to review its clinical presentation and various treatment modalities. Methodology and study design: Reported cases of stonefish stings to Hong Kong Poison Information Centre from October 2008 to October 2018 were included in the study. The cases were retrieved from the Hong Kong Poison Information Centre electronic database. Information on patient demographic data, clinical parameters (e.g. the site of injury, presenting symptoms), and various treatment modalities (e.g. analgesics, hot water immersion, and use of antivenom) was collected. Results: There were 32 eligible patients included in this case series. All of them sustained the injury over either their fingers or hands. All patients reported pain over the site of injury. Other reported symptoms included numbness (41%), swelling (81%), and redness (47%). Twenty-five patients (78%) had radiograph done, and one of them was noted to have foreign body retained at the site of envenomation. All patients received hot water immersion to the affected part at 40°C–45°C for at least 30 min. Altogether eight patients (25%) received stonefish antivenom for pain relief. One patient developed compartment syndrome and received emergency operation of fasciotomy of right hand and forearm. Conclusion: Stonefish envenomation can cause extreme pain, swelling, and erythema, which can be managed with hot water immersion, analgesics, and prophylactic antibiotics. Use of antivenom can be considered in selected case.

Clinical characteristics of stonefish “Oni‐daruma‐okoze” envenomation in Japan

“…In a report released by the Hong Kong Poison Information Center, a total of 32 cases were observed during a 10-year period. 5 Thus, the annual number of stonefish envenomation cases in the current study was similar to that reported in Hong Kong. However, a hospital in Singapore reported 30 cases during a 2-year observation period 2 (i.e., five-fold higher incidence versus that reported in Japan).…”

“…12 In the study undertaken in Hong Kong, 25% of patients received treatment with antivenom. 5 The only commercially available fish antivenom is the stonefish antivenom produced by CSL (Melbourne, Australia). This antivenom consists of the purified F(ab)2 fragment of equine immunoglobulin G antibodies raised against the venom of S. trachynis.…”

“…They are primarily found in the coastal waters of the Indo-Pacific region, including the USA, Australia, Malaysia, Hong Kong, and Singapore. [1][2][3][4][5] In Japan, stonefish, also termed "Oni-daruma-okoze" (Synanceia verrucosa Block et Schneider) ( Fig. 1), inhabit the waters surrounding the Okinawa/Amami districts located in the southern part of Japan.…”

Marine Envenomation

“…Epidemiology: Stonefish stings, including those from reef stonefish, are a common injury seen in the emergency room. They are primarily found in the coastal waters of the Indo-Pacific region, including the USA, Australia, Malaysia, Hong Kong, and Singapore [17][18][19][20][21]. Few Japanese studies of stonefish envenomation have been reported [22,23]; however, Hifumi et al recently reported 15 cases over a 5-year observation period [24] and two deaths related to stonefish envenomation have been reported in Japan [25].…”

“…Antivenom is available and consists of the purified F(ab)2 fragment of equine IgG antibodies raised against the venom of Synanceia trachynis [26]. In a study conducted in Hong Kong, 25% of patients received treatment with antivenom [21].…”