An Unintended Hazard of Environmental Stewardship: Marine Envenomation Following Invasive Lionfish Culling in Curacao

Marine envenomations are common non-infectious hazards for travelers. Lionfish, venomous fish native to Indo-Pacific waters, have become an invasive species in the Atlantic Ocean and threat to native marine ecosystems. Various control measures have been implemented in response to rapidly expanding lionfish populations, including licensed culling by recreational divers. We herein review lionfish envenomation through framing with a case that occurred during a diving trip to Curacao for the purpose of lionfish spearfishing. Following initial management in Curacao with hot water immersion, wound care, and antibiotic prophylaxis, the patient continued to have persistent swelling, bruising, and pain to the puncture site and was referred to our outpatient clinic for further evaluation. In addition to reviewing clinical syndromes and approach to management for common marine envenomations that may be encountered in the post-travel setting, we situate this case within the broader ecological context of expanding invasive species ranges with climate change and rising sea temperatures. Pre-travel providers should counsel patients at high risk for marine envenomations on preventative measures, along with how and when to seek care following exposure. Post-travel providers should be familiar with the immediate and long-term sequelae of non-infectious envenomations and intoxications, including marine exposures. Larger national and multinational collaborations are required to mitigate the effects of climate change and international marine movement on invasive species, especially those that incur risk to marine and human health alike.