What are the risk factors for stingray envenomation? How should stingray envenomation be managed? What are the potential complications of stingray envenomation? How can an interprofessional team improve the care of patients with stingray injuries?

Understanding Stingray Anatomy and Venom

Stingrays are a subtype of the cartilaginous fish known as rays, which belong to the Chondrichthyes class alongside sharks and skates. All rays have a flat body with enlarged pectoral fins permanently fused to their heads. Their mouths are located on the ventral (bottom) side of their bodies. The most dangerous aspect of stingrays is their tail, which houses a spinal blade or “barb” covered in sharp spines made of a cartilaginous material called vasodentin.

Stingrays can have between one and three of these spinal blades, and the venom is stored within secretory cells along the grooves on the underside of the spine. Freshwater stingrays have a more toxic venom than their saltwater counterparts, as they have more secretory cells covering a larger area of the barb.

Epidemiology of Stingray Envenomations

Stingrays are widely distributed throughout tropical marine and freshwater environments, with over 150 species ranging in size from inches to 6.5 feet and weighing up to 800 pounds. They are commonly found in or near coral reefs, leading to frequent human encounters and injuries.

In the United States, an estimated 750 to 2,000 stingray injuries are reported annually. The incidence is much higher in tropical regions, with thousands of cases per year reported in areas with freshwater stingrays. Stingray victims are typically male, with an average age of 28 years, and the most common sites of injury are the lower and upper extremities.

While most stingray injuries have low morbidity, freshwater stings tend to have higher rates of serious injuries and complications. Fatalities related to stingray envenomations occur one to two times per year in the United States and Indo-Pacific nations, but can be as high as 8 per year in South American countries with Amazonian stingrays.

Pathophysiology of Stingray Stings

Stingrays are not typically aggressive, but they will use their tails to puncture and envenomate potential threats, such as predators or unsuspecting swimmers and divers who accidentally step on them. The mechanism of injury involves both mechanical and venomous components.

First, the sharp barbs pierce the skin, causing a laceration or puncture wound. In some cases, these wounds can lead to arterial or spinal cord injury. The sheath of the barb may also remain embedded in the patient’s skin, requiring debridement for removal.

The venom of the stingray is known to be heat-labile and cardiotoxic, and its primary effect is severe pain. Other symptoms can include headaches, sweating, vertigo, nausea, vomiting, diarrhea, fainting, muscle cramps, fasciculations, and breathing difficulties.

Management of Stingray Envenomations

The immediate management of a stingray sting involves the removal of any retained barbs, wound care, and immersion of the affected area in hot water (as hot as can be tolerated) to inactivate the venom. Pain management, tetanus prophylaxis, and antibiotic administration may also be necessary.

In cases of more severe injuries, such as those involving the abdomen, chest, or head, the patient should be stabilized and promptly transported to a healthcare facility for further evaluation and treatment. Complications like arterial injury, spinal cord injury, and infection require specialized medical care.

Role of the Interprofessional Team

The care of patients with stingray injuries requires an interprofessional approach to ensure the best possible outcomes. Emergency medical technicians, emergency department physicians and nurses, orthopedic surgeons, and infectious disease specialists may all be involved in the management of these patients.

Effective communication, coordination, and collaboration among the interprofessional team members are crucial to provide prompt and comprehensive care, manage complications, and educate patients on prevention strategies to reduce the risk of future stingray encounters.

Preventing Stingray Encounters

To avoid stingray stings, it is recommended to shuffle or slide one’s feet through the sand rather than walking, as this helps alert the stingrays to the presence of a potential threat and allows them to swim away. Wearing protective footwear, such as water shoes or dive booties, can also help prevent direct contact with the stingrays.

Additionally, being aware of the local stingray population and their habitats, and exercising caution when swimming or wading in known stingray-infested waters, can help reduce the risk of accidental encounters and subsequent injuries.

Stingray Sting – StatPearls – NCBI Bookshelf

Aubri Charnigo; Geoffrey Thiele; Erwin L. Kong; Rebecca J. Ondrus.

Author Information and Affiliations

Last Update: July 19, 2022.

Continuing Education Activity

Stingray envenomations are common injuries. Practitioners should recognize that these injuries vary in level of severity, and clinical concerns should vary accordingly. The type of stingray involved and the anatomical region of injury affect the associated morbidity and, in some cases, mortality. Short-term management includes the removal of any retained barbs, wound care, and immersion of the injury in hot water to inactivate the toxin. This activity outlines the evaluation and treatment of stingray stings and reviews the role of the interprofessional team in the care of patients with this condition.

Objectives:

• Review the risk factors for stingray envenomation.

• Outline the management of stingray envenomation.

• Describe the complications of stingray envenomation.

• Summarize the importance of collaboration among interprofessional team members to enhance the care of stingray injuries and improve outcomes for affected patients.

Access free multiple choice questions on this topic.

Introduction

Stingrays are a subset of the cartilaginous fish commonly known as rays. Rays are members of the Chondrichthyes class, which also includes sharks and skates. All rays share a flat body with enlarged pectoral fins that permanently fuse to their heads. The mouth of a stingray is on the ventral side of the animal. The most dangerous aspect of the stingray is the tail due to the spinal blade, also known as its stinger or barb. Rays with longer spines located more distally on their tail represent the greatest danger for sting injuries.[1]

Etiology

Stingrays can have between one and three spinal blades. The stinger is covered with rows of sharp spines made of vasodentin, a cartilaginous material that can easily cut through the skin. The stingray is unique from other venomous animals in that the venom storage is not in a gland. The venom is stored inside its own secretory cells within the grooves on the undersides of the spine. Freshwater stingrays have more secretory cells that cover a larger area along the blade. Because of this fact, freshwater stingrays have a venom that is more toxic than that of their saltwater relatives. The venom of the stingray has been relatively unstudied but is known to be heat-labile and cardiotoxic.[1][2]

Epidemiology

Stingrays are very common throughout tropical marine waters and freshwaters. There are over 150 species of stingray worldwide, ranging in size from inches to 6.5 feet and in the larger species weighing as much as 800 pounds. Stingrays often feed in or near coral reefs, causing frequent human injuries. In the United States, there are approximately 750 to 2000 stingray injuries reported annually.[3] There are estimated thousands of cases per year in tropical regions with freshwater stingrays that occupy inland rivers. [3] In one retrospective review of 119 cases seen in a California emergency department over 8 years, 80% of stingray victims were male, with an average age of 28 years (range 9 to 68 years old).[4] In a prospective study of freshwater stingray injuries in Brazil, 80% to 90% of the injuries were in men.[5] The most common site of injury is the lower extremities, followed by the upper extremities.[4][5] The majority of stingray injuries have low morbidity, with higher rates of serious injuries and complications in freshwater stings compared to marine stings. In the United States and Indo-Pacific nations, fatalities related to stingray injuries occur one to two times a year, compared to fatality rates up to 8 per year in South American nations related to Amazonian stingrays.[3]

Pathophysiology

Stingrays are not known to be aggressive, nor are they known to act defensively. In fact, the primary defensive action of the stingray is simply to swim away from the area. However, when attacked by a predator or stepped on, the ray will use its tail to puncture and envenomate its potential attacker. Human injuries are most common on the extremities of swimmers and divers and those who accidentally step on a stingray. One way to prevent this is to slide or shuffle through the sand instead of walking.

The mechanism of stingray stings includes both mechanical and venomous injury. First, the barbs pierce through the skin, causing a laceration or puncture wound. In most cases, these wounds are minor, but there are reports of arterial or spinal cord injury related to stingray wounds. The sheath of the barb can also remain in the patient’s skin, which may require debridement for removal. The most common venomous effect is severe pain, but the venom can also cause headaches, diaphoresis, vertigo, nausea, vomiting, diarrhea, syncope, muscle cramps, fasciculations, dyspnea, cardiac arrhythmias, hypotension, and seizures.[4][6]

History and Physical

Patients will present with a puncture wound or laceration and report pain out of proportion to the wound. They will often have a known exposure to a stingray or may have a wound on their foot and report that they stepped on something in the ocean. The onset of severe pain is usually immediate. It reaches maximum intensity within 30 to 90 minutes and can last for up to 48 hours.[6] The site of the wound may have evidence of edema and discoloration. In delayed presentations, there may be evidence of local necrosis. Patients may also report systemic symptoms such as nausea, vomiting, diarrhea, lightheadedness, syncope, shortness of breath, headache, abdominal pain, vertigo, or seizures.[3]

Evaluation

The wound should be evaluated using standard procedures, including irrigation of the wound. Plain films may be obtained to evaluate for foreign bodies at the discretion of the provider. Stingray barbs are radioopaque and are visible on plain films. There is not currently a recommended standard for obtaining radiographs in stingray injuries. However, in one retrospective review, 57% of patients had radiographic imaging. Foreign body identification was found in only 2 cases of 119 (and only definitively in one case; there was a possible barb in the other case). [4] 

If the patient presents with an injury to the chest or abdomen or severe systemic symptoms, consider an electrocardiogram (EKG), cardiac monitoring, lab work, and chest radiography. If there is a concern for severe systemic illness, including cardiogenic shock, the patient should be transferred to a facility with ICU capabilities, and a medical toxicology consult may be obtained.

Treatment / Management

The standard treatment for stingray injuries is hot water immersion.[4][6][7] Stingray venom is heat-labile and can be inactivated by heat. Water should be heated to a temperature that will not result in burns, and the temperature should be tested on a non-affected extremity, as the patient may have impaired sensation on the injured extremity. Hot water immersion should be initiated as soon as possible, ideally in the field by lifeguards or paramedics. A small prospective study found that hot water immersion alone resulted in statistically significant pain reduction. [7] Another retrospective study found that hot water immersion alone provided effective pain relief in 9 out of 10 patients. Oral NSAIDs or opioids were used concurrently with hot water immersion in the other 10% of patients. Only 2% of patients required additional pain control at discharge.[4] In patients with freshwater stings in Brazil, hot water immersion was found to help reduce pain but did not decrease rates of skin necrosis.[5]

In addition to hot water immersion, standard wound care techniques should be applied. Irrigate the wound. If there is suspicion for a retained foreign body, obtain radiographs, explore the injury and remove any foreign bodies as they may result in delayed healing and wound necrosis. If the wound is small, it should be left to close by secondary intention or delayed primary closure, due to the risks of infection. Tetanus status should be inquired about and tetanus immunizations updated as necessary. If there is evidence of necrosis, the wound should be debrided. [3] 

There is not a clear consensus on whether antibiotic prophylaxis should be given with some experts arguing that most injuries are minor and prophylaxis should only be given for deep penetrating wounds, wounds complicated by a foreign body, or patients who are immunocompromised. However, in a retrospective review, 70% of patients were prescribed prophylactic antibiotics on initial presentation, and only one patient returned with possible early wound infection. Of the 30% of patients not prescribed antimicrobial prophylaxis, 17% returned with signs of wound infection.[4] Antibiotic prophylaxis, therefore, seems prudent, and coverage should include gram-negative species, including Vibrio, as well as Staphylococcus and Streptococcus.

Differential Diagnosis

• Laceration

• Cellulitis

• Necrotizing fasciitis 

• Sea urchin

• Lionfish

• Jellyfish

• Coral

• Sea anemone

• Shark bite

• Octopus bite

• Alligator or crocodile attack

• Ciguatera

• Scombroid

• Pufferfish tetrodotoxin

• Shellfish toxin

Prognosis

Stingray injuries, whether through puncture, laceration, or envenomation, usually have a good prognosis. It is important to instruct patients to look for signs of infection after discharge. While it is possible to develop further complications such as infection, most patients will have a significantly decreased amount of pain in one to two days after the incident. Necrosis following marine envenomations was rarely reported in the United States but reported at high rates after freshwater stings in Brazil. A study of 84 freshwater stings in Brazil reported a rate of ulcers and necrosis in 90.4% of cases. The ulcers lasted approximately 3 months and often resulted in scars.[5] 

Systemic toxicity or death related to stingray stings is rare and associated with stings resulting in penetrating trauma to the abdomen, chest, or neck resulting in a cardiac laceration, cardiac tamponade, pneumothorax, airway compromise, or hemorrhagic shock. There are cases of delayed fatality secondary to septic shock, osteomyelitis, gangrene, and wound botulism from an infected wound.[3]

Complications

The most common complication of stingray sting is wound infection or necrosis. There are significantly higher rates of skin necrosis associated with freshwater stingray injuries.[5] There are case reports of necrotizing fasciitis following stingray injury.[8]

Consultations

For patients with severe toxic effects, including systemic illness, cardiogenic shock, syncope, shortness of breath, or seizures, a medical toxicology consult may be obtained. The local Poison Control Center may also be a useful consult for these patients.

Deterrence and Patient Education

Stingrays are generally docile animals and are not known for actively attacking humans unless threatened. Stingray injuries can be prevented by encouraging swimmers, divers, and beach-goers to avoid provoking stingrays. Most injuries occur due to accidentally stepping on a ray. This can be prevented by shuffling through the sand without lifting the feet or using a stick or pole to poke the sand ahead of placing the feet. Divers should avoid swimming too close to the seafloor. A fisher who accidentally catches a stingray should not attempt to disentangle it from a net or line. [3]

Enhancing Healthcare Team Outcomes

An interprofessional team approach to managing stingray injuries includes proper training of local medics and lifeguards. Many patients with minor stingray injuries do not present to healthcare facilities and may be managed in the field setting by these first responders. In a review of 153 stingray cases reported to Texas poison centers, 61% were not managed in healthcare facilities.[9] First-responders should be trained to immerse stingray wounds in hot water. They should also require training to transfer the patient to a medical facility for wounds with ongoing bleeding, deep penetration, evidence of systemic toxicity, ongoing pain, or patients with comorbid medical conditions. Within the emergency department setting, nurses and technicians are integral in ensuring that the patient has continuous hot water immersion for 30 to 90 minutes. Emergency clinicians should promptly manage any severe effects of the toxin or wound. Medical toxicology may be consulted for severe effects as well.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Sting ray with barb. Image courtesy S Bhimji MD

References

1.

O’Connell C, Myatt T, Clark RF, Coffey C, Nguyen BJ. Stingray Envenomation. J Emerg Med. 2019 Feb;56(2):230-231. [PubMed: 30738566]

2.

Sachett JAG, Sampaio VS, Silva IM, Shibuya A, Vale FF, Costa FP, Pardal PPO, Lacerda MVG, Monteiro WM. Delayed healthcare and secondary infections following freshwater stingray injuries: risk factors for a poorly understood health issue in the Amazon. Rev Soc Bras Med Trop. 2018 Sep-Oct;51(5):651-659. [PubMed: 30304272]

3.

Diaz JH. The evaluation, management, and prevention of stingray injuries in travelers. J Travel Med. 2008 Mar-Apr;15(2):102-9. [PubMed: 18346243]

4.

Clark RF, Girard RH, Rao D, Ly BT, Davis DP. Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases. J Emerg Med. 2007 Jul;33(1):33-7. [PubMed: 17630073]

5.

Haddad V, Neto DG, de Paula Neto JB, de Luna Marques FP, Barbaro KC. Freshwater stingrays: study of epidemiologic, clinic and therapeutic aspects based on 84 envenomings in humans and some enzymatic activities of the venom. Toxicon. 2004 Mar 01;43(3):287-94. [PubMed: 15033327]

6.

Meyer PK. Stingray injuries. Wilderness Environ Med. 1997 Feb;8(1):24-8. [PubMed: 11990133]

7.

Myatt T, Nguyen BJ, Clark RF, Coffey CH, O’Connell CW. A Prospective Study of Stingray Injury and Envenomation Outcomes. J Emerg Med. 2018 Aug;55(2):213-217. [PubMed: 29803633]

8.

Ho PL, Tang WM, Lo KS, Yuen KY. Necrotizing fasciitis due to Vibrio alginolyticus following an injury inflicted by a stingray. Scand J Infect Dis. 1998;30(2):192-3. [PubMed: 9730311]

9.

Forrester MB. Pattern of stingray injuries reported to Texas poison centers from 1998 to 2004. Hum Exp Toxicol. 2005 Dec;24(12):639-42. [PubMed: 16408617]

Disclosure: Aubri Charnigo declares no relevant financial relationships with ineligible companies.

Disclosure: Geoffrey Thiele declares no relevant financial relationships with ineligible companies.

Disclosure: Erwin Kong declares no relevant financial relationships with ineligible companies.

Disclosure: Rebecca Ondrus declares no relevant financial relationships with ineligible companies.

Stingray Sting – StatPearls – NCBI Bookshelf

Aubri Charnigo; Geoffrey Thiele; Erwin L. Kong; Rebecca J. Ondrus.

Author Information and Affiliations

Last Update: July 19, 2022.

Continuing Education Activity

Stingray envenomations are common injuries. Practitioners should recognize that these injuries vary in level of severity, and clinical concerns should vary accordingly. The type of stingray involved and the anatomical region of injury affect the associated morbidity and, in some cases, mortality. Short-term management includes the removal of any retained barbs, wound care, and immersion of the injury in hot water to inactivate the toxin. This activity outlines the evaluation and treatment of stingray stings and reviews the role of the interprofessional team in the care of patients with this condition.

Objectives:

• Review the risk factors for stingray envenomation.

• Outline the management of stingray envenomation.

• Describe the complications of stingray envenomation.

• Summarize the importance of collaboration among interprofessional team members to enhance the care of stingray injuries and improve outcomes for affected patients.

Access free multiple choice questions on this topic.

Introduction

Stingrays are a subset of the cartilaginous fish commonly known as rays. Rays are members of the Chondrichthyes class, which also includes sharks and skates. All rays share a flat body with enlarged pectoral fins that permanently fuse to their heads. The mouth of a stingray is on the ventral side of the animal. The most dangerous aspect of the stingray is the tail due to the spinal blade, also known as its stinger or barb. Rays with longer spines located more distally on their tail represent the greatest danger for sting injuries.[1]

Etiology

Stingrays can have between one and three spinal blades. The stinger is covered with rows of sharp spines made of vasodentin, a cartilaginous material that can easily cut through the skin. The stingray is unique from other venomous animals in that the venom storage is not in a gland. The venom is stored inside its own secretory cells within the grooves on the undersides of the spine. Freshwater stingrays have more secretory cells that cover a larger area along the blade. Because of this fact, freshwater stingrays have a venom that is more toxic than that of their saltwater relatives. The venom of the stingray has been relatively unstudied but is known to be heat-labile and cardiotoxic.[1][2]

Epidemiology

Stingrays are very common throughout tropical marine waters and freshwaters. There are over 150 species of stingray worldwide, ranging in size from inches to 6.5 feet and in the larger species weighing as much as 800 pounds. Stingrays often feed in or near coral reefs, causing frequent human injuries. In the United States, there are approximately 750 to 2000 stingray injuries reported annually.[3] There are estimated thousands of cases per year in tropical regions with freshwater stingrays that occupy inland rivers.[3] In one retrospective review of 119 cases seen in a California emergency department over 8 years, 80% of stingray victims were male, with an average age of 28 years (range 9 to 68 years old).[4] In a prospective study of freshwater stingray injuries in Brazil, 80% to 90% of the injuries were in men.[5] The most common site of injury is the lower extremities, followed by the upper extremities. [4][5] The majority of stingray injuries have low morbidity, with higher rates of serious injuries and complications in freshwater stings compared to marine stings. In the United States and Indo-Pacific nations, fatalities related to stingray injuries occur one to two times a year, compared to fatality rates up to 8 per year in South American nations related to Amazonian stingrays.[3]

Pathophysiology

Stingrays are not known to be aggressive, nor are they known to act defensively. In fact, the primary defensive action of the stingray is simply to swim away from the area. However, when attacked by a predator or stepped on, the ray will use its tail to puncture and envenomate its potential attacker. Human injuries are most common on the extremities of swimmers and divers and those who accidentally step on a stingray. One way to prevent this is to slide or shuffle through the sand instead of walking.

The mechanism of stingray stings includes both mechanical and venomous injury. First, the barbs pierce through the skin, causing a laceration or puncture wound. In most cases, these wounds are minor, but there are reports of arterial or spinal cord injury related to stingray wounds. The sheath of the barb can also remain in the patient’s skin, which may require debridement for removal. The most common venomous effect is severe pain, but the venom can also cause headaches, diaphoresis, vertigo, nausea, vomiting, diarrhea, syncope, muscle cramps, fasciculations, dyspnea, cardiac arrhythmias, hypotension, and seizures.[4][6]

History and Physical

Patients will present with a puncture wound or laceration and report pain out of proportion to the wound. They will often have a known exposure to a stingray or may have a wound on their foot and report that they stepped on something in the ocean. The onset of severe pain is usually immediate. It reaches maximum intensity within 30 to 90 minutes and can last for up to 48 hours.[6] The site of the wound may have evidence of edema and discoloration. In delayed presentations, there may be evidence of local necrosis. Patients may also report systemic symptoms such as nausea, vomiting, diarrhea, lightheadedness, syncope, shortness of breath, headache, abdominal pain, vertigo, or seizures.[3]

Evaluation

The wound should be evaluated using standard procedures, including irrigation of the wound. Plain films may be obtained to evaluate for foreign bodies at the discretion of the provider. Stingray barbs are radioopaque and are visible on plain films. There is not currently a recommended standard for obtaining radiographs in stingray injuries. However, in one retrospective review, 57% of patients had radiographic imaging. Foreign body identification was found in only 2 cases of 119 (and only definitively in one case; there was a possible barb in the other case).[4] 

If the patient presents with an injury to the chest or abdomen or severe systemic symptoms, consider an electrocardiogram (EKG), cardiac monitoring, lab work, and chest radiography. If there is a concern for severe systemic illness, including cardiogenic shock, the patient should be transferred to a facility with ICU capabilities, and a medical toxicology consult may be obtained.

Treatment / Management

The standard treatment for stingray injuries is hot water immersion.[4][6][7] Stingray venom is heat-labile and can be inactivated by heat. Water should be heated to a temperature that will not result in burns, and the temperature should be tested on a non-affected extremity, as the patient may have impaired sensation on the injured extremity. Hot water immersion should be initiated as soon as possible, ideally in the field by lifeguards or paramedics. A small prospective study found that hot water immersion alone resulted in statistically significant pain reduction.[7] Another retrospective study found that hot water immersion alone provided effective pain relief in 9 out of 10 patients. Oral NSAIDs or opioids were used concurrently with hot water immersion in the other 10% of patients. Only 2% of patients required additional pain control at discharge.[4] In patients with freshwater stings in Brazil, hot water immersion was found to help reduce pain but did not decrease rates of skin necrosis.[5]

In addition to hot water immersion, standard wound care techniques should be applied. Irrigate the wound. If there is suspicion for a retained foreign body, obtain radiographs, explore the injury and remove any foreign bodies as they may result in delayed healing and wound necrosis. If the wound is small, it should be left to close by secondary intention or delayed primary closure, due to the risks of infection. Tetanus status should be inquired about and tetanus immunizations updated as necessary. If there is evidence of necrosis, the wound should be debrided.[3] 

There is not a clear consensus on whether antibiotic prophylaxis should be given with some experts arguing that most injuries are minor and prophylaxis should only be given for deep penetrating wounds, wounds complicated by a foreign body, or patients who are immunocompromised. However, in a retrospective review, 70% of patients were prescribed prophylactic antibiotics on initial presentation, and only one patient returned with possible early wound infection. Of the 30% of patients not prescribed antimicrobial prophylaxis, 17% returned with signs of wound infection.[4] Antibiotic prophylaxis, therefore, seems prudent, and coverage should include gram-negative species, including Vibrio, as well as Staphylococcus and Streptococcus.

Differential Diagnosis

• Laceration

• Cellulitis

• Necrotizing fasciitis 

• Sea urchin

• Lionfish

• Jellyfish

• Coral

• Sea anemone

• Shark bite

• Octopus bite

• Alligator or crocodile attack

• Ciguatera

• Scombroid

• Pufferfish tetrodotoxin

• Shellfish toxin

Prognosis

Stingray injuries, whether through puncture, laceration, or envenomation, usually have a good prognosis. It is important to instruct patients to look for signs of infection after discharge. While it is possible to develop further complications such as infection, most patients will have a significantly decreased amount of pain in one to two days after the incident. Necrosis following marine envenomations was rarely reported in the United States but reported at high rates after freshwater stings in Brazil. A study of 84 freshwater stings in Brazil reported a rate of ulcers and necrosis in 90.4% of cases. The ulcers lasted approximately 3 months and often resulted in scars.[5] 

Systemic toxicity or death related to stingray stings is rare and associated with stings resulting in penetrating trauma to the abdomen, chest, or neck resulting in a cardiac laceration, cardiac tamponade, pneumothorax, airway compromise, or hemorrhagic shock. There are cases of delayed fatality secondary to septic shock, osteomyelitis, gangrene, and wound botulism from an infected wound.[3]

Complications

The most common complication of stingray sting is wound infection or necrosis. There are significantly higher rates of skin necrosis associated with freshwater stingray injuries.[5] There are case reports of necrotizing fasciitis following stingray injury.[8]

Consultations

For patients with severe toxic effects, including systemic illness, cardiogenic shock, syncope, shortness of breath, or seizures, a medical toxicology consult may be obtained. The local Poison Control Center may also be a useful consult for these patients.

Deterrence and Patient Education

Stingrays are generally docile animals and are not known for actively attacking humans unless threatened. Stingray injuries can be prevented by encouraging swimmers, divers, and beach-goers to avoid provoking stingrays. Most injuries occur due to accidentally stepping on a ray. This can be prevented by shuffling through the sand without lifting the feet or using a stick or pole to poke the sand ahead of placing the feet. Divers should avoid swimming too close to the seafloor. A fisher who accidentally catches a stingray should not attempt to disentangle it from a net or line. [3]

Enhancing Healthcare Team Outcomes

An interprofessional team approach to managing stingray injuries includes proper training of local medics and lifeguards. Many patients with minor stingray injuries do not present to healthcare facilities and may be managed in the field setting by these first responders. In a review of 153 stingray cases reported to Texas poison centers, 61% were not managed in healthcare facilities.[9] First-responders should be trained to immerse stingray wounds in hot water. They should also require training to transfer the patient to a medical facility for wounds with ongoing bleeding, deep penetration, evidence of systemic toxicity, ongoing pain, or patients with comorbid medical conditions. Within the emergency department setting, nurses and technicians are integral in ensuring that the patient has continuous hot water immersion for 30 to 90 minutes. Emergency clinicians should promptly manage any severe effects of the toxin or wound. Medical toxicology may be consulted for severe effects as well.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Sting ray with barb. Image courtesy S Bhimji MD

References

1.

O’Connell C, Myatt T, Clark RF, Coffey C, Nguyen BJ. Stingray Envenomation. J Emerg Med. 2019 Feb;56(2):230-231. [PubMed: 30738566]

2.

Sachett JAG, Sampaio VS, Silva IM, Shibuya A, Vale FF, Costa FP, Pardal PPO, Lacerda MVG, Monteiro WM. Delayed healthcare and secondary infections following freshwater stingray injuries: risk factors for a poorly understood health issue in the Amazon. Rev Soc Bras Med Trop. 2018 Sep-Oct;51(5):651-659. [PubMed: 30304272]

3.

Diaz JH. The evaluation, management, and prevention of stingray injuries in travelers. J Travel Med. 2008 Mar-Apr;15(2):102-9. [PubMed: 18346243]

4.

Clark RF, Girard RH, Rao D, Ly BT, Davis DP. Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases. J Emerg Med. 2007 Jul;33(1):33-7. [PubMed: 17630073]

5.

Haddad V, Neto DG, de Paula Neto JB, de Luna Marques FP, Barbaro KC. Freshwater stingrays: study of epidemiologic, clinic and therapeutic aspects based on 84 envenomings in humans and some enzymatic activities of the venom. Toxicon. 2004 Mar 01;43(3):287-94. [PubMed: 15033327]

6.

Meyer PK. Stingray injuries. Wilderness Environ Med. 1997 Feb;8(1):24-8. [PubMed: 11990133]

7.

Myatt T, Nguyen BJ, Clark RF, Coffey CH, O’Connell CW. A Prospective Study of Stingray Injury and Envenomation Outcomes. J Emerg Med. 2018 Aug;55(2):213-217. [PubMed: 29803633]

8.

Ho PL, Tang WM, Lo KS, Yuen KY. Necrotizing fasciitis due to Vibrio alginolyticus following an injury inflicted by a stingray. Scand J Infect Dis. 1998;30(2):192-3. [PubMed: 9730311]

9.

Forrester MB. Pattern of stingray injuries reported to Texas poison centers from 1998 to 2004. Hum Exp Toxicol. 2005 Dec;24(12):639-42. [PubMed: 16408617]

Disclosure: Aubri Charnigo declares no relevant financial relationships with ineligible companies.

Disclosure: Geoffrey Thiele declares no relevant financial relationships with ineligible companies.

Disclosure: Erwin Kong declares no relevant financial relationships with ineligible companies.

Disclosure: Rebecca Ondrus declares no relevant financial relationships with ineligible companies.

Poisonous inhabitants of the seas | lemur59.ru

American zoologist William Beebe about forty-five years ago wrote: see this amazing world with your own eyes.

We have tens of thousands of people of various ages and professions, wearing flippers and masks, immerse themselves in the depths of the sea, full of colorful landscapes and inhabitants unusual for the human eye. Fans of such boat trips need to learn to recognize “by sight” the poisonous inhabitants of our seas.

So, in the Black and Azov Seas, one should be wary of meeting with a katran, a stingray, a sea dragon, an astrologer, a scorpion, an angler, a lyre mouse. In the Baltic Sea there are stingrays and kerchak. In the Far Eastern seas live: katran, astrologer, stingray, high-beam perch.

There are quite a lot of poisonous fish in our seas, let’s talk briefly about those that are found more often than others.

With the help of sharp fins, spines and thorns that can injure a person, through special ducts, fish inject toxins into the blood of the victim, most often affecting the nervous and circulatory systems of a person. The ratio of poisons in different types of fish can vary greatly. The most dangerous are substances that affect the nervous system, since they act very quickly and practically do not allow timely assistance to the victim. Poisons that affect the circulatory system cause poisoning much more slowly, which in most cases makes it possible to save a person’s life. The response to these toxins largely depends on the characteristics of the human body.

In people with increased excitability (especially with vegetative neuroses), as well as those suffering from diseases of the liver and kidneys, signs of poisoning are more pronounced.

It should be noted that poisonous fish are not aggressive and never attack a person themselves. Injuries usually occur as a result of the swimmer’s carelessness. Most often, a diver steps on a fish buried in the sand.

Sea cats and other most dangerous reptiles of the Baltic Sea

According to scientists, there are not only dangerous waterfowl with fins, tails and tentacles in the Baltic Sea, but also microorganisms that threaten human health and life.

Cats and dragons Miral Viktor Ananyevich Dygalo, one of the most dangerous inhabitants of the Baltic is sea cat – a stingray with a sharp spike at the end of the tail (sometimes it has two such spikes-thorns).

Stingrays are relatives of sharks, they also belong to cartilaginous fish, they have no bones, and the spine, ribs, and skull are made of cartilage. The stingray has no sides – only the back and belly, top and bottom. Stingray, aka sea cat , can reach up to 70 cm in length. They live at the bottom, they also find food at the bottom – mollusks, crabs; therefore, their mouth is displaced under a flat head, and their eyes and splashes – gill slits – are located on top. Stingrays swim, waving wide body planes like wings, and their tail fin disappears, only its stem remains – the tail itself. Stingray uses it as a weapon. He has a thorn on his tail, or rather a real sword – up to 20 centimeters in length. Its edges are very sharp, and besides, jagged, a groove runs along the blade, along which flows thick, visible to the eye, dark poison from the poisonous gland on the tail. If you hit a stingray lying at the bottom, it will hit with its tail like a whip; at the same time, he sticks out his thorn and can inflict a deep chopped wound. A wound inflicted by a stingray is treated like any other. Fortunately, sea cats are shy, they are afraid of noise, they try to swim away from bathers, and, naturally, where children bathe, they are not there.

The largest, four-meter sea cat has a tail as thick as a human leg, and a spike reaches 30 centimeters. Such a monster with a similar pin easily pierces the bottom of the boat.

According to Viktor Ananyevich’s description, a prick of a sea cat’s poisonous thorn is very dangerous for a person – the victim’s cardiovascular system is affected (blood pressure drops, heartbeat quickens). For any such contact, a swimmer stung by a stingray should receive emergency medical attention.
Toxicologist A. Potapova gives examples of the dangerous consequences of encounters with another inhabitant of the Baltic Sea – snake fish (sea dragon) .

Sea dragon. Elongated in length, similar to a snake, with an angular large head, bottom fish. Like other bottom predators, the dragon has bulging eyes on the top of its head and a huge, greedy mouth. His character is in his appearance. Unlike the scorpionfish living among stones, the dragon prefers soft soils – sand, silt, into which it burrows, lying in wait for prey – small fish; above the surface of the bottom there are only his keen evil eyes. And above the sand sticks out the front dorsal fin, similar to a bunch of brown algae. All five rays of this fin are poisoned spines. Another venomous spine grows backwards from the operculum. There are cases in the world when people stepped on a prickly dragon in sandy shallows. Fishermen sometimes get hurt when they catch him on a bait – in this case it is better not to try to take the dragon off the hook alive – it will prick. The wounds inflicted by the whelp are considered more dangerous than those of the scorpionfish, but the treatment is the same.

Contact with the sea dragon, whose venom glands are located on the fins and gills, can paralyze the arms and legs, and deaths are also known.

What to do if you are stung by a sea dragon

If you are attacked by a dangerous predator, you must immediately take a few actions:

• Vigorously suck out the poison for 10 minutes. Do not worry that the toxic poison will enter the bloodstream through the mouth – saliva has bactericidal properties that can neutralize the poison.
• The wound should be treated with hydrogen peroxide or a strong solution of potassium permanganate (potassium permanganate).
• Apply a sterile dressing to avoid additional infection.
• After first aid, immediately go to the hospital to see a doctor.

The health consequences of dragon stab victims vary – in this case, the depth of the wound was inflicted, whether the fish was large and how strong the human body is.

katrans and jellyfish

V. A. Dygalo names among the dangerous inhabitants of the Baltic Sea also the jellyfish Cyanea (Lion’s mane) and 90 005 katran shark . Katran is less common in the Baltic than in the Black Sea, but still contacts of scuba divers with it are not excluded.

Katran is a shark that does not pose a serious threat to human life. The only danger to humans is the possibility of injuring themselves with the prickly fins of the fish. The special placoid scales that cover the skin of a shark are similar in composition to teeth and bones. So, shark scales consist of leather plates that are adjacent to each other and form pointed peaks. The shark has sharp and poisonous spines covered with mucus, but the poison of the katran is far from fatal. Katran has small and multi-row sharp teeth that are updated throughout life. They gradually fall out and are replaced by new ones.

These sharks have venom glands located near their fins. The poison of the katrans is of low toxicity, but swelling of the extremities, a violation of the heartbeat and respiration, such poisoning can cause.
Unpleasant consequences, according to Viktor Ananievich, from attacks on a person jellyfish Tsyanei .

The body of the cyanide has a variety of colors, with a predominance of red and brown tones. In adult specimens, the upper part of the dome is yellowish, and its edges are red. The mouth lobes are crimson red, the marginal tentacles are light, pink and purple. Young individuals are colored much brighter.

The cyanide bell has a hemispherical shape, its edges are transformed into 16 blades, separated from each other by cutouts. At the base of the cutouts there are ropalia – the so-called marginal bodies, which contain the organs of vision (eyes) and balance (statocysts). The long marginal tentacles are collected in 8 bundles and are attached to the inner concave side of the dome under the lobes between the ropalia.

In the center of the lower part of the dome there is a mouth opening surrounded by large, folded mouth lobes hanging down like curtains. The radial channels of the digestive system, extending from the stomach, enter the marginal and oral lobes of the bell, where they form branches.

The Arctic cyanide is the largest jellyfish in the oceans. There are specimens with a dome diameter reaching 2 m. The tentacles of such large specimens can stretch up to 20 m. Usually cyanideas do not grow more than 50-60 cm. The largest jellyfish reached 36.5 meters, and the diameter of the “cap” was 2.3 meters.

It looks like a bell and sometimes reaches almost 3 meters in size. Cyanea has 20-meter poisonous tentacles similar to a lion’s mane (hence its name). They just pose a danger – touching these processes causes allergic reactions, rashes and burning.

Algae kill people?

If all of the above inhabitants of the Baltic have poisonous body parts that they need for life – defense from enemies or hunting, then algae microorganisms Alexandrium ostenfeldii, no less dangerous to humans, according to Finnish oceanologists, have become so due to a radically changed ecological situation .

The news that the Baltic Sea is rapidly filling with toxic luminous algae Alexandrium ostenfeldii (also called sea fire) was spread by Finnish scientists from the Institute of National Resources at the end of last autumn. According to the Finns, sea fire, saturated with saxitocin and neurotoxin, destroys not only the inhabitants of the depths of the Baltic, but also sea birds, as well as people. These toxins contribute to the numbness of the organisms of all living things with which they come into contact.

Scientists noticed blue-green microalgae in the Baltic Sea 40 years ago, and with climate change, they began to spread more and more actively in this basin. In 2015, sea fire bloomed in the coastal waters of the Baltic because of the heat. Experts attribute the flowering cycle of Alexandrium ostenfeldii to climate change and the influx of water from the Atlantic.
Domestic oceanologists from the Moscow Institute of Oceanology named after P. P. Shirshov of the Russian Academy of Sciences have confirmed that certain highly concentrated toxins are actually able to paralyze the respiratory muscles, cause allergic reactions, and damage the kidneys and liver. Meanwhile, neither Finnish nor domestic oceanologists provided statistics on the impact of sea fire on human health. Only deaths from eating toxic fish caught in the bays of the Baltic in East Prussia were mentioned. But they date back to the 20-30s of the XX century.

Nikolay Syr Omyatnikov

POISONOUS FISH OF OUR SEAS

SEA DRAGON OR SEA SCORPION

The most poisonous fish in many European seas lives in the Black Sea and the Kerch Strait. Length – up to 36 centimeters. A smaller species lives in the western part of the Baltic – the small sea dragon, or viper (12-14 centimeters). The structure of the poisonous apparatus of these fish is similar, and therefore the development of signs of poisoning is similar.

The body of the sea dragon is compressed from the sides, the eyes are set high, close together and look up. The fish lives at the bottom and often burrows into the ground so that only the head is visible. If you step on it with your bare foot or grab it with your hand, its sharp spines pierce the body of the “offender”. Poisonous glands in a scorpion are provided with 6-7 rays of the anterior dorsal fin and spines of gill covers.

Depending on the depth of the injection, the size of the fish, the condition of the victim, the consequences of being hit by a dragon may be different. At first, a sharp, burning pain is felt at the site of injury. The skin in the area of ​​the wound turns red, edema appears, tissue necrosis develops. There is a headache, fever, profuse sweating, pain in the heart, breathing is weakened. Paralysis of the limbs can occur, and in the most severe cases, death. However, poisoning usually disappears after 2-3 days, but a secondary infection, necrosis and a sluggishly current (up to 3 months) ulcer necessarily develop in the wound. It has been established that dragon venom contains mainly substances that act on the circulatory system, the percentage of neurotropic toxins is small. Therefore, the vast majority of cases of poisoning ends with the recovery of a person.

STARGAZER OR SEA-COW

Close relatives of the dragon. Their usual sizes are 30-40 centimeters. They live in the Black Sea and the Far East.

Stargazer, or sea cow, living in the Black Sea, has a grayish-brown spindle-shaped body with white, irregularly shaped spots running along the lateral line. The eyes of the fish are directed upwards, towards the sky. Hence its name. The stargazer spends most of its time at the bottom, burrowing into the ground, exposing its eyes and mouth with a protruding worm-like tongue that serves as bait for fish.

There are sharp spikes on the gill covers and above the pectoral fins of the sea cow. During the breeding season, from late May to September, an accumulation of toxin-producing cells develops at their base. Through the grooves on the spikes, the poison enters the wound.

Soon after the injury, a person develops acute pain at the injection site, the affected tissue swells, and breathing becomes difficult. Only after a few days the person recovers. The venom secreted by stargazers is similar in effect to dragonfish toxin, but has not been well studied. Cases of fatal outcomes are known when these species of fish living in the Mediterranean Sea are affected.

Found in the Black and Azov Seas, also common in the Kerch Strait. Length – up to 31 centimeters. The coloration is brownish-pink: the back is dark brown with dark spots, the belly is pink. Large head, slightly flattened from top to bottom. The eyes are set high and close together. The scorpion loves the rocky bottom and in low light resembles a rock with algae growing on it. Eleven rays of the anterior dorsal, one ventral and three rays of the anal fin have venom glands. The poisons they secrete are especially dangerous in early spring. The pricks of the fins are very painful. In small doses, the toxin causes local inflammation of the tissues, in large doses – paralysis of the respiratory muscles. The poison of the sea ruff contains mainly substances that act on the blood, so the symptoms of poisoning in the victims persist for several days and then disappear without complications.

These fish, otherwise called sea cats, are found in the Black, Azov and southern Baltic Seas. In the Far East, a giant stingray lives in Peter the Great Bay, and a red stingray is common in the waters of southern Primorye. Individual specimens reach a length of 2.5 meters (tail up to 50-80 centimeters). These fish are well known, they have a flattened diamond-shaped body, which ends with a thin long tail, equipped with a sharp spike serrated from the sides (sometimes there are two or three). Poison glands lie in the two lower grooves of the spike. Stingrays lead a bottom way of life. If you accidentally step on a stingray buried in the ground in shallow water with a sandy bottom, it begins to defend itself and inflicts a deep wound on a person with its “weapon”. A prick is like being stabbed with a blunt knife. The pain quickly increases and after 5-10 minutes becomes unbearable. Local phenomena (edema, hyperemia) are accompanied by fainting, dizziness, impaired cardiac activity. In severe cases, death can occur from heart failure. Usually on the 5-7th day the victim recovers, but the wound heals much later.

The venom of a sea cat, once in the wound, causes painful phenomena similar to the bites of a poisonous snake. It acts equally on both the nervous and circulatory systems.

SPIKED SHARK OR KATRAN

Inhabits the Black, Barents, Okhotsk and Japan seas. Length – up to 2 meters. It is called prickly for two strong sharp spikes, at the base of which there are poisonous glands located in front of the dorsal fins. With them, the katran is capable of inflicting deep wounds on an unwary scuba diver. An inflammatory reaction develops at the site of the lesion: pain, hyperemia, edema. Sometimes there is a rapid heartbeat, slow breathing. It should not be forgotten that the katran has shark teeth, despite its modest size. Its poison, unlike the others, contains mainly myotropic (acting on the muscles) substances and has a rather weak effect, therefore, in the vast majority of people poisoning ends with a complete recovery.

KERCHAK, SEA PERCH, YORSH-NOSAR, AUHA OR CHINESE ROOF, SEA MOUSE-LYRE, HIGH-BEAM PERCH

In addition to the listed poisonous fish, in our seas there are also kerch k, living in the Baltic , Barents and White Seas; monkfish and sea mouse-lyre – in the Black Sea; sea ​​bass – in the Barents Sea and, finally, high-beam perch that lives in the Japan and Barents Seas. All these fish have poisonous “weapons” in the form of sharp spikes and thorns, but the toxins they produce are less dangerous to humans and cause only local damage.

European scorpion, or sea scorpion (lat. Myoxocephalus scorpius) is a species of marine scorpion-like fish from the scorpion family. One of the largest members of the family, which can reach up to 60 cm in length.

Distribution

coasts of Europe north of the Baltic Gulf, in the Barents, Kara and Baltic Seas, as well as along the Murmansk coast and in the White Sea. It lives on rocky, sandy and muddy bottom, at a depth of 2 to 60 meters.

Description Kerchak European head is wide and spiked, and a powerful and scaleless body . Pectoral (pectoral) fins are large; pelvic fins with long rays. There are two noticeable spines in front of the gill covers: the upper one is longer than the lower one, but less than the diameter of the eye. Below and above the lateral line on the body there are several small spines. The coloration is very variable within the species, it can be camouflage. The fish are usually speckled with orange undersides in females or red undersides in males.

Lyra sea mouse (Callionymus lyra)

Lyre sea mouse is the largest and most numerous member of the lyre family. It is nocturnal and usually lies buried in the sand during the day. Males grow faster than females and reach sexual maturity at 3-5 years of age. Spawning is accompanied by a courtship procedure. Fertilized eggs float to the surface. Feeds on small crustaceans and mollusks.

Appearance: is the largest and most numerous member of the Lyre family. A huge lipped head with a long hooked snout, similar to the head of a camel. Gill openings are small. Preopercular spine with three denticles above, two of which are directed upwards and one backwards, and with one directed anteriorly and hidden in the skin with a spine at their base. The body is low, naked, in its upper part there is a lateral line, from which transverse branches extend up and down. The caudal stalk is rounded in cross section.

Rays of spiny dorsal fin in juveniles do not reach, slightly in females, in males considerably beyond the beginning of the base of the soft dorsal fin; 1-2.5 times the length of the head. The rays of the soft dorsal fin are shorter than its base, the last ray in males is often elongated and extends beyond the beginning of the caudal fin, the 1st ray is 1.7-2.1 times the length of the base, the last ray is 1-2. 4 times.

Caudal fin shorter than head, contained 1.1-1.5 times. The anal papilla is strongly developed in males and hidden in females. The coloration is extremely varied. The upper part of the body in males is yellow with a reddish tint, with light blue or purple spots. On the sides of the body from the upper base of the pectoral fin to the caudal fin there is a blue stripe and orange and blue stripes below.

Spiny dorsal dull lemon color with reddish or purple stripes at the base, soft dorsal with four pale blue stripes, anal with a dark border along the apex, caudal lemon and bluish colors, upper part of the pectorals reddish brown with indistinct stripes, ventral bluish-purple with a few light spots at the base.

Colour: female lyre mouse dull brown, lighter on the sides and white below, with irregularly spaced darker and lighter spots along the body above the lateral line and an irregular row of eight dark spots below it. The spiny dorsal fin is blue-black in the back, soft bluish with a yellowish stripe in the middle, the caudal fin has three transverse stripes, the ventrals are dark.

Sizes: length 15-25 cm, largest sizes of males 24, met up to 30 cm, females 18.5, up to 25 cm are indicated.

Distribution: northern Mediterranean, in Gibraltar, off the coast of Algeria, in the Aegean and Adriatic seas, off the southern coast of Iceland, along the Atlantic coast of Europe from Norway to Mauritania, off the British Isles, the Azores and Madeira. Our sea mouse-lyre lives in the Black Sea.

EVERYONE SHOULD KNOW

divers, scuba divers, tourists and just relaxing by the sea must observe the following precautions.

Never try to grab fish with an unprotected hand, especially unknown to you, located in crevices or lying on the bottom.

It is not always safe, as experienced scuba divers testify, to touch unfamiliar objects on sandy ground. These can be stingrays camouflaged there, sea dragons, stargazers and sea mouse-lyre. It is also dangerous to search underwater caves with your hands – you can stumble upon a hidden scorpionfish in them.

Those who like walking barefoot on the seashore at low tide need to carefully look under their feet. Remember: sea dragons often remain in the wet sand after the water recedes, and they are easy to step on. Children and those who first came to the sea coast should be especially warned about this.

Emergency measures for spiny poisonous fish should be aimed at relieving pain from the injury and poison, overcoming the effects of the toxin and preventing secondary infection. When injured, it is necessary to immediately vigorously suck the poison out of the wound with the mouth along with the blood for 15-20 minutes. The suctioned liquid must be quickly spit out. There is no need to be afraid of the action of the toxin: the bactericidal substances contained in saliva reliably protect against poisoning. However, remember that this procedure cannot be performed on those who have wounds, injuries, sores on their lips and in the oral cavity. After this, the site of the lesion must be washed with a strong solution of potassium permanganate or hydrogen peroxide and an aseptic bandage applied. Then the victim is given an analgesic and diphenhydramine to prevent the development of allergic reactions, as well as drinking plenty of water, preferably strong tea. In the future, the prompt qualified help of a doctor is needed.

In conclusion, we remind you once again: be careful and careful when swimming, diving and scuba diving. You can easily avoid unpleasant contact with dangerous inhabitants, since they themselves never attack a person, but use their weapons solely for the purpose of self-defense.

A. POTAPOVA, toxicologist, and A. POTAPOV, master of sports in scuba diving (Leningrad).0001

The Black Sea does not belong to tropical seas teeming with poisonous fish and dangerous animals. There are no electric rays, no man-eating sharks, no Portuguese boats, no toothy moray eels, however, in its waters there are marine life that pose a danger to human health.

The bathing season of 2017 will begin very soon, and vacationers yearning for the long winter for the sun and water will be massively drawn to the banks of rivers, lakes, and of course, they will go to rest on the Black Sea coast. The Black Sea is very friendly to people, there are practically no animals dangerous to humans, however, here you need to be on the alert so as not to thoroughly spoil your vacation. These are the few inhabitants of the Black Sea who can give us trouble.

Cornerot jellyfish (Rhizostoma pulmo). It is easily distinguished by its fleshy, bell-like dome and the heavy beard of the oral lobes underneath. On these lacy lobes are poisonous stinging cells. Try to swim around them; but in general, ordinary nettle burns more than cornerot. A jellyfish poses a certain danger to human mucous membranes, so you should beware of diving with your eyes open and putting jellyfish into swimming trunks.

Another large Black Sea jellyfish – Aurelia (Aurelia aurita). Her stinging cells are weaker, they do not pierce the skin on the body, but it can hurt to burn the mucous membrane of the eye or the edges of the lips of Aurelia; Therefore, it is better not to throw jellyfish at each other. The stinging cells of Aurelia are on a fringe of small tentacles that border the edge of the dome of the jellyfish. If you touched a jellyfish, even a dead one, rinse your hands – stinging cells may remain on them, and if you then rub your eyes with them, you will burn yourself.

Spiny shark or katran .

Lives in the Black, Barents, Okhotsk and Japan seas. Length – up to 2 meters. It is called prickly for two strong sharp spikes, at the base of which there are poisonous glands located in front of the dorsal fins. With them, the katran is capable of inflicting deep wounds on an unlucky fisherman or a careless scuba diver. An inflammatory reaction develops at the site of the lesion: pain, hyperemia, swelling. Sometimes there is a rapid heartbeat, slow breathing. It should not be forgotten that the katran has shark teeth, despite its modest size. Its poison, unlike the others, contains mainly myotropic (acting on the muscles) substances and has a rather weak effect, therefore, in the vast majority of people poisoning ends with a complete recovery.

Sea ruff or Black Sea scorpion – Scorpaena porcus. This is a real monster – a large head covered with outgrowths, horns, bulging crimson eyes, a huge mouth with thick lips. The rays of the dorsal fin are turned into sharp spines, which the scorpionfish, if disturbed, spreads; at the base of each ray is a poisonous gland. This is the protection of the ruff from predators, its weapon of defense. And the weapon of attack – the jaws with many sharp crooked teeth – are intended for careless fish that approached the scorpion at a distance of its swift, furious throw. The whole appearance of the scorpion speaks of its danger; and at the same time she is beautiful – and there are scorpionfish of very different colors – black, gray, brown, raspberry-yellow, pink …

These spiny predators lurk between stones, under algae, and, like all bottom fish, change color to match the color of their surroundings, can quickly lighten or darken depending on the light. They hide the scorpion and numerous outgrowths, spikes and leathery tentacles, turning it into one of the stones, overgrown with marine vegetation. Therefore, it is difficult to notice her, and she herself relies so much on her inconspicuousness that she swims away (more precisely, flies away like a bullet from a gun!) Only if you get close to her. Sometimes you can even touch it – but you just don’t need to do this – you will prick! It is more interesting, lying on the surface of the water and breathing through a tube, watching the scorpionfish hunt…

There are two species of scorpionfish in the Black Sea – the conspicuous scorpionfish Scorpaena notata, it is no more than 15 centimeters in length, and the Black Sea scorpionfish Scorpaena porcus – up to half a meter – but such large ones are found deeper, further from the coast. The main difference between the Black Sea scorpionfish is long, rag-like, supraorbital tentacles. In the conspicuous scorpion, these outgrowths are short. The poisons they secrete are especially dangerous in early spring. The pricks of the fins are very painful.

Wounds from scorpion thorns cause burning pain, the area around the injections turns red and swells, then general malaise, fever, and your rest is interrupted for a day or two. Wounds should be treated like normal scratches. The main symptoms of sea ruff poisoning are local inflammation (where they were pricked) and a general allergic reaction. Therefore, the only pills that can help are anti-allergic (antihistamine) drugs – remember to strictly follow the instructions for using the pills that come with all medicines. There are no known deaths from scorpion stings. No one accidentally steps on it either – curious divers and fishermen suffer from its thorns when they remove the ruff from the hook or take it out of the net. By the way, the sea ruff is a very tasty fish, but you need to clean it carefully – the poison is preserved even in a scorpionfish that has lain in the refrigerator.

In small doses, the toxin causes local tissue inflammation, in large doses it causes paralysis of the respiratory muscles. The poison of the sea ruff contains mainly substances that act on the blood, so the symptoms of poisoning in the victims persist for several days and then disappear without complications.

Stingray stingray aka sea cat .

Grows up to 1 m in length. He has a thorn on his tail, or rather a real sword – up to 20 centimeters in length. Some fish have two or even three spines. Its edges are very sharp, and besides, jagged, along the blade, on the underside there is a groove in which dark poison from the poisonous gland on the tail is visible. If you hit a stingray lying at the bottom, it will hit with its tail like a whip; at the same time, he sticks out his thorn and can inflict a deep chopped or stab wound. A stingray wound is treated like any other.

Stingrays lead a bottom lifestyle. Despite the fact that sea cats are quite shy, they are afraid of noise, they try to swim away from bathers, if they accidentally step on a stingray burrowed into the ground in shallow water with a sandy bottom, it begins to defend itself and inflicts a deep wound on a person with its “weapon”. A prick is like being stabbed with a blunt knife. The pain quickly increases and after 5-10 minutes becomes unbearable. Local phenomena (edema, hyperemia) are accompanied by fainting, dizziness, impaired cardiac activity. In severe cases, death can occur from heart failure. Usually on the 5-7th day the victim recovers, but the wound heals much later.

The venom of a sea cat, once in the wound, causes painful phenomena similar to the bites of a poisonous snake. It acts equally on both the nervous and circulatory systems. Unlike the katran and scorpionfish, after a close acquaintance with a sea cat, it is unlikely that it will be possible to do without the help of a doctor.

Stargazer , or Sea Cow .

Their usual size is 30-40 centimeters. They live in the Black Sea and the Far East. Stargazer, or sea cow, living in the Black Sea, has a grayish-brown spindle-shaped body with white, irregularly shaped spots running along the lateral line. The eyes of the fish are directed upwards, towards the sky. Hence its name. The stargazer spends most of his time at the bottom, burrowing into the ground, exposing his eyes and mouth with a protruding worm-like tongue that serves as bait for fish. There are sharp spikes on the gill covers and above the pectoral fins of the sea cow. During the breeding season, from late May to September, an accumulation of toxin-producing cells develops at their base. Through the grooves on the spikes, the poison enters the wound.

Shortly after the injury, a person develops acute pain at the injection site, the affected tissue swells, breathing becomes difficult. Only after a few days the person recovers. The venom secreted by stargazers is similar in effect to dragonfish toxin, but has not been well studied. Cases of fatal outcomes are known when these species of fish living in the Mediterranean Sea are affected.

Rounding out our list is Sea Dragon , or Sea Scorpion .

The most poisonous fish in many European seas lives in the Black Sea and the Kerch Strait. Length – up to 36 centimeters. A smaller species lives in the western part of the Baltic – the small sea dragon, or viper (12-14 centimeters). The structure of the poisonous apparatus of these fish is similar, and therefore the development of signs of poisoning is similar. In a sea dragon, the body is compressed from the sides, the eyes are set high, close together and look up. The fish lives at the bottom and often burrows into the ground so that only the head is visible.

If you step on it with your bare foot or grab it with your hand, its sharp spines pierce the body of the “offender”. Poisonous glands in a scorpion are provided with 6-7 rays of the anterior dorsal fin and spines of gill covers. Depending on the depth of the injection, the size of the fish, the condition of the victim, the consequences of being hit by a dragon may be different. At first, a sharp, burning pain is felt at the site of injury. The skin in the area of ​​the wound turns red, edema appears, tissue necrosis develops. There is a headache, fever, profuse sweating, pain in the heart, breathing is weakened. Paralysis of the limbs can occur, and in the most severe cases, death. However, poisoning usually disappears after 2-3 days, but a secondary infection, necrosis and a sluggishly current (up to 3 months) ulcer necessarily develop in the wound.

It has been established that dragon venom contains mainly substances that act on the circulatory system, the percentage of neurotropic toxins is small. Therefore, the vast majority of cases of poisoning ends with the recovery of a person.

To prevent poisonous fish poisoning, divers, snorkellers, scuba divers, campers and seaside enthusiasts should take the following precautions.

Never try to catch fish with your unprotected hand, especially fish you don’t know, in crevices or on the bottom.

It is not always safe, as experienced scuba divers testify, to touch unfamiliar objects on sandy ground. It can be stingrays camouflaged there, sea dragons or stargazers. It is also dangerous to search underwater caves with your hands – you can stumble upon a hidden scorpionfish in them.

Those who like walking barefoot on the seashore at low tide need to carefully look under their feet. Remember: sea dragons often remain in the wet sand after the water recedes, and they are easy to step on. Children and those who first came to the sea coast should be especially warned about this.

Emergency measures for spiny poisonous fish should be aimed at relieving pain from the injury and poison, overcoming the effects of the toxin and preventing secondary infection. When injured, it is necessary to immediately vigorously suck the poison out of the wound with the mouth along with the blood for 15-20 minutes.

The aspirated liquid must be quickly spit out. There is no need to be afraid of the action of the toxin: the bactericidal substances contained in saliva reliably protect against poisoning. However, remember that this procedure cannot be performed on those who have wounds, injuries, sores on their lips and in the oral cavity. After this, the site of the lesion must be washed with a strong solution of potassium permanganate or hydrogen peroxide and an aseptic bandage applied. Then the victim is given an analgesic and diphenhydramine to prevent the development of allergic reactions, as well as drinking plenty of water, preferably strong tea.

When stinging any poisonous fish, there is a proven folk way to reduce the pain of the wound. If you caught the offender, and most often it is careless fishermen who get injured, then you need to cut off a piece of meat from the fish that injured you and apply it to the wound. The pain will subside significantly, however, in the case of the sea dragon, the stargazer and the stingray, the soonest qualified medical assistance is needed in the future.

In conclusion, I would like to remind you once again: be careful and careful when swimming, diving and scuba diving.