Skip to main content
  1. Venomous fish
  2. Biomedical Database
  3. Clinical entry: Venomous fishes

Clinic: Venomous fishes

Examine for venom effects

Local Effects

  • Pain
  • Tender local (spreading) swelling
  • Lymphangiopathy and lymphadenopathy
  • Necrotic soft tissue
  • Spine, membrane and other foreign material may remain in the wound.

Neurological effects

Neuromuscular dysfunction

Autonomic nervous system dysfunction

Cholinergic effects 

  • Vomiting; sweating, hypersalivation and hyperlacrimation.
  • Bradycardia, arterial hypotension, shock. Priapism. 

Adrenergic effects 

  • Tachycardia, arrhythmias, arterial hypertension, myocardial failure, pulmonary oedema, cardiac ischaemia, shock.

Cardiac effects

  • Bradycardia, tachycardia, arrhythmias
  • Arterial hypotension
  • Heart failure
  • ECG: Tachyarrhythmias, sinus bradycardia, varying degrees of atrioventricular block, ST-T wave changes.

Species-specific envenoming pattern

The assessment of the envenoming pattern is based on the data from publication in which the identification of the snakes is clearly specified and in accordance with accepted criteria.

   Local effects Cardiac and neurological effectsA
Stingrays1    
Stonefishes (Synanceiidae)2    
Lionfishes (Pteroinae)3    
Other Mail-cheeked fishes (Scorpaeniformes)4    
Weeverfishes (Trachinus sp.)5    
Catfishes6    
All other stinging fishes (see Biomedical database)  

ACardiac / Neurological effects

Signs and symptoms such as nausea, vomiting, diarrhoea, hypersalivation, hypotension, cardiac arrhythmias, cardiac arrest, respiratory distress, pulmonary oedema and muscle paralysis are listed in various combinations in case reports of venomous fish accidents.
However, in encounters with different venomous fish species, it remains to various degrees controversial how much secondary effects play a role in the overall picture such as responses related to intense/agonizing pain, circumstantial effects, e.g. near drowning. Age and underlying preexisting health condition most likely also contribute to the outcome reported.
Given the uncertainties about systemic envenoming in accidents caused by various venomous fish, systemic venom induced cardiac effects and neurological, including autonomous effects, are discussed together.

1Stingrays

Local effects
Immediate intense/agonizing pain, superficial or deep puncture wounds or lacerated wounds (Graininger 1985; Haddad et al. 2013).
Injury to internal organs with or without additional damaging effects of venom have been described. Penetration of the spine into the pericardial cavity with subsequent toxic myocardial necrosis, ventricle perforation, cardiac tamponade and death 6 days after the accident (Fenner et al. 1989). Penetration of the pleural cavity (Barss 1984); the heart (Liggins 2006), the abdominal cavity and the liver (Jhamb and Corsetti 2013).
Mechanical injury of inner organs is the main cause of death (Fenner et al. 1989b, Liggins 2006, Meyer et al. 1997, Russell et al. 1958).
If the spine breaks off, parts of it may remain in the wound, as may other foreign matter, and, in addition to causing local toxic effects and bacterial infections, can lead to poor wound healing and extensive necroses (Brass 1984, Fenner et al. 1989b, Haddad et al. 2013, Halstead and Bunker 1953, Haigh et al. 2019, Sachett et al. 2018) (see 'Specific aspects of wound management' below).
Stingray venom contains venom components that cause extensive necroses. It is important to bear this in mind in particular with deep injuries in which the venom may be introduced into regions that are inaccessible for inspection. The death of a child 6 days after a sting came about in this manner (Fenner et al. 1989b). Extensive, deep necroses that may be missed on superficial inspection of the wound can also occur with soft tissue injuries, e.g. of the extremities.

Systemic effects
Various systemic accident-related responses (listed above) have been described and are also for stingrays controversially discussed (Diaz 2008, Graininger 1985; Haddad et al. 2013; Harris 2024). Haddad et al. (2013) summarize: “The systemic symptoms observed are usually fever, cold sweats, nausea, vomiting and restlessness, associated to the pain and stress of the victims.” Cardiac arrhythmias (e.g. supraventricular bigeminy, commencing 25 min after the sting, duration approx. 15 min described in a case report by Ikeda (1989) and arrhythmias previously described by Halstead (1988) and Russell (1953) have been attributed to the venom. The effect was so far only rarely observed.

2Stonefishes (Synanceiidae)

Local effects
Immediate, intense/agonizing pain that can radiate as far as the trunk; local paraesthesias; puncture wound(s), which may bleed. If the spine breaks off, parts of it may remain in the wound, as may other foreign matter, and, in addition to causing local toxic effects and bacterial infections – which is common - can lead to poor wound healing and extensive necroses (see 'Specific aspects of wound management' below). Erythematous swelling can involve the entire extremity, necroses (Bottard 1889, Maillaud et al. 2020).

Systemic effects
In stonefish accidents systemic envenoming appears reasonably well documented and points towards cardiovascular effects of the venoms (myocardial dysfunction including cardiac arrythmias, pulmonary oedema, cardiopulmonary failure) (Bottard 1889; Harris 2024, Harris et al. 2021; Maillaud et al. 2020; Lehmann and Hardy 1993). 

3Lionfishes (Pteroniae)

Local effects
Immediate, intense, puncture wound(s), erythematous swelling (Hadad et al. 2015; Kizer et al. 1985; Trestrail and Al-Mahasneh 1989).
Secondary effects: Remaining spines and other foreign material, bacterial infections – which is common - can lead to poor wound healing and extensive necroses (see 'Specific aspects of wound management' below).

Systemic effects
Various systemic accident-related responses have been described.
Given the fact that accidents usually happen under well-controlled conditions of aquarists who did not require medical care for systemic complications, severe systemic envenomation seems to be the extremely rare exception. This is supported by the observation of Haddad et al. (2015).

4Other Mail-cheeked fishes (Scorpaeniformes)

Scorpionfish

Local effects
Immediate, intense pain, puncture wound(s), which may bleed, erythematous swelling (Haddad et al. 2003; Kizer et al. 1985).
Secondary effects: Remaining spines and other foreign material, bacterial infections – which is common - can lead to poor wound healing (see 'Specific aspects of wound management' below).

Systemic effects
Various systemic accident-related responses have been described and are also for scorpionfishes controversially discussed. The discussion of a case by Abdun-Nur, Marcus and Russell (1981) is instructive for the challenges of establishing causality. In the case discussed, the authors came to the conclusion “it became evident that the envenomation was only casually related to the chest findings.” (Abdun-Nur et al. 1981). Haddad et al. (2003) observed in 23 patients a range of systemic signs & symptoms. They also concluded “… although the symptoms could be credited to the intense pain of envenoming”. Similarly, Kizer et al. (1985).

5Weeverfishes (Trachinus sp.)

Local effects
Immediate, intense/agonizing pain, puncture wound(s), which may bleed, mild erythematous swelling (Cain 1983, Ferreira et al. 2025, Gorman et al. 2020).
Secondary effects: Remaining spines and other foreign material, bacterial infections – which is common - can lead to poor wound healing and extensive necroses (see 'Specific aspects of wound management' below).

Systemic effects
Various systemic accident-related responses have been observed and are also for weeverfishes controversially discussed (Gorman et al. 2020, Ferreira et al. 2025).
Given the thousands of weever fish accidents occurring every year and almost exclusively not requiring medical care for systemic complications, severe systemic envenomation seems to be the rare exception. The regularly cited death (Borondo et al. 2001) is difficult to interpret: The significant time period of the events relies on the report of friends – medical lay people - of the deceased including the resuscitation attempt.

6Catfishes

Local effects
Immediate, intense pain, puncture wound(s), which may bleed, erythematous swelling (Haddad et al. 2008; McKinstry 1993). Deaths can occur due to perforation of inner organs (Haddad et al. 2008)
Secondary effects: Remaining spines and other foreign material, bacterial infections – which is common - can lead to poor wound healing and extensive necroses (see 'Specific aspects of wound management' below).

Systemic effects
Various systemic accident-related responses have been described.
Given the many catfish accidents occurring every year and almost exclusively not requiring medical care for systemic complications, severe systemic envenomation seems to be the very rare exception. This is supported by the observation of Haddad and Martins (2006) and others.

Publications reporting broadly on venomous fish envenoming

  • Halstead BW. Poisonous and Venomous Marine Animals of the World. 2nd ed. New Jersey: Darwin Press; 1988.
  • Harris, R.J. The piscine arsenal: an updated review of venomous fishes. Rev Fish Biol Fisheries 34, 539–574 (2024). https://doi.org/10.1007/s11160-023-09828-w
  • Harris RJ, Saggiomo SL, Paxton G, Motti CA. Sting Stories: Firsthand Experiences of Fish Envenomation Through a Small-Scale Questionnaire. Toxins (Basel). 2025 Mar 13;17(3):134. PMID: 40137907; PMCID: PMC11946659. https://doi.org/10.3390/toxins17030134
  • Isbister GK. Venomous fish stings in tropical northern Australia. Am J Emerg Med. 2001 Nov;19(7):561-5. PMID: 11699001. https://doi.org/10.1053/ajem.2001.28325

Species-specific publications: see ‘References’ at the end of the file. 

Clinical management

See also Clinical Management: venomous fish

for advice on diagnosis (clinical, laboratory) and treatment (supportive).

First Aid

Hot water immersion

Immersion or showering of the affected extremity in water as hot as can be tolerated, especially if it is not possible to get immediate medical assistance (water temperature just below 45°C, temperature should be checked by a companion or with a healthy extremity in order to avoid burns, duration of treatment variable (30 - 90 min); if necessary repeatedly (Atkinson et al. 2006).
Skin damage is a very serious drawback of the hot water immersion if the temperature is not carefully controlled (Abdul Jalil and Quaayum 2020; Lewis et al. 2020).
The venom, which, in addition to the physical injury, is responsible for pain and tissue destruction, is heat-labile. Controversy exists if temperatures which can be safely applied to human skin suffice to inactivate venom injected at various depth into the tissues by venomous fishes. Alternative hypotheses are modulation of pain receptors in the nervous system. The debate is ongoing, e.g., Atkinson et al. 2006; Barnett et al. 2017; Harris (2024) and Harris et al. (2025). 

Local treatment

Pain control
If hot water immersion (see ‘First Aid, above) fails to control pain, injection of a local anaesthetic (lignocaine 1%) without the addition of a vasoconstrictor directly into and around the wound. Nerve block anaesthesia with lignocaine 1% or bupivacaine which has a longer duration of action (Dormon 1985).
Wound management
Tetanus prophylaxis
Standard wound care (WHO 2010)

Specific aspects of wound management

Diagnosis and removal of spines, membranes and other foreign material
X-ray examination to find foreign material that may be buried deep in the wound. Not all foreign material, however, is radiopaque.
Wound exploration in order to remove foreign matter. Wound exploration must be carried out along the entire wound to the depth to which the spine penetrated. It must be ensured that the spine did not penetrate the abdominal, pleural or pericardial cavities and that no internal organs, vessels or nerves were injured (Carbone et al. 2024, Docter et al. 2021. Haigh et al. 2019, Negreiros et al. 2016, O’Malley et al. 2015, 2019, Palatchi et al. 2021, Trickett at al. 2008, Zeman 1989).

Wound infection
Uncomplicated and properly attended wounds heal without the need of antibiotics (Katzer et al. 2022).
Clostridium tetani infections occur and deaths due to Tetanus have been reported (Torrez et al. 2015, Rathjen and Halstead 1969).
Large, lacerated (barbed spines!), necrotizing wounds are at high risk of getting infected and progressing in locally expanding and systemic infections (erysipelas, necrotizing fasciitis, sepsis) and chronic wounds. Marine fish injury infections are caused by a wide variety of bacteria including Chromobacterium (C. violaceum), Edwardsiella, Mycobacterium marinum, Photobacterium, Shewanella, Staphylococcus, Streptococcus, Vibrio (V. vulnificus). Bacteria causing freshwater fish injury infections include bacteria of the genus Aeromonas (Aeromonas hydrophila) and also, Mycobacterium marinum (Diaz 2014, Sachett et al. 2018). 

Systemic supportive treatment

A general understanding of emergency medicine is required, or can be found in emergency medicine guidelines, e.g. ABCDE approach, WHO-ICRC Basic Emergency Care.

Obey Venomous fish - specific features

see 'Species-specific envenoming pattern above'.

Key issues

Diagnosis and removal of spines, membranes and other foreign material
(see above)

Wound infection
(see above)

Respiratory failure

  • Airway management
  • Breathing: Oxygen ⇨ assisted ventilation ⇨ mechanical ventilation

ABCDE-approch is lifesaving as supportive treatment until the antivenom applied acts or when antivenom (stonefish) is not available or fails.

Specific treatment (antivenoms)

The only commercially available antivenom neutralizes the venoms of Synanceia trachynis, S. verrucosa and S. horrida and has paraspecific activity against venoms of the Californian scorpion fish (Scorpaena guttata) and other members of the Scorpaenidae family (Warrell 2023).

Stonefish Antivenom (Seqiris, previously CSL, Parkville, Australia)

Recommended dose
Seqirus (2019)
1 or 2 punctures: 1 vial (2,000 units),
3 or 4 punctures: 2 vials (4,000 units),
5 or 6 punctures: 3 vials (6,000 units).
In severe envenoming the dose can be increased.

  • Sutherland 1992
    26 cases in which antivenom was administered and which are well documented. In all cases debilitating pain commenced immediately after the sting. The hot water method (see above) only provided limited pain relief.
    Dose: 1 vial i.m. 18/26, 2 vials i.m. 8/26.
    Efficacy: efficient and permanent relief of pain in all patients.
    Adverse reactions: 15/26 were observed for a sufficient period of time. 2 developed serum sickness.

Antivenom indications
All patients with stonefish envenoming.
Exceptions: only mild complaints; straightforward accident that occurred several hours previously, and if there has already been improvement of the symptoms (Sutherland and Tibballs 2001).

References

  • Abdul Jalil KI, Qayyum MT. Iatrogenic thermal burn after hot water immersion for weever fish sting treatment: a case report. Scars Burn Heal. 2020 Sep 14;6:2059513120944045. PMID: 32974056; PMCID: PMC7493226. https://doi.org/10.1177/2059513120944045

  • Abdun-Nur D, Marcus CS, Russell FE.Pericarditis associated with scorpionfish (Scorpaena buttata) sting. Toxicon. 1981;19(4):579-81. PMID: 7330893. https://doi.org/10.1016/0041-0101(81)90019-2
  • Atkinson PR, Boyle A, Hartin D, McAuley D. Is hot water immersion an effective treatment for marine envenomation? Emerg Med J. 2006 Jul;23(7):503-8. PMID: 16794088; PMCID: PMC2579537. https://doi.org/10.1136/emj.2005.028456
  • Barnett S, Saggiomo S, Smout M, Seymour J. Heat deactivation of the stonefish Synanceia horrida venom - implications for first-aid management. Diving Hyperb Med. 2017 Sep;47(3):155-158. PMID: 28868595; PMCID: PMC6159625. https://doi.org/10.28920/dhm47.3.155-158
  • Barss P. Wound necrosis caused by the venom of stingrays. Pathological findings and surgical management. Med J Aust. 1984 Dec 8-22;141(12-13):854-5. PMID: 6150422. https://doi.org/10.5694/j.1326-5377.1984.tb132970.x
  • Borondo JC, Sanz P, Nogué S, Poncela JL, Garrido P, Valverde JL. Fatal weeverfish sting.Hum Exp Toxicol. 2001 Feb;20(2):118-9. PMID: 11327512. https://doi.org/10.1191/096032701668435659
  • Bottard A (1889) Les poissons venimeux, contribution à l'hygiene navale.Impr. du Journal Le Havre. (French thesis).
  • Cain D. Weever fish sting: an unusual problem. Br Med J (Clin Res Ed). 1983 Aug 6;287(6389):406-7. PMID: 6135490; PMCID: PMC1548902. https://doi.org/10.1136/bmj.287.6389.406
  • Carbone SJ, Jozefick JL, Sigal AP, Nordell RH 4th. Catfish Puncture Wound and Retained Spine Management in the ED Setting: A Case Report. Wilderness Environ Med. 2024 Dec;35(4):474-478. Epub 2024 Sep 10. PMID: 39256930. https://doi.org/10.1177/10806032241273505
  • Diaz JH. The evaluation, management, and prevention of stingray injuries in travelers. J Travel Med. 2008 Mar-Apr;15(2):102-9. PMID: 18346243. https://doi.org/10.1111/j.1708-8305.2007.00177.x
  • Diaz JH. Skin and soft tissue infections following marine injuries and exposures in travelers. J Travel Med. 2014 May-Jun;21(3):207-13. Epub 2014 Mar 14. PMID: 24628985. https://doi.org/10.1111/jtm.12115
  • Docter TA, Altschuh LB, Medak AJ, Statum SM, Chung CB, Van Hoesen KB, Coffey CH. Comparison of Radiographic, Ultrasound, and Magnetic Resonance Imaging for the Detection of Retained Stingray Barb: A Cadaveric Study. Wilderness Environ Med. 2021 Sep;32(3):302-307. Epub 2021 Jul 20. PMID: 34294537. https://doi.org/10.1016/j.wem.2021.03.012
  • Dormon FM. Local nerve block after stingray injury.Lancet. 1985 Nov 16;2(8464):1131-2. PMID: 2865605. https://doi.org/10.1016/s0140-6736(85)90725-1
  • Fenner PJ, Williamson JA, Skinner RA.Fatal and non-fatal stingray envenomation. Med J Aust. 1989b Dec 4-18;151(11-12):621-5. PMID: 2593906. https://doi.org/10.5694/j.1326-5377.1989.tb139631.x
  • Ferreira LFLC, Barbosa DJ, Dinis-Oliveira RJ.The toxicology of greater weever (Trachinus draco): Clinical and forensic aspects. Toxicon. 2025 Oct;265:108492. Epub 2025 Jul 8. PMID: 40639489. https://doi.org/10.1016/j.toxicon.2025.108492
  • Gorman LM, Judge SJ, Fezai M, Jemaà M, Harris JB, Caldwell GS. The venoms of the lesser (Echiichthys vipera) and greater (Trachinus draco) weever fish- A review. Toxicon X. 2020 Feb 7;6:100025. PMID: 32550581; PMCID: PMC7285994. https://doi.org/10.1016/j.toxcx.2020.100025
  • Grainger CR. Sting ray injuries.Trans R Soc Trop Med Hyg. 1985;79(4):443-4.PMID: 4082253. https://doi.org/10.1016/0035-9203(85)90055-0
  • Haigh K, Delbridge P, Meda K, Chilamkurthi R. Stingray envenomation in a returning traveller: a complicated disease course. BMJ Case Rep. 2019 Jul 2;12(7):e228644. PMID: 31270086; PMCID: PMC6613965. https://doi.org/10.1136/bcr-2018-228644
  • Haddad V Jr, Martins IA. Frequency and gravity of human envenomations caused by marine catfish (suborder siluroidei): a clinical and epidemiological study. Toxicon. 2006 Jun 15;47(8):838-43. Epub 2006 May 19. PMID: 16713609. https://doi.org/10.1016/j.toxicon.2006.02.005
  • Haddad V Jr, Martins IA, Makyama HM. Injuries caused by scorpionfishes (Scorpaena plumieri Bloch, 1789 and Scorpaena brasiliensis Cuvier, 1829) in the Southwestern Atlantic Ocean (Brazilian coast): epidemiologic, clinic and therapeutic aspects of 23 stings in humans. Toxicon. 2003 Jul;42(1):79-83. PMID: 12893064. https://doi.org/10.1016/s0041-0101(03)00103-x
  • Haddad V, de Souza RA, Auerbach PS. Marine catfish sting causing fatal heart perforation in a fisherman. Wilderness Environ Med. 2008 Summer;19(2):114-8. PMID: 18513109. https://doi.org/10.1580/07-weme-cr-1182.1
  • Haddad V Jr, Cardoso JL, Neto DG.Injuries by marine and freshwater stingrays: history, clinical aspects of the envenomations and current status of a neglected problem in Brazil. J Venom Anim Toxins Incl Trop Dis. 2013 Jul 29;19(1):16. PMID: 23895313; PMCID: PMC3735412. https://doi.org/10.1186/1678-9199-19-16
  • Haddad V Jr, Stolf HO, Risk JY, França FO, Cardoso JL. Report of 15 injuries caused by lionfish (pterois volitans) in aquarists in Brazil: a critical assessment of the severity of envenomations. J Venom Anim Toxins Incl Trop Dis. 2015 Mar 20;21:8. PMID: 25810712; PMCID: PMC4373524. https://doi.org/10.1186/s40409-015-0007-x
  • Halstead BW. Poisonous and Venomous Marine Animals of the World. 2nd ed. New Jersey: Darwin Press; 1988.
  • HALSTEAD BW, BUNKER NC. Stingray attacks and their treatment. Am J Trop Med Hyg. 1953 Jan;2(1):115-28. PMID: 13007932. https://doi.org/10.4269/ajtmh.1953.2.115
  • Haigh K, Delbridge P, Meda K, Chilamkurthi R. Stingray envenomation in a returning traveller: a complicated disease course. BMJ Case Rep. 2019 Jul 2;12(7):e228644. PMID: 31270086; PMCID: PMC6613965. https://doi.org/10.1136/bcr-2018-228644
  • Harris, R.J. The piscine arsenal: an updated review of venomous fishes. Rev Fish Biol Fisheries 34, 539–574 (2024). https://doi.org/10.1007/s11160-023-09828-w
  • Harris RJ, Youngman NJ, Chan W, Bosmans F, Cheney KL, Fry BG. Getting stoned: Characterisation of the coagulotoxic and neurotoxic effects of reef stonefish (Synanceia verrucosa) venom. Toxicol Lett. 2021 Aug 1;346:16-22. Epub 2021 Apr 17. PMID: 33878385. https://doi.org/10.1016/j.toxlet.2021.04.007
  • Harris RJ, Saggiomo SL, Paxton G, Motti CA.Sting Stories: Firsthand Experiences of Fish Envenomation Through a Small-Scale Questionnaire. Toxins (Basel). 2025 Mar 13;17(3):134. PMID: 40137907; PMCID: PMC11946659. https://doi.org/10.3390/toxins17030134 
  • Ikeda T. Supraventricular bigeminy following a stingray envenomation: a case report. Hawaii Med J. 1989 May;48(5):162, 164. PMID: 2473965.
  • Jhamb S, Corsetti RL. Management of penetrating thoracoabdominal stingray trauma.Am Surg. 2013 Feb;79(2):E54-5. PMID: 23336630.
  • Katzer RJ, Schultz C, Pham K, Sotelo MA.The Natural History of Stingray Injuries. Prehosp Disaster Med. 2022 Jun;37(3):350-354. Epub 2022 Apr 8. PMID: 35392997; PMCID: PMC9118052. https://doi.org/10.1017/s1049023x22000565
  • Kizer KW, McKinney HE, Auerbach PS. Scorpaenidae envenomation. A five-year poison center experience. JAMA. 1985 Feb 8;253(6):807-10. PMID: 3968819. https://doi.org/10.1001/jama.253.6.807
  • Lehmann DF, Hardy JC. Stonefish envenomation. N Engl J Med. 1993 Aug 12;329(7):510-1. PMID: 8332171. https://doi.org/10.1056/nejm199308123290718
  • Lewis CJ, Wood F, Goodwin-Walters A. Iatrogenic Thermal Burns Secondary to Marine Sting Treatment. J Burn Care Res. 2020 Jul 3;41(4):878-881. PMID: 32141503. https://doi.org/10.1093/jbcr/iraa042
  • Liggins JB. Death due to a stingray barb piercing the heart: a New Zealand case from 1939. An unusual bathing fatality. N Z Med J. 2006;119(1241):U2164.PMID: 16964633.
  • Maillaud C, Hoang-Oppermann T, Hoang-Oppermann V, Rigot H, Girardot S, Nour M. Is stonefish Synanceia verrucosa envenomation potentially lethal? Toxicon. 2020 Sep;184:78-82. Epub 2020 May 28. PMID: 32473254. https://doi.org/10.1016/j.toxicon.2020.05.019
  • Maretic Z. Some epidemiological, clinical and therapeutic aspects of envenomation by weeverfish sting. In: De Vries A, Kochva E, editors. Toxins of Animals and Plant Origin, vol. 3. New York: Gordon & Breach; 1973. p. 1055–65.
  • Meyer PK. Stingray injuries. Wilderness Environ Med. 1997 Feb;8(1):24-8. PMID: 11990133. https://doi.org/10.1580/1080-6032(1997)008[0024:si]2.3.co;2
  • Negreiros MM, Yamashita S, Sardenberg T, Fávero EL Junior, Ribeiro FA, Haddad WT Junior, Haddad V Junior. Diagnostic imaging of injuries caused by venomous and traumatogenic catfish. Rev Soc Bras Med Trop. 2016 Jul-Aug;49(4):530-3. PMID: 27598647. https://doi.org/10.1590/0037-8682-0359-2015
  • O'Malley G, Lark J. Stingray Envenomation Requires Imaging. J Emerg Med. 2019 Feb;56(2):229-230. PMID: 30738565. https://doi.org/10.1016/j.jemermed.2018.09.055
  • O'Malley GF, O'Malley RN, Pham O, Randolph F. Retained Stingray Barb and the Importance of Imaging. Wilderness Environ Med. 2015 Sep;26(3):375-9. Epub 2015 Apr 30. PMID: 25937550. https://doi.org/10.1016/j.wem.2015.03.006
  • Palatchi Oldak J, Angulo-Lozano JC.A New Endoscopic Approach to Remove a Retained Stingray Barb. Cureus. 2022 Jul 18;14(7):e26990. PMID: 35989733; PMCID: PMC9385398. https://doi.org/10.7759/cureus.26990
  • Rathjen WF, Halstead BW. Report on two fatalities due to stingrays. Toxicon. 1969 May;6(4):301-2. PMID: 5817148. https://doi.org/10.1016/0041-0101(69)90101-9
  • RUSSELL FE, PANOS TC, KANG LW, WARNER AM, COLKET TC 3rd. Studies on the mechanism of death from stingray venom; a report of two fatal cases. Am J Med Sci. 1958 May;235(5):566-84 passim. PMID: 13533419. https://doi.org/10.1097/00000441-195805000-00010
  • 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. PMID: 30304272. https://doi.org/10.1590/0037-8682-0356-2017
  • Seqirus (2019) Australian product information-stonefish antivenom solution for injection. https://labeling.seqirus.com/PI/AU/Stonefish-Antivenom/EN/Stonefish-Antivenom-product-information.pdf 
  • Sutherland SK. Antivenom use in Australia. Premedication, adverse reactions and the use of venom detection kits. Med J Aust. 1992 Dec 7-21;157(11-12):734-9.PMID: 1360618.
  • Sutherland SK, Tibballs J. Australian Animal Toxins. The Creatures, their Toxins and Care of the Poisoned Patient. 2nd ed. Melbourne: Oxford University Press; 2001. ISBN 0-19-550643-X
  • Torrez PP, Quiroga MM, Said R, Abati PA, França FO. Tetanus after envenomations caused by freshwater stingrays. Toxicon. 2015 Apr;97:32-5. Epub 2015 Jan 6. PMID: 25576234. https://doi.org/10.1016/j.toxicon.2014.12.001
  • Trestrail JH 3rd, al-Mahasneh QM. Lionfish string experiences of an inland poison center: a retrospective study of 23 cases. Vet Hum Toxicol. 1989 Apr;31(2):173-5.PMID: 2929130.
  • Trickett R, Whitaker IS, Boyce DE. Sting-ray injuries to the hand: case report, literature review and a suggested algorithm for management.J Plast Reconstr Aesthet Surg. 2009 Aug;62(8):e270-3. Epub 2008 Feb 29. PMID: 18313375. https://doi.org/10.1016/j.bjps.2007.12.022 
  • Warrell DA. Venomous and poisonous animals.In: Farrar J, Garcia PJ, Hotez T, Junghanss T, Kang G, Laloo D (eds.). Manson’s tropical diseases. 24th ed. Elsevier; 2023.
  • WHO (2010) Wound and lymphoedema management. WHO/HTM/NTD/GBUI/20101 I. 2010. https://www.who.int/publications/i/item/9789241599139
  • WHO-ICRC Basic Emergency Care: approach to the acutely ill and injured (2018)  https://www.who.int/publications-detail-redirect/basic-emergency-care-approach-to-the-acutely-ill-and-injured
  • WHO ABCDE Approach  https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/bec-quick-cards/becp-edu29-pdf-en-finl.pdf?sfvrsn=2532d61b_2

Species-specific evidence

Stingrays

Australia

  • Barss (1984)
    1 case allegedly inflicted by Dasyatis kuhlii, the blue-spotted stingray; 1 case by D. sephen, the cowtail ray.
  • Fenner and Williams (1989)
    4 serious cases, 1 of which ended fatally; not identified. Summary of 100 minor stingray injuries.

Brazil

Marine and freshwater stingrays

  • Haddad et al. (2013)
    2 illustrated cases and review

Freshwater stingrays

  • Torrez et al. (2015)
    2 cases

Cuba

  • Trickett et al. (2009)
    Case report, literature review and a suggested algorithm for management

Japan

  • Ikeda (1989)
    1 case; Dasyatis akajei.

New Zealand

  • Liggins (2006)
    1 case, which ended fatally; not identified.


Papua New Guinea

  • Barss (1984)
    2 cases; “In one patient, the wound was allegedly inflicted by Dasyatis kuhlii, the blue-spotted stingray; in the other, by D. sephen, the cowtail ray.”

Seychelles

  • Grainger (1980)
    1 case; Dasyatis sp.


Suriname

  • Rathjen and Halstead (1969)
    1 case; not definitely identified: Dasyatis violacea?

USA

  • Clark et al. (2007)
    119 cases; retrospective hospital chart review.
  • Halstead and Bunker (1953)
    2 cases, both of which ended fatally; Holorhinus californicus 1/2, Aetobatus narinari 1/2.
  • Jhamb and Corsetti (2013)
    1 case
  • Katzer et al. (2022)
    393 participants; prospective study. «The study’s geographic area was most commonly populated by the round stingray, Urobatis halleri.”
  • Russell et al. (1958)
    2 cases; Dasyatis longus 1/2; not identified 1/2; both cases ended fatally.

West Atlantic

  • Rathjen and Halstead (1969)
    1 case; Himantura schmardae (= Dasyatis schmardae) (Werner).

Stonefishes (Synanceiidae)

Reviews

  • Harris et al. (2021)
  • Harris (2024)

Australia

  • Sutherland (1992)
    26 cases in which antivenom was administered and which are well documented (see also ‘Antivenom’ above).

Mariana Islands, Western Pacific Ocean

  • Lehmann and Hardy (1993)
    1 case.

Mozambique

  • Smith (1957)
    1 case; victim died within an hour of the accident; Stonefish not identified.

New Caledonia and French Polynesia

  • Mailand et al. (2020)

Reunion

  • Bottard (1889)
    25 cases (pp 64-76)

Seychelles

  • Smith (1957)
    1 case; victim died within a short time after the accident; Stonefish not identified.

Singapore

  • Lee et al (2004)
    8 cases; direct identification 4/8, picture identification 3/8, strong history 1/8.

Lionfishes (Pteroinae)

Aquarium accidents

  • Auerbach et al. (1987)
    1 Lionfish sting. Identification: Pterois volitans; aquarium accident.
  • Haddad et al (2015)
    15 cases; Identification: Pterois volitans.
  • Kizer et al. (1985)
    45 Lionfish stings (identification: in some cases, Pterois volitans; not identified in most cases); aquarium accidents; retrospective study.
  • Vetrano et al. (2002)
  •  Trestrail and al-Mahasneh (1989)
    23 Pterois sp. stings (identified as Pterois sp. 23/23); aquarium accidents; retrospective study.

Mail-cheeked fishes (excluding Lionfishes and Stonefishes)

Scorpionfishes (Scorpaena)

Aquarium accidents

  • Kizer et al. (1985)
    6 Scorpaena guttata stings (identified); aquarium accidents; retrospective study.

Brazil

  • Haddad et al. (2003)
    23 cases

USA (California)

  • Halstead (1951)
    1 Scorpaena guttata sting. Identification: criteria not specified.
  • Abdun-Nur et al. (1981)
    1 Scorpaena guttata sting. Identification: criteria not specified.

Weeverfishes (Trachinus sp.)

Reviews
Greater weever (Trachinus draco)
Ferreira et al. (2025)

Lesser (Echiichthys vipera) and greater (Trachinus draco) weever fish
Gorman et al. (2020)

Malta

  • Paolino and Di Nicola (2023)
    Echiichthys vipera
    Case report and review of the literature

Spain

  • Borondo et al. (2001)

UK

Trachinus draco

  • Davies and Evans (1996)
    2 cases.
  • Paolino and Di Nicola (2023)
    Case report and review of the literature

Catfishes

Brazil

  • Haddad and Martins (2006)
    127 cases
  • Haddad et al. (2008)
    Genidens genidens
    1 case
  • Negreiros et al. (2016)
    5 cases of 127 accidents.

Persian Gulf

  • Greenslade and Furnell (1988)
    1 saltwater Catfish sting. Identification: not identified.

USA

  • Carbone et al. (2024)
    1 case
  • MacKinstry (1993)
    1 Catfish sting and review of the literature
    Identification: most likely Noturus gyrinus. Literature review: 30 English-language reports of Catfish stings. Identification: Ictalurus catus 1/30, Noturus gyrinus 2/30, Noturus insignis 1/30, Galeichthys felis 1/30. Classification of all Catfishes that caused these accidents with the help of additional indirect criteria: freshwater Catfishes (e.g. Ictalurus sp.)14/30, other small freshwater Catfishes (Noturus sp.), saltwater Catfishes (e.g. Galeichthys sp. and Bagre sp.) 10/30.
  • Zeman (1989)
    3 cases

References 

  • Abdun-Nur D, Marcus CS, Russell FE.Pericarditis associated with scorpionfish (Scorpaena buttata) sting. Toxicon. 1981;19(4):579-81. PMID: 7330893. https://doi.org/10.1016/0041-0101(81)90019-2
  • Auerbach PS, McKinney HE, Rees RS, Heggers JP. Analysis of vesicle fluid following the sting of the lionfish Pterois volitans. Toxicon. 1987;25(12):1350-3. PMID: 3438924. https://doi.org/10.1016/0041-0101(87)90014-6
  • Barss P. Wound necrosis caused by the venom of stingrays. Pathological findings and surgical management. Med J Aust. 1984 Dec 8-22;141(12-13):854-5. PMID: 6150422. https://doi.org/10.5694/j.1326-5377.1984.tb132970.x
  • Borondo JC, Sanz P, Nogué S, Poncela JL, Garrido P, Valverde JL.Fatal weeverfish sting. Hum Exp Toxicol. 2001 Feb;20(2):118-9. PMID: 11327512. https://doi.org/10.1191/096032701668435659
  • Bottard A (1889) Les poissons venimeux, contribution à l'hygiene navale. Impr. du Journal Le Havre. (French thesis). https://books.google.de/books?id=z209AAAAYAAJ&printsec=frontcover&hl=de&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false
  • Carbone SJ, Jozefick JL, Sigal AP, Nordell RH 4th. Catfish Puncture Wound and Retained Spine Management in the ED Setting: A Case Report. Wilderness Environ Med. 2024 Dec;35(4):474-478. Epub 2024 Sep 10. PMID: 39256930. https://doi.org/10.1177/10806032241273505
  • 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. Epub 2007 May 30. PMID: 17630073. https://doi.org/10.1016/j.jemermed.2007.03.043
  • Davies RS, Evans RJ. Weever fish stings: a report of two cases presenting to an accident and emergency department. J Accid Emerg Med. 1996 Mar;13(2):139-41. PMID: 8653243; PMCID: PMC1342661. https://doi.org/10.1136/emj.13.2.139
  • Fenner PJ, Williamson JA, Skinner RA.Fatal and non-fatal stingray envenomation. Med J Aust. 1989 Dec 4-18;151(11-12):621-5. PMID: 2593906. https://doi.org/10.5694/j.1326-5377.1989.tb139631.x
  • Ferreira LFLC, Barbosa DJ, Dinis-Oliveira RJ.The toxicology of greater weever (Trachinus draco): Clinical and forensic aspects. Toxicon. 2025 Oct;265:108492. Epub 2025 Jul 8. PMID: 40639489. https://doi.org/10.1016/j.toxicon.2025.108492
  • Gorman LM, Judge SJ, Fezai M, Jemaà M, Harris JB, Caldwell GS. The venoms of the lesser (Echiichthys vipera) and greater (Trachinus draco) weever fish- A review. Toxicon X. 2020 Feb 7;6:100025. PMID: 32550581; PMCID: PMC7285994. https://doi.org/10.1016/j.toxcx.2020.100025
  • Grainger CR. Occupational injuries due to sting-rays.Trans R Soc Trop Med Hyg. 1980;74(3):408.PMID: 7192022. https://doi.org/10.1016/0035-9203(80)90115-7
  • Greenslade GL, Furnell M. Poisonous fish and seasnakes in the Arabian Gulf. J R Nav Med Serv. 1988 Winter;74(3):195-7.PMID: 3256641.
  • Haddad V Jr, Martins IA. Frequency and gravity of human envenomations caused by marine catfish (suborder siluroidei): a clinical and epidemiological study. Toxicon. 2006 Jun 15;47(8):838-43. Epub 2006 May 19. PMID: 16713609. https://doi.org/10.1016/j.toxicon.2006.02.005
  • Haddad V Jr, Martins IA, Makyama HM. Injuries caused by scorpionfishes (Scorpaena plumieri Bloch, 1789 and Scorpaena brasiliensis Cuvier, 1829) in the Southwestern Atlantic Ocean (Brazilian coast): epidemiologic, clinic and therapeutic aspects of 23 stings in humans. Toxicon. 2003 Jul;42(1):79-83. PMID: 12893064. https://doi.org/10.1016/s0041-0101(03)00103-x
  • Haddad V, de Souza RA, Auerbach PS.Marine catfish sting causing fatal heart perforation in a fisherman. Wilderness Environ Med. 2008 Summer;19(2):114-8. PMID: 18513109. https://doi.org/10.1580/07-weme-cr-1182.1
  • Haddad V Jr, Cardoso JL, Neto DG.Injuries by marine and freshwater stingrays: history, clinical aspects of the envenomations and current status of a neglected problem in Brazil. J Venom Anim Toxins Incl Trop Dis. 2013 Jul 29;19(1):16. PMID: 23895313; PMCID: PMC3735412.
  • Haddad V Jr, Stolf HO, Risk JY, França FO, Cardoso JL. Report of 15 injuries caused by lionfish (pterois volitans) in aquarists in Brazil: a critical assessment of the severity of envenomations. J Venom Anim Toxins Incl Trop Dis. 2015 Mar 20;21:8. PMID: 25810712; PMCID: PMC4373524. https://doi.org/10.1186/s40409-015-0007-xhttps://doi.org/10.1186/1678-9199-19-16
  • HALSTEAD BW. Injurious effects from the sting of the scorpionfish, Scorpaena guttata. With report of a case. Calif Med. 1951 May;74(5):395-6. PMID: 14848700; PMCID: PMC1520702.
  • HALSTEAD BW, BUNKER NC. Stingray attacks and their treatment. Am J Trop Med Hyg. 1953 Jan;2(1):115-28. PMID: 13007932. https://doi.org/10.4269/ajtmh.1953.2.115
  • Harris, R.J. The piscine arsenal: an updated review of venomous fishes. Rev Fish Biol Fisheries 34, 539–574 (2024). https://doi.org/10.1007/s11160-023-09828-w
  • Harris RJ, Youngman NJ, Chan W, Bosmans F, Cheney KL, Fry BG. Getting stoned: Characterisation of the coagulotoxic and neurotoxic effects of reef stonefish (Synanceia verrucosa) venom. Toxicol Lett. 2021 Aug 1;346:16-22. Epub 2021 Apr 17. PMID: 33878385. https://doi.org/10.1016/j.toxlet.2021.04.007
  • Ikeda T. Supraventricular bigeminy following a stingray envenomation: a case report. Hawaii Med J. 1989 May;48(5):162, 164. PMID: 2473965.
  • Jhamb S, Corsetti RL. Management of penetrating thoracoabdominal stingray trauma.Am Surg. 2013 Feb;79(2):E54-5. PMID: 23336630.
  • Katzer RJ, Schultz C, Pham K, Sotelo MA.The Natural History of Stingray Injuries. Prehosp Disaster Med. 2022 Jun;37(3):350-354. Epub 2022 Apr 8. PMID: 35392997; PMCID: PMC9118052. https://doi.org/10.1017/s1049023x22000565
  • Kizer KW, McKinney HE, Auerbach PS. Scorpaenidae envenomation. A five-year poison center experience. JAMA. 1985 Feb 8;253(6):807-10. PMID: 3968819. https://doi.org/10.1001/jama.253.6.807
  • Lee JY, Teoh LC, Leo SP.Stonefish envenomations of the hand--a local marine hazard: a series of 8 cases and review of the literature. Ann Acad Med Singap. 2004 Jul;33(4):515-20. PMID: 15329767.
  • Lehmann DF, Hardy JC. Stonefish envenomation. N Engl J Med. 1993 Aug 12;329(7):510-1. PMID: 8332171. https://doi.org/10.1056/nejm199308123290718
  • Liggins JB. Death due to a stingray barb piercing the heart: a New Zealand case from 1939. An unusual bathing fatality. N Z Med J. 2006;119(1241):U2164.PMID: 16964633.
  • McKinstry, D. M. Catfish stings in the United States: case report and review. J. Wilderness Med. 1993; 4: 293-303
  • Maillaud C, Hoang-Oppermann T, Hoang-Oppermann V, Rigot H, Girardot S, Nour M. Is stonefish Synanceia verrucosa envenomation potentially lethal? Toxicon. 2020 Sep;184:78-82. Epub 2020 May 28. PMID: 32473254. https://doi.org/10.1016/j.toxicon.2020.05.019
  • Negreiros MM, Yamashita S, Sardenberg T, Fávero EL Junior, Ribeiro FA, Haddad WT Junior, Haddad V Junior. Diagnostic imaging of injuries caused by venomous and traumatogenic catfish. Rev Soc Bras Med Trop. 2016 Jul-Aug;49(4):530-3. PMID: 27598647. https://doi.org/10.1590/0037-8682-0359-2015
  • Paolino G, Di Nicola MR.Weevers (Trachinidae) stings in European seas: Double case report and review of the literature.J Eur Acad Dermatol Venereol. 2023 Jul;37(7):e926-e929. Epub 2023 Mar 21. PMID: 36913249. https://doi.org/10.1111/jdv.19030
  • Rathjen WF, Halstead BW. Report on two fatalities due to stingrays. Toxicon. 1969 May;6(4):301-2. PMID: 5817148. https://doi.org/10.1016/0041-0101(69)90101-9
  • RUSSELL FE, PANOS TC, KANG LW, WARNER AM, COLKET TC 3rd. Studies on the mechanism of death from stingray venom; a report of two fatal cases. Am J Med Sci. 1958 May;235(5):566-84 passim. PMID: 13533419. https://doi.org/10.1097/00000441-195805000-00010
  • Smith, J. L. B. (1957) Two rapid fatalities from stonefish stabs. Copeia 3: 249
  • Sutherland SK. Antivenom use in Australia. Premedication, adverse reactions and the use of venom detection kits. Med J Aust. 1992 Dec 7-21;157(11-12):734-9.PMID: 1360618.
  • Torrez PP, Quiroga MM, Said R, Abati PA, França FO. Tetanus after envenomations caused by freshwater stingrays. Toxicon. 2015 Apr;97:32-5. Epub 2015 Jan 6. PMID: 25576234. https://doi.org/10.1016/j.toxicon.2014.12.001
  • Trestrail JH 3rd, al-Mahasneh QM. Lionfish string experiences of an inland poison center: a retrospective study of 23 cases. Vet Hum Toxicol. 1989 Apr;31(2):173-5.PMID: 2929130.
  • Trickett R, Whitaker IS, Boyce DE. Sting-ray injuries to the hand: case report, literature review and a suggested algorithm for management. J Plast Reconstr Aesthet Surg. 2009 Aug;62(8):e270-3. Epub 2008 Feb 29. PMID: 18313375. https://doi.org/10.1016/j.bjps.2007.12.022
  • Vetrano SJ, Lebowitz JB, Marcus S. Lionfish envenomation. J Emerg Med. 2002 Nov;23(4):379-82. PMID: 12480019. https://doi.org/10.1016/s0736-4679(02)00572-3
  • Zeman MG. Catfish stings: a report of three cases. Ann Emerg Med. 1989 Feb;18(2):211-3. PMID: 2916789. https://doi.org/10.1016/s0196-0644(89)80119-2