Stonefish envenomation presenting to a Singapore hospital

Stonefish, belonging to the genus Synanceia and classified under the Synanceiidae family, are commonly found in the shallow waters of the Indo-Pacific region and are considered the most dangerous and venomous of this family. The aim of the study was to describe the presenting features, clinical course and current management of this series of patients with stonefish envenomation presenting to a tertiary general hospital in Singapore.

Data involving stonefish stings was retrospectively retrieved from the Singapore General Hospital Accident & Emergency Emerge Version 3.7.6 database from October 2004 to September 2006. Information, such as the patients' demographics, date and location of the incident, identity of the fish, local or systemic effects, pain score (upon arrival and after treatment), investigations and treatment as well as the outcome of the patients, were evaluated.

30 cases were identified. The median age of the patients was 28 years. The majority of patients were male (80 percent) and 47 percent of cases were foreign nationals. Most incidences occurred on weekends/public holidays (77 percent), with November having the highest number of cases (seven cases). The majority of cases (80 percent) arrived at the hospital within two hours of envenomation. Symptoms included extreme pain, swelling and redness of the affected limbs. 24 (80 percent) patients received hot water soak treatment and 27 (90 percent) patients received either intramuscular pethidine or diclofenac for analgesia, where nine patients (33 percent) required additional analgesics after a period of observation. 17 patients (58 percent) were treated and discharged, eight (26 percent) were referred to a specialist for follow-up and five (16 percent) were admitted for an average of three days. 13 out of 25 patients (52 percent) were discharged with antibiotics. One case complained of persistent pain and hyperalgesia five months post-envenomation. One patient required surgical intervention. No deaths and systemic symptoms were reported.

Cases of stonefish envenomation that presented to our hospital showed that the majority of patients were young male adults. Stonefish envenomation, though it rarely kills, can cause extreme pain, swelling and erythema, which can be managed with symptomatic treatment.