Marine Envenomations in Tennessee?

Marine Envenomation's in Tennessee???

Even though Tennessee is landlocked, the Tennessee Poison Center (TPC) occasionally receives calls about envenomation's or poisonings from marine sources.

 I have this pet...

 The TPC received a call from an outpatient site regarding a patient who had a sting from his lionfish.

 Lionfish are a salt water fish that are commonly imported from the Philippines. Lionfish are in the Scorpaenidae family of vertebrate fish. The scorpionfish are divided into three genera depending on the venom organ structure. The genera are Pterosis (lionfish, turkeyfish, etc), Scorpaena (scorpion fish, etc) and Synanceja (stonefish). Pterosis have long slender spines as noted in the picture above left. The venom gland is covered by a thin integumentary sheath. Scorpaena have heavier spines with a thick integumentary sheath. Stonefish (Synanceja) have short thick spines with well-developed venom glands.  Stonefish are very well camouflaged in their native environment as noted in the picture to the right where it is difficult to find the stonefish. Scorpaenidae are usually bottom dwellers and inhabit shallow waters around coral reefs and kelp beds in the warm waters of the South Pacific.

 Lionfish are popular as a salt water aquarium inhabitant as they have a distinctive and graceful appearance. Captive lionfish are venomous, and they can move quickly to envenomate. The envenomation occurs via the dorsal, anal, or pelvic spines that pierce into the skin. Envenomation's from lionfish that have recently died have also been reported. (JAMA 1985;253:807-810) The most common exposure is on the hands and fingers while the owner is trying to clean the aquarium or transfer the live specimen to another aquarium. Occasionally the envenomation occurs when the owner is trying to hand-feed the fish.

 “It floats like a butterfly, but stings like a bee”.  

Symptoms from envenomation include severe and intense pain at the wound site with about half of the cases developing swelling. Systemic effects may include nausea, diaphoresis, difficulty breathing, hypotension, and syncope. The venom is poorly characterized, is heat labile, and is not dialyzable.  Recommendations for treatment include

  • soaking the affected area in non-scalding hot water (approximately 45oC)
  • wound care and pain management
  • administration of tetanus prophylaxis as needed. 


Interestingly, there are sightings of Lionfish along the Southeastern coast of the United States (see map for locations in year 2003, map is from website of National Oceanic and Atmospheric Administration).  The source of the lionfish may be from the aquarium trade and less likely from the release of ballast water by ships. The impact of these non-native fish in this ecosystem is uncertain.

National Oceanic and Atmospheric Administration, 2003