Case report: Weever fish sting--an unusual cause of foot pain

Venomous Bites, Stings and Poisoning by European Vertebrates as an Overlooked and Emerging Medical Problem: Recognition, Clinical Aspects and Therapeutic Management

Europe presents a high number of venomous and poisonous animals able to elicit medically relevant symptoms in humans. However, since most of the accidents involving venomous or poisonous animals in Europe are unreported, their incidence and morbidity are severely overlooked. Here we provide an overview of the European vertebrate species of greatest toxicological interest, the clinical manifestations their toxins can cause, and their treatment. We report the clinical symptoms induced by envenomations and poisoning caused by reptiles, fishes, amphibians and mammals in Europe, ranging from mild, local symptoms (e.g., erythema, edema) to systemic and potentially deadly. The present work constitutes a tool for physicians to recognize envenomation/poisoning symptoms caused by the most medically relevant European vertebrates and to decide which approach is the most appropriate to treat them.

Lesser weever fish (Echiichthys vipera Cuvier, 1829) venom is cardiotoxic but not haemorrhagic

Despite comprising over half of the biodiversity of living venomous vertebrates, fish venoms are comparatively understudied. Venom from the lesser weever fish (Echiichthys vipera syn. Trachinus vipera) has received only cursory attention despite containing one of the most potent venom toxins (trachinine). Literature records are further complicated by early studies combining the venom with that of the related greater weever (Trachinus draco). The current study used a chicken chorioallantoic membrane assay to investigate venom bioactivity following the application of measured quantities of crude venom to a major bilateral vein at 1 cm distance from the heart. The venom had a dose-dependent effect on survival rate and exhibited dose-dependent cardiotoxic properties at day six of development. Crude E. vipera triggered tachycardia at doses of 37.58 and 44.88 μg/μL and bradycardia at 77.4 μg/μL. The three highest doses (65.73, 77.4 and 151.24 μg/μL) caused significant mortality. These data also suggested intra-specific variation in E. vipera venom potency. Unlike a number of other piscine venoms, E. vipera venom was not haemorrhagic at the concentrations assayed.

The venoms of the lesser (Echiichthys vipera) and greater (Trachinus draco) weever fish- A review

In comparison with other animal venoms, fish venoms remain relatively understudied. This is especially true for that of the lesser Echiichthys vipera and greater weever fish Trachinus draco which, apart from the isolation of their unique venom cytolysins, trachinine and dracotoxin, respectively, remain relatively uncharacterised. Envenomation reports mainly include mild symptoms consisting of nociception and inflammation. However, like most fish venoms, if the venom becomes systemic it causes cardiorespiratory and blood pressure changes. Although T. draco venom has not been studied since the 1990's, recent studies on E. vipera venom have discovered novel cytotoxic components on human cancer cells, but due to the scarcity of research on the molecular make-up of the venom, the molecule(s) causing this cytotoxicity remains unknown. This review analyses past studies on E. vipera and T. draco venom, the methods used in the , the venom constituents characterised, the reported symptoms of envenomation and compares these findings with those from other venomous Scorpaeniformes.

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Research on the weever fish venoms Echiichthys vipera and Trachinus draco has

been scarce.

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E. vipera and T. draco venoms elicit cardiorespiratory symptoms in victims.

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E. vipera and T. draco contain unique cytolysins – Trachinine and Dracotoxin.

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Dracotoxin is haemolytic and contains membrane depolarising activities.

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E. vipera venom triggers apoptosis in human colon carcinoma cells.

Purified Lesser weever fish venom (Trachinus vipera) induces eryptosis, apoptosis and cell cycle arrest

Accidents caused by the sting of Trachinus vipera (known as Lesser weever fish) are relatively common in shallow waters of the Mediterranean. Symptoms after the sting vary from severe pain to edema or even tissue necrosis in some cases. Here we show that purified Lesser weever fish venom induces eryptosis, the suicidal erythrocyte death, and apoptosis of human colon carcinoma cells. The venom leads to erythrocyte shrinkage, phosphatidylserine translocation and increased intracellular Ca²⁺, events typical for eryptosis. According to mitochondrial staining cancer cells dyed after the activation of the intrinsic apoptotic pathway. Trachinus vipera venom further causes cell cycle arrest.

Envenomation by Trachinus draco in the eastern Mediterranean

Injuries caused by weever fish ( spp) are probably more ubiquitous than reported. Such injuries are extremely painful and require prompt treatment. Only relatively few clinical descriptions of envenomation have been published. We present three patients with envenomation and describe their treatment. Two patients were fishermen injured while handling caught fish and one was a tourist wading into the sea for pleasure. The clinical picture was dominated by extreme pain, which responded partly to the application of warm water, and usually necessitated systemic opiates for adequate control. Follow-up in one of the patients indicated prolonged, slow recovery of the local inflammatory reaction. Prompt analgesia is the mainstay of treatment of this non-lethal but extremely painful envenomation, with the application of hot water being effective, although not always completely.

Fatal weeverfish sting

We report a case of fatal weeverfish sting. An 18-year-old man was stung on the left leg by a weeverfish, which he was attempting to capture while snorkelling off the coast of Majorca (Spain). The man felt intense pain, but managed to swim to his boat where he lost consciousness after boarding rapidly. An hour later, when examined by a doctor, the subject was found to be in cardiorespiratory arrest. Reanimation manoeuvres were unsuccessful. The most import post-mortem findings were in the skin and lungs. A puncture wound, which traversed the greater saphenous vein and was covered by an intense haemorrhagic infiltrate, was observed in the skin. The lungs showed haemorrhagic alveolar oedema.