Photograph by Joe Mac Hudspeth, Jr. ·


Marine Stings and Poisonings

From the Spring 2018 issue

Many of us across the South gravitate to the Gulf Beaches to vacation most anytime throughout the year. If you are planning a trip to the sunny beach you should be informed about some things which can ruin your trip, primarily from contact with sea creatures and food poisonings peculiar to seafood.

Food Poisonings:

Scromboid poisoning occurs with eating red meat fish that have been improperly stored. Bacterial overgrowth produces a toxin similar to histamine. Common species putting you at risk include amberjack, anchovy, sardines, salmon, yellowfin tuna, wahoo, mackerel, herring, and mahi-mahi.

Cooking kills the bacteria, but does not neutralize the toxin which often causes the fish to have a metallic or peppery taste. Symptoms may consist of nausea, vomiting, diarrhea, abdominal cramping, hives with itching, headache, pounding heart beats, and burning in the mouth. These symptoms usually begin 30 minutes to an hour post ingestion and may last up to three hours. Severe cases with anaphylaxis have been reported. Treatment is supportive with fluids, antihistamines and medications for vomiting, diarrhea, and pain. Interestingly, the toxin does not affect everyone and there is no specific testing for the toxin in fish. It’s best, then, to inquire regarding the freshness and storage/transport of the fish. If you are served one tasting metallic or peppery, do not eat it.

Ciguatera poisoning occurs with ingesting reef feeding fish, such as grouper, amberjack, snapper, and king mackerel. Dinoflagellates, algae-like organisms prevalent in reef environments, are the root cause as they are ingested by small herbivorous fish which then become prey for larger carnivorous ones. The algae travels unchanged up the food chain to the dinner table causing illness.

This poisoning can affect the gastrointestinal, cardiovascular, and neurological systems. Symptoms usually onset from six to twelve hours with vomiting, diarrhea and cramping. The heart rate may become slow and cause a drop in blood pressure. Neurologically one may experience pain and weakness in the extremities, difficulty walking, and a paradoxical temperature perception with hot objects feeling cold and vice versa. Numbness may occur around the mouth and involve the tongue. Unfortunately there are no tests to detect the illness, nor does a fish display a specific color, odor, or taste. Treatment is again supportive. Early detection can be treated with gastric decontamination with activated charcoal. Again, fluids, antiemetics, antihistamines, and anti-inflammatory drugs such as ibuprofen are in order. Gabapentin can be helpful with treating the neurological symptoms.

Vibrio bacteria can cause illness in two ways. It is prevalent in all ocean waters, but especially so in warmer climates. Vibio ingestion is most common with eating shellfish, especially raw oysters, and can result in vomiting and diarrhea. The treatment is supportive as described above. Of interest is people with chronic illnesses are eighty times more likely to suffer from vibrio ingestion than the healthy population.

Vibrio can also cause serious soft tissue infections in open wounds exposed to sea water. One should not wash fresh wounds sustained in the surf or rocky beaches with sea water. Thoroughly cleanse a wound with fresh water. Follow usual first aid guidelines.

Coelenterate stings. Coelenterates consist of jellyfish, sea anemones, and coral forming animals. They sting with specialized cells called nematocysts when in contact with their prey or predators. Coelenterate stings are the most common salt water injuries.

Common gulf and Florida coastal jellyfish are Moon Jellies, Atlantic Sea Nettles, Cannonball jellyfish, Pink Meanies (especially prevalent around Dauphin Island, AL), and Portuguese Man of War. These animals generally move with current or wave action and are frequently found in the surf or washed up on beaches. Nematocysts are located in their tentacles or warty projections under their bodies. Moon Jellies are common in the gulf and are easily identified by their transparent globular domes revealing pink four-leaf-clover shaped internal organs. Their stings are relatively mild, usually resulting in minor skin irritations. Portuguese Man of War, also common in the gulf, resemble floating purple balloons trailing long tentacles, often 50 feet or more long. The sting from this species can be quite serious and should be treated with immersion in hot water, temperature 104-113 degrees Fahrenheit, for twenty minutes. Most jellyfish stings respond to hydrocortisone cream, antihistamines, and ibuprofen. More serious stings resulting in vomiting, headache, fainting, etc, should be treated in the emergency room as soon as possible. Insert: “cannonball jellyfish” and “pink meanies”

Sea Anemones are round colorful flower-like creatures found attached to solid surfaces such as rocks, piers, or seashells. They are also a popular addition to salt water aquariums. Their nematocysts are located on their bodies, as are those on coral organisms. Remember, coral is a living microscopic creature which upon its death adds minerals to form coral reefs. Anemone larva can get inside bathing suits and cause “sun bather’s eruption,” a particularly irritating/itching condition.

Treatment of coelenterate stings consists of washing the affected areas with sea water to neutralize the poison, and removing the tentacles and nematocysts. Vinegar can also be used to neutralize most jellyfish stings, but not Portuguese Man of War stings, as it actually causes the nematocysts to extrude more poisonous chemical. Ironically fresh water does the same with most other jellyfish stings. Tweezers or gentle scraping with the edge of a plastic object such as credit card is useful to remove tentacles. Use shaving cream and a razor to remove anemone and coral nematocysts. An immediate shower and hydrocortisone cream is recommended for sun bather’s eruption. Remember to use gloves when aiding in removing nematocysts.

Echinoderm Stings. This animal class includes sea urchins, starfish, and sea cucumbers. These creatures are so named for their spiny skin and are often found in the seabed and reefs. They are recognized by their usually round shape with appendages, often five in number, radiating from the central body. Injuries from these animals usually occur in divers or folks walking in the surf accidently coming in contact with the spines which can inflict painful puncture wounds. Initial symptoms are pain, swelling, and redness. The calcium spines are delicate and break off easily into one’s exposed body parts. Spines in some species are venomous. Treatment is their careful removal with tweezers. Poison is neutralized with immersion in water up to 113 degrees for 30-90 minutes. Any spines broken under the skin surface should be removed in the ER with ultrasound guidance. Open wounds should be flushed with soapy fresh water and not be sutured or glued as they need to drain. Antibiotics and pain medication are often needed. Insert: “sea urchin”

Stingray injuries are serious. These rays often bury themselves in the sand and anyone stepping on one is likely to receive the business end of its tail which contains a venomous spine. The victim should be treated immediately in an ER as removal of the spine and appropriate wound care in mandatory. The sting is rarely fatal, but the venom can cause significant skin and soft tissue loss. These wounds are also prone to infection. Punctures from salt water catfish dorsal or pectoral fin spines similarly are quite painful and often become infected. Seek immediate attention for these, as well. Do not wait for them to become infected. It should go without saying all shark bites require emergent care in an ER.

If you vacation at the beach by all means have fun. But go with an appreciation of the things there which can cause you or a loved one illness and pain. Be sure your first aid kit contains supplies and medications to treat minor stings and poisonings and that you know the location of a local ER or urgent care clinic in case you need one.

Be safe!