182: Bites and Stings of Terrestrial and Aquatic Life Flashcards
1
Q
What are the common bacterial infections associated with bites of land animals?
A
Pasteurella multocida infection, Staphylococcus intermedius infection, Capnocytophagia infection, Porphyromonas species infection, Cat scratch disease
2
Q
What viral infections are associated with bites of land animals?
A
Rabies, Herpesvirus simiae (B virus) infection
3
Q
What are the types of jellyfish stings?
A
Sea nettles, Portuguese Man-of-war, Box jellyfish (Cubomedusae)
4
Q
What are the types of echinoderms?
A
Sea urchins, Starfish, Sea cucumbers
5
Q
What types of dermatitis can result from marine worms?
A
Bristleworm dermatitis, Leech bites, Cercarial dermatitis (Clam Digger’s itch), Seabather’s eruption
6
Q
What are the potential injuries caused by mollusks?
A
Cone snail envenomations, Octopus bites
7
Q
What types of injuries can result from venomous fish spines?
A
Stingrays, Catfish, Scorponfish, Weeverfish, Fish spine envenomations
8
Q
What are the common injuries caused by corals and sponges?
A
Fire coral injuries, Coral cuts, Dermatitis from sponges
9
Q
What is the significance of rabies in the context of animal bites?
A
Rabies is a critical viral infection that can be transmitted through bites from infected animals, necessitating immediate medical attention and potential post-exposure prophylaxis.
10
Q
What are the clinical implications of sea anemone dermatitis?
A
Sea anemone dermatitis can cause localized skin reactions, including pain, redness, and swelling, and may require symptomatic treatment depending on severity.
11
Q
What is the most common type of animal bite involving humans and what percentage does it represent?
A
Dog bites account for 80-90% of all mammalian bites involving humans.
12
Q
What are the recommended prophylactic antibiotics for hand bites?
A
Co-amoxiclav (Co-amox) or ceftriaxone
13
Q
What is the management protocol for infected wounds from animal bites?
A
Infected wounds require intravenous antibiotics and surgical drainage.
14
Q
What should be done for human bites that penetrate the epidermis?
A
Prophylactic antibiotics should be administered, specifically Co-amoxiclav or quinolones with clindamycin if the patient is penicillin allergic.
15
Q
What is the clinical significance of anaerobic infections in human bites?
A
30% of human bites become infected with aerobic or anaerobic mouth organisms, which can lead to severe damage if the infection spreads in the metacarpal-phalangeal space.
16
Q
What is the recommended action for clenched fist injuries resulting from human bites?
A
Clenched fist injuries should be referred to a hand surgeon due to the high likelihood of complications such as septic arthritis and osteomyelitis.
17
Q
A patient presents with a dog bite on their hand. The wound is deep and shows signs of infection. What is the recommended management and antibiotic treatment?
A
Management includes thorough cleaning, debridement, and prophylactic antibiotics. Co-amoxiclav is the treatment of choice for hand bites, deep cat bites, scratches, and sutured wounds. If allergic to penicillin, quinolones or tetracyclines can be used. Evaluate tetanus status and consider rabies prophylaxis.
18
Q
What is the primary type of animal involved in mammalian bites to humans, and what percentage do they represent?
A
Dog bites account for 80-90% of all mammalian bites involving humans.
19
Q
Which type of animal bite is the second most common and what is the likelihood of infection compared to dog bites?
A
Cat bites are the second most common type and are twice as likely to become infected compared to dog bites.
20
Q
What are the common types of injuries that are likely to become infected from animal bites?
A
Hand wounds, puncture wounds, and crush injuries are likely to become infected from animal bites.
21
Q
What is the recommended management for infected hand bites?
A
For infected hand bites, the management includes IV antibiotics and surgical drainage.
22
Q
What prophylactic antibiotics are recommended for hand bites?
A
Co-amoxiclav or ceftriaxone are recommended for prophylaxis in hand bites.
23
Q
What should be done for deep cat bites, scratches, and sutured wounds?
A
For deep cat bites, scratches, and sutured wounds, cover for Pasteurella multocida with Co-amox or ceftriaxone.
24
Q
What is the protocol for rabies exposure following an animal bite?
A
The protocol includes rabies prophylaxis and quarantine of the animal for 10 days.
25
What is the infection rate for human bites and what types of organisms are typically involved?
**30%** of human bites become infected, typically involving **aerobic or anaerobic mouth organisms**.
26
What is the recommended management for human bites that penetrate the epidermis?
Management includes **thorough washing**, **debridement**, and prophylactic antibiotics such as **Co-amox** or **quinolones + clindamycin** if allergic to penicillin.
27
What is the risk associated with clenched fist injuries from human bites?
Clenched fist injuries have a high likelihood of complications such as **septic arthritis** and **osteomyelitis**, and should be referred to a hand surgeon.
28
What is the significance of performing a culture and gram stain on bite wounds?
Performing a culture and gram stain helps identify the presence of **aerobic or anaerobic organisms** and guides appropriate treatment.
29
What is the clinical approach for managing infected wounds from animal bites?
The clinical approach includes using **IV antibiotics**, **surgical drainage**, and evaluating the need for **tetanus prophylaxis**.
30
What are the key considerations for managing puncture wounds from animal bites?
Key considerations include **thorough washing**, **irrigation**, and possibly leaving the wound open to prevent infection.
31
What is the role of prophylactic antibiotics in the management of animal bites?
Prophylactic antibiotics are used to prevent infection in cases of **hand bites** and other high-risk bite injuries.
32
What should be done if a bite wound is infected?
Infected bite wounds require **IV antibiotics** and may necessitate **surgical drainage** to manage the infection effectively.
33
What is the importance of evaluating tetanus status in bite victims?
Evaluating tetanus status is crucial to determine if a **tetanus booster** is needed to prevent tetanus infection from the bite.
34
What are the common organisms associated with human bite infections?
Human bite infections are commonly associated with **aerobic and anaerobic organisms** found in the mouth.
35
What is the recommended duration for prophylactic antibiotics in dog and cat bites?
Prophylactic antibiotics are typically recommended for **7-10 days** following dog and cat bites.
36
What is the clinical significance of anaerobic infections in human bites?
Anaerobic infections in human bites can spread to the **metacarpal-phalangeal space**, causing severe damage.
37
What is the recommended action for wounds that should be left open after a human bite?
Wounds that should be left open after a human bite should be monitored for infection and managed accordingly.
38
What are the potential complications of clenched fist injuries?
Potential complications of clenched fist injuries include **septic arthritis** and **osteomyelitis**, necessitating surgical referral.
39
What is the significance of using prophylactic antibiotics for deep cat bites?
Prophylactic antibiotics for deep cat bites are important to prevent infections from **Pasteurella multocida** and other pathogens.
40
What is the recommended management for puncture wounds from animal bites?
Management includes **thorough washing**, **irrigation**, and possibly leaving the wound open to promote healing.
41
What is the role of surgical drainage in the treatment of infected bite wounds?
Surgical drainage is essential in the treatment of infected bite wounds to remove pus and infected tissue, promoting healing.
42
What should be done if a bite wound shows signs of infection?
If a bite wound shows signs of infection, it should be treated with **IV antibiotics** and may require **surgical intervention**.
43
What is the importance of gram staining in the management of bite wounds?
Gram staining is important for identifying the type of bacteria present, guiding appropriate antibiotic therapy.
44
What are the key steps in managing a human bite?
Key steps include **thorough washing**, **debridement**, and administering **prophylactic antibiotics** if necessary.
45
What is the recommended follow-up for patients with animal bites?
Recommended follow-up includes monitoring for signs of infection and ensuring appropriate wound care and management.
46
What is the significance of animal quarantine following a bite?
Animal quarantine is significant for monitoring potential rabies exposure and ensuring the safety of the bitten individual.
47
What are the common pathogens associated with dog bites?
**Pasteurella multocida**, **Staphylococcus**, and **Streptococcus** species.
48
What is the clinical approach for managing bites from monkeys?
The clinical approach includes thorough washing, debridement, and considering prophylactic antibiotics due to the risk of infection.
49
What is the importance of thorough washing in the management of bite wounds?
Thorough washing is crucial to remove contaminants and reduce the risk of infection in bite wounds.
50
What is the primary clinical feature of infections caused by Pasteurella multocida after a dog or cat bite?
Local infection characterized by adenitis, which can present several hours or 24-48 hours after the bite or scratch.
51
What is the treatment of choice for infections caused by Pasteurella multocida?
The treatment of choice (TOC) is **Co-amoxiclav** for 7-10 days. Alternatives include **quinolones**, **tetracyclines**, and **TMP-SMX**.
52
What distinguishes Staphylococcus intermedius from Staphylococcus aureus?
Staphylococcus intermedius has oxacillin resistance and can be differentiated by its negative acetoin production from glucose and positive galactosidase activity.
53
What are the clinical features associated with Capnocytophagia canomorsus infections?
Meningitis can occur, especially in immunocompromised individuals, and may present as overwhelming sepsis.
54
What is the significance of Porphyromonas spp. in animal bite infections?
Porphyromonas spp. is found in deep gingival pockets of animals and humans and is present in 28% of patients infected with cat and dog bite wounds.
55
What are the causative agents of cat scratch disease?
The causative agents include **Bartonella henselae**, **Afipia felis**, and **Serratia marcescens**.
56
What is the primary clinical feature of Pasteurella multocida infection following a dog or cat bite?
Local infection characterized by adenitis, which can present several hours or 24-48 hours after the bite or scratch.
57
What is the treatment of choice for Pasteurella multocida infections?
**Co-amoxiclav** for 7-10 days is the treatment of choice; alternatives include **quinolones**, **tetracyclines**, and **TMP-SMX**.
58
What distinguishes Staphylococcus intermedius from Staphylococcus aureus in canine infections?
Staphylococcus intermedius is resistant to oxacillin and can be differentiated by its negative acetoin production from glucose and positive galactosidase activity.
59
What serious condition can Capnocytophagia canomorsus cause in immunocompromised individuals?
Capnocytophagia canomorsus can cause meningitis, which may present as overwhelming sepsis, particularly in splenectomized or immunocompromised patients.
60
What is the significance of Porphyromonas spp. in relation to animal bites?
Porphyromonas spp. is found in deep gingival pockets and is present in 28% of patients infected with cat and dog bite wounds.
61
What are the common pathogens associated with cat scratch disease?
The common pathogens associated with cat scratch disease include **Bartonella henselae**, **Afipia felis**, and **Serratia marcescens**.
62
What is the recommended treatment for cat scratch disease?
The recommended treatments for cat scratch disease include **TMP-SMX** or **quinolone**.
63
What are the potential systemic complications of a Pasteurella multocida infection?
Potential systemic complications include infections entering the respiratory tract, bacteremia, and meningitis.
64
What is a common clinical feature of a cat bite infection caused by Pasteurella multocida?
A common clinical feature is tenosynovitis of osteomyelitis due to inoculation in the periosteum.
65
How does the clinical presentation of Staphylococcus intermedius differ in dogs over 40 lbs?
Staphylococcus intermedius is associated with canine gingival flora and can lead to infections that may require differentiation from S. aureus due to its resistance patterns.
66
What is the incubation period for rabies?
The incubation period for rabies can range from **5 days to several years**.
67
What are the clinical features of rabies during the prodromal phase?
**High fever**, **Headache**, **Malaise**, **Paresthesia** at the site of inoculation
68
What diagnostic methods are used for rabies?
**Viral isolation** from saliva or CSF during the first 2 weeks of illness, **Serum antibodies** from day 6-13, **Fluorescent antibody method** to detect viral antigen, **Skin biopsy** from neck or brain tissue once CNS symptoms appear
69
What is the recommended post-exposure prophylaxis for rabies?
**Human diploid cell rabies vaccine (HDRV)**: 3 doses/IM on days 0, 7, and 21
70
What diagnostic methods are used for rabies during the first two weeks of illness?
Diagnostic methods for rabies during the first two weeks of illness include:
- **Viral isolation** from saliva or CSF
- **Serum antibodies** testing from day 6-13
- **Fluorescent antibody method** to detect viral antigen
71
What is the recommended post-exposure prophylaxis for rabies?
Post-exposure prophylaxis for rabies includes:
1. **Human diploid cell rabies vaccine (HDRV)**: 3 doses/IM on days 0, 7, and 21/28, repeated every 2 years.
2. If intradermally vaccinated, perform a **neutralizing antibody titer** to ensure sufficient immunity.
72
What factors should be considered to determine the need for post-exposure prophylaxis for rabies?
Factors to consider include:
- **Status of animal rabies** in the locale of exposure
- **Provoked or unprovoked attack**
- **Species and size of the animal**
- **Health and vaccination record** of the animal
- **Examination of the animal's brain** within 48 hours
- **Ability to effectively quarantine** the animal
73
What should be done if a household pet bites someone?
If a household pet (dog/cat) bites someone, and the animal is healthy and available for observation for **10 days**, the patient should not be treated unless the animal develops rabies.
74
How should bites from wild animals be managed?
Bites from wild animals (such as groundhogs, foxes, coyotes, raccoons, bobcats) are regarded as rabid unless laboratory tests prove negative. In such cases, treatment should include **rabies immunoglobulin (RIG)** and vaccination.
75
What is the incubation period for rabies after exposure to an infected animal?
The incubation period for rabies can range from **5 days to several years**.
76
What are the common clinical features of rabies during the prodromal phase?
Common clinical features during the prodromal phase of rabies include:
- **High fever**
- **Headache**
- **Malaise**
- **Paresthesia at the site of inoculation**
77
What should be done if a wild animal is suspected to be rabid?
If a wild animal (e.g., groundhogs, foxes, coyotes, raccoons, bobcats) is suspected to be rabid, it should be regarded as rabid unless laboratory tests prove negative. The individual should be treated with **RIG and vaccine**.
78
What are the severe symptoms that may occur in the later stages of rabies?
Severe symptoms in the later stages of rabies may include:
- **Agitation**
- **Hyperesthesia**
- **Dysphagia**
- **Excessive thirst**
- **Paralysis**
- **Death**
79
What is the significance of performing a skin biopsy in rabies diagnosis?
A skin biopsy from the neck or brain tissue is significant in rabies diagnosis as it is performed once patients exhibit **CNS symptoms**, indicating advanced disease progression.
80
What is the recommended treatment for bites from small animals like squirrels and hamsters?
1. Clean the wound with soap and water, then apply 70% alcohol (rabicidal).
2. Administer RIG and vaccine if the person is not previously vaccinated or lacks immunity:
- If immune, give only the vaccine at day 0 and 3.
- For non-immune hosts:
- RIG (passive immunization): 20 IU/kg (50% around the bite site, 50% at thigh or arm).
- HDRV (active immunization): IM x 5 doses (day 0, 3, 7, 14, and 28).
3. Collect serum for rabies antibody 2 weeks after the 5th dose; if no response, give a booster dose.
81
What are the clinical features of snakebites?
- Pain occurs at the site of the bite within 5 minutes.
- Wheal with local edema, numbness, ecchymosis, and painful lymphadenopathy (LAD).
- If within 8 hours of the bite there is no edema and erythema, significant envenomation did not occur.
- Other symptoms may include nausea, vomiting, sweating, fever, drowsiness, and slurred speech.
82
What is the treatment for Herpesvirus simiae (B virus) infection?
- Initial treatment includes Acyclovir or Ganciclovir.
- For long-term management, Acyclovir is used for years.
83
A child is bitten by a wild raccoon. What steps should be taken to manage the risk of rabies?
Wild animals like raccoons are regarded as rabid unless proven otherwise by laboratory tests. Administer rabies immunoglobulin (RIG) and vaccine. Clean the wound with soap, water, and 70% alcohol.
84
What is the recommended treatment for bites from small animals like hamsters and guinea pigs if the patient is not previously vaccinated against rabies?
1. Clean the wound with soap and water, then apply 70% alcohol (rabicidal).
2. Administer RIG (passive immunization) at a dose of 20 IU/kg, with 50% around the site of the bite and 50% at the thigh or arm.
3. Administer HDRV (active immunization) via IM injection in 5 doses on days 0, 3, 7, 14, and 28.
4. Collect serum for rabies antibody testing 2 weeks after the 5th dose; if no response, give a booster dose.
85
What are the clinical features of a snakebite and how can they indicate the severity of envenomation?
- Pain occurs at the site of the bite within 5 minutes.
- Wheal formation with local edema, numbness, ecchymosis, and painful lymphadenopathy (LAD) may occur.
- If there is no edema and erythema within 8 hours of the bite, significant envenomation is unlikely.
- Other symptoms may include nausea, vomiting, sweating, fever, drowsiness, and slurred speech.
86
What is the significance of elevated titers in non-immunized individuals after a suspected rabies exposure?
Elevated titers in non-immunized individuals indicate active infection, which necessitates immediate medical intervention and management to prevent rabies progression.
87
What are the two major types of poisonous snakes mentioned, and what are their common names?
1. Pit viper: includes rattlesnake, water moccasin, and copperhead.
2. Coral snake.
88
What is the initial treatment for Herpesvirus simiae infection after exposure to macaque monkeys?
Initial treatment includes Acyclovir or Ganciclovir, with Acyclovir continued for years as needed.
89
What are the steps to manage a patient who has been bitten by a non-immune host and requires rabies prophylaxis?
1. Clean the wound thoroughly with soap and water, then apply 70% alcohol.
2. Administer RIG (20 IU/kg) around the bite site and at the thigh or arm.
3. Start HDRV with 5 IM doses on days 0, 3, 7, 14, and 28.
4. Collect serum for rabies antibody testing 2 weeks after the last dose; if no response, provide a booster dose.
90
What are the potential complications of untreated Herpesvirus simiae infection?
Untreated Herpesvirus simiae infection can lead to rapidly progressive ascending neuropathy and encephalitis, which can be severe and life-threatening.
91
How does the size and condition of the snake affect the degree of toxicity in a snakebite?
The degree of toxicity depends on:
- **Potency of venom**: Different snakes have varying venom strengths.
- **Amount injected**: More venom leads to more severe symptoms.
- **Size and condition of the snake**: A larger, healthier snake may inject more venom.
- **Size of the person bitten**: Smaller individuals may experience more severe effects from the same amount of venom compared to larger individuals.
92
What is the protocol for rabies vaccination in an individual with prior immunity after a bite from a potentially rabid animal?
If the individual has prior immunity, only the rabies vaccine should be administered on days 0 and 3, without the need for RIG.
93
What are the signs that indicate significant envenomation from a snakebite?
Signs of significant envenomation include:
- Rapid onset of pain at the bite site.
- Development of edema and erythema within 8 hours.
- Systemic symptoms such as nausea, vomiting, sweating, fever, drowsiness, and slurred speech.
94
What are the initial steps in managing a snakebite from a poisonous snake?
1. Establish that the bite is from a poisonous snake by checking for fang punctures, immediate local pain, and edema/discoloration within 30 minutes.
2. Stabilize the patient and keep them immobilized.
3. Administer anti-venom as soon as possible.
95
What is the recommended position for the affected site after a snakebite?
The affected site should be immobilized below the level of the heart to minimize swelling and complications.
96
Why are venous compression bands not recommended in snakebite management?
Venous compression bands are not recommended because they may:
- Delay transport time due to application.
- Concentrate the venom in the affected limb.
- Cause arterial compression if the affected limb swells in reaction to the toxin.
97
What is the dosing protocol for antivenom (FabAV) after a snakebite?
- Administer 4-6 vials as a loading dose until control is achieved.
- Follow with 3 maintenance doses at 6, 12, and 18 hours after the initial dose.
- Note: Antivenom is not used for coral snake bites.
98
What surgical intervention may be necessary if medical management fails after a snakebite?
If medical management fails, surgical intervention may include:
1. Elevation of the bitten body part.
2. Administering 4-6 vials of crotalidae polyvalent immune Fab (FabAV) for 1 hour.
3. Debridement 4-5 days after envenomation.
4. In rare cases, fasciotomy may be required for true compartment syndrome.
99
What supportive treatments are recommended for severe snakebites?
Supportive treatments for severe snakebites include:
- Coagulopathy management with antivenin (FFP not effective).
- Anti-tetanus therapy.
- Penicillin prophylaxis or Tetracycline for severe bites.
100
A patient develops systemic symptoms like fever and drowsiness after a snakebite. What are the key steps in management?
Stabilize the patient, immobilize the affected limb below heart level, and administer antivenom (FabAV) within 4 hours. Remove constricting bands and provide supportive care.
101
What should be done if a venous compression dressing is applied in the field after a snakebite?
If a venous compression dressing is applied in the field, it should be left in place until the patient is in a healthcare facility and antivenom is administered, provided it is not causing vascular compromise and arterial pulses are still palpable distal to the ligature.
102
What are the common hemorrhagic manifestations associated with snakebites?
Common hemorrhagic manifestations associated with snakebites include:
- Bleeding of gums.
- Hematemesis (vomiting blood).
103
What is the significance of immobilizing the affected site below the level of the heart in snakebite management?
Immobilizing the affected site below the level of the heart helps to:
- Reduce the spread of venom through the circulatory system.
- Minimize swelling and tissue damage in the affected limb.
104
What features indicate that a snakebite is from a poisonous snake?
Features indicating a snakebite is from a poisonous snake include:
- Fang punctures
- Immediate local pain
- Edema/discoloration within 30 minutes
105
What are the common hemorrhagic manifestations associated with snakebites?
Common hemorrhagic manifestations associated with snakebites include:
- Bleeding of gums.
- Hematemesis (vomiting blood).
106
What is the significance of immobilizing the affected site below the level of the heart in snakebite management?
Immobilizing the affected site below the level of the heart helps to:
- Reduce the spread of venom through the circulatory system.
- Minimize swelling and tissue damage in the affected limb.
107
What features indicate that a snakebite is from a poisonous snake?
Features indicating a snakebite from a poisonous snake include:
- Fang punctures.
- Immediate local pain.
- Edema and discoloration occurring within 30 minutes of the bite.
108
What is the role of antivenom in the treatment of snakebites?
Antivenom plays a critical role in the treatment of snakebites by:
- Neutralizing the venom's effects.
- Preventing further systemic complications.
- It should be administered as soon as possible, ideally within 4 hours after the bite.
109
What are the clinical features of a seal bite caused by Mycoplasma sp. and its treatment?
**Clinical Features:**
- Seal finger/Speak finger
- Incubation period: 4-8 days
- Throbbing pain, erythema at site
- Swelling of joint proximal to the site
- Progression to cellulitis, tenosynovitis, and arthritis
**Treatment:**
- Tetracyclines 500mg QID x 10 days
- Immobilize and elevate the finger
110
What are the cutaneous and systemic clinical features of sea nettles stings?
**Cutaneous Features:**
- Zigzag, whip-like pattern of raised welts (2-3mm)
**Systemic Features:**
- Seldom lethal
- Painful, sharp burning pain in area contacted by the tentacles
- Purplish brown petechial and post-inflammatory hyperpigmentation may persist
111
What are the clinical features and systemic effects of a Portuguese Man-of-war sting?
**Cutaneous Features:**
- Irregular single line or multiple lines of red papules, beaded streaks, or erythematous welts
- Wheals resolve in hours but may progress to vesicular, hemorrhagic, necrotic, or ulcerative stages before healing
- Post-inflammatory striae
**Systemic Effects:**
- Within 10-15 minutes: nausea, vomiting, abdominal pain, difficulty of breathing
- Causes severe sting when stepped on or touched
- More severe and painful
- Sharp shock-like burning pain
- Painful paresthesias in the sting area
112
A diver is stung by a Portuguese Man-of-War. What are the cutaneous and systemic symptoms, and how should the sting be treated?
Cutaneous symptoms include irregular red papules, beaded streaks, or erythematous welts that may progress to vesicular, hemorrhagic, necrotic, or ulcerative stages. Systemic symptoms include nausea, vomiting, abdominal pain, and difficulty breathing within 10-15 minutes. Treatment involves washing the area with seawater and applying vinegar.
113
A patient develops cellulitis and tenosynovitis after a seal bite. What is the treatment of choice?
The treatment of choice is tetracyclines 500 mg QID for 10 days. Immobilize and elevate the affected finger.
114
What are the clinical features associated with a seal bite from Mycoplasma sp. and the recommended treatment?
**Clinical Features:**
- Seal finger/Speak finger
- Incubation period: 4-8 days
- Throbbing pain, erythema at site
- Swelling of joint proximal to the site
- Progression to cellulitis, tenosynovitis, and arthritis
**Treatment:**
- Tetracyclines 500mg QID x 10 days
- Immobilize and elevate the finger
115
Describe the cutaneous and systemic effects of a sea nettle sting and the significance of nematocysts.
**Cutaneous Effects:**
- Zigzag, whip-like pattern of raised welts (2-3mm)
**Systemic Effects:**
- Seldom lethal
- Painful, sharp burning pain in area contacted by the tentacles
- Purplish brown petechial and post-inflammatory hyperpigmentation may persist
**Significance of Nematocysts:**
- Nematocysts contain toxins that cause these effects.
116
What are the complications associated with Chironex fleckeri (Box jellyfish) stings?
1. Death due to cardiotoxic and neurotoxic agents
- Ventricular arrhythmias
- Cardiac arrest
- Respiratory failure
2. Intravascular hemolysis
- Precipitate acute renal failure (ARF)
117
What are the cutaneous effects of a sting from Chironex fleckeri (Box jellyfish)?
- Linear welts that give the appearance of having been whipped
- Frosted, cross hatched or ladderlike appearance
- Dusky, cyanotic appearance in severely stung areas
- Blister formation and necrosis
- Slow healing process, complicated by bacterial infection
- Intense pain that lasts for hours
118
What is Irukandji syndrome and what are its symptoms?
Irukandji syndrome is a severe and delayed response to the sting of small box jellyfish (Carukia barnesi). Symptoms include:
- Local signs of inflammation
- Severe back pain
- Muscle cramps
- Piloerection
- Sweating
- Nausea and vomiting
- Headache and palpitations
- Severe cases may lead to hypertension and cardiac failure
119
A patient develops severe back pain, muscle cramps, and hypertension after a jellyfish sting. What syndrome is likely, and how should it be managed?
The patient likely has Irukandji syndrome caused by the sting of a small box jellyfish. Severe cases may involve hypertension and cardiac failure. Management includes IV verapamil for ventricular arrhythmias.
120
A patient is stung by a box jellyfish and develops dusky, cyanotic skin with blister formation. What complications should be monitored, and what is the treatment?
Complications include death due to cardiotoxic and neurotoxic agents, ventricular arrhythmias, cardiac arrest, and respiratory failure. Treatment includes IV verapamil for arrhythmias and supportive care.
121
What are the complications associated with Chironex fleckeri (Box jellyfish) stings?
1. Death due to cardiotoxic and neurotoxic agents
2. Ventricular arrhythmias
3. Cardiac arrest
4. Respiratory failure
5. Intravascular hemolysis
6. Precipitate acute renal failure (ARF)
122
What are the cutaneous manifestations of a Chironex fleckeri sting?
- Linear welts resembling whip marks
- Frosted, cross-hatched, or ladderlike appearance
- Dusky, cyanotic appearance in severely stung areas
- Blister formation and necrosis
- Slow healing process, complicated by bacterial infection
- Intense pain lasting for hours
123
What is Irukandji syndrome and what are its symptoms?
Irukandji syndrome is a severe and delayed response to the sting of the small box jellyfish (Carukia barnesi). Symptoms include:
- Local signs of inflammation
- Severe back pain
- Muscle cramps
- Piloerection
- Sweating
- Nausea and vomiting
- Headache and palpitations
- Severe cases may lead to hypertension and cardiac failure
124
What is the most established record of lethality among jellyfish, particularly in children?
Cubomedusae, specifically Chironex fleckeri (Box jellyfish), has the most established record of lethality, especially in children.
125
What are the potential outcomes of severe stings from Chironex fleckeri?
Severe stings from Chironex fleckeri can lead to:
- Digital gangrene due to arterial spasm
- Intravascular hemolysis
- Acute renal failure
126
What treatment is recommended for ventricular arrhythmias caused by jellyfish stings?
IV verapamil is recommended for the treatment and prophylaxis of ventricular arrhythmias caused by jellyfish stings.
127
What are the symptoms and treatment for sea anemone dermatitis caused by Sagartia sp.?
Symptoms include:
- Itching and burning at the sting site within minutes
- Erythema, edema, and vesicles
Treatment involves:
- Healing slowly and requiring treatment with antibiotics
## Footnote
Similar to jellyfish envenomations.
128
What are the characteristics and management of fire coral dermatitis caused by Millepora alcicornis?
Characteristics include:
- Mild pruritic erythema for true corals
- Erythematous, papular lesions that may become pustular for fire coral
- Possible progression to necrosis and eschar formation
- Painful and may lead to persistent and delayed allergic contact dermatitis (ACD)
Management includes:
- **Fire coral treatment:**
- Sea water
- Vinegar
- Isopropyl alcohol
- Topical steroids
- **Coral cuts treatment:**
1. Wound cleansing
2. Irrigation with saline
3. Hydrogen peroxide wash before dressing
4. Tape stripping
5. Antibiotic ointment
6. Tetanus prophylaxis
129
What are the symptoms and treatment for sponge dermatitis caused by Tedania ignis?
Symptoms include:
- Local erythema progressing to a popular, vesicular, or bullous eruption with weeping of a serous or purulent fluid.
Treatment is similar to poison ivy dermatitis and includes:
- Tape stripping to remove spicules.
## Footnote
Spicules can cause irritant dermatitis or localized foreign body reaction.
130
A fisherman develops erythema, edema, and vesicles on his hands after handling a sea anemone. What is the likely diagnosis and treatment?
The diagnosis is sea anemone dermatitis. Treatment involves wound cleaning, antibiotics for secondary infection, and symptomatic management.
131
A patient develops erythema, edema, and vesicles after handling fire coral. What is the treatment?
Treatment includes washing with seawater, vinegar, or isopropyl alcohol, applying topical steroids, and providing wound care.
132
A patient presents with a painful, erythematous papular eruption after contact with a Hawaiian fire sponge. What is the treatment?
Treatment includes tape stripping to remove spicules and symptomatic management similar to poison ivy dermatitis.
133
What are the symptoms of sea anemone dermatitis caused by Sagartia sp.?
Symptoms include **itching** and **burning** at the sting site within minutes, along with **erythema**, **edema**, and **vesicles**.
134
What is the treatment for sea anemone stings?
Treatment for sea anemone stings includes **healing slowly** and requiring **antibiotics**.
135
What are the characteristics of fire coral dermatitis caused by Millepora alcicornis?
Fire coral dermatitis is characterized by **erythematous**, **papular** lesions that may become **pustular** and can progress to **necrosis** and **eschar formation**. It is also **painful** and may cause **persistent and delayed allergic contact dermatitis (ACD)**.
136
What factors complicate the healing of coral cuts?
Factors that complicate healing of coral cuts include:
1. **Lower extremity involvement** – decreased blood supply
2. **Irregular wound edges** – often contused, crushed, and abraded
3. **Contamination** of pathogenic bacteria in shore waters
4. **Foreign bodies** may be implanted in the wound.
137
What are the recommended treatments for fire coral and coral cuts?
Recommended treatments include:
1. **Wound cleansing**
2. **Irrigation with saline**
3. **Hydrogen peroxide wash** before dressing
4. **Tape stripping**
5. **Antibiotic ointment**
6. **Tetanus prophylaxis**
7. For fire coral: **sea water**, **vinegar**, **isopropyl alcohol**, and **topical steroids**.
138
What are the symptoms of sponge dermatitis caused by Tedania ignis?
Symptoms of sponge dermatitis include **local erythema**, progressing to a **papular**, **vesicular**, or **bullous eruption** with **weeping** of a serous or purulent fluid.
139
What is the treatment for sponge dermatitis?
Treatment for sponge dermatitis is similar to that for **poison ivy dermatitis** and includes **tape stripping** to remove spicules.
140
What are spicules and their effect on the skin?
Spicules can cause **irritant dermatitis** or a **localized foreign body reaction**.
141
What are the systemic reactions associated with exposure to the Poison bun sponge (Microciona prolifera)?
Systemic reactions include:
- Itching, prickling, stinging, or burning that appear within minutes of exposure.
- Pain, swelling, and stiffness.
- Fingers may become immobile within 24 hours if involved.
142
What are the immediate reactions to sea urchin stings?
Immediate reactions include:
1. Localized severe burning pain at the wound site.
2. Rapid redness and swelling, which may bleed profusely.
3. Black or purple discoloration at the site of spine penetration, likely disappearing within 48-72 hours.
4. Paresthesias.
5. Systemic symptoms in venomous species.
143
What are the recommended treatments for sea urchin stings?
Recommended treatments include:
1. Soak in hot water for 30-90 minutes.
2. Apply 1-2% lidocaine without epinephrine.
3. Removal of spines.
4. Antibiotics for secondary infection.
5. Tetanus prophylaxis.
144
What are the delayed type hypersensitivity reactions associated with sea urchin stings?
Delayed type hypersensitivity reactions include:
- Erythema and intense pruritus after the initial injury.
145
What are the characteristics of nodular reactions from sea urchin stings?
Nodular reactions are characterized by:
- Central umbilication or a keratotic surface.
- Localized to the area of spine penetration.
- Not usually painful.
146
What is the diffuse form of reaction from sea urchin stings?
The diffuse form typically involves:
- Fingers or toes.
- Fusiform swelling of the affected digit with pain and loss of function.
- Tenosynovitis.
147
What is the likely diagnosis and management for a patient with erythema multiforme and anaphylactoid reactions after exposure to a red sponge?
The diagnosis is dermatitis caused by Microciona prolifera (red sponge). Management includes symptomatic treatment for itching, swelling, and stiffness.
148
What are the immediate management steps for a patient who develops severe pain and swelling after a sea urchin spine penetration?
Soak the affected area in hot water for 30-90 minutes, administer 1-2% lidocaine without epinephrine, remove spines, and provide tetanus prophylaxis.
149
What type of hypersensitivity reaction occurs after a sea urchin sting, and how is it managed?
The type of hypersensitivity reaction is delayed type hypersensitivity, managed with symptomatic treatment.
150
What is a delayed-type hypersensitivity reaction, and how is it managed?
This is a delayed-type hypersensitivity reaction. Management includes soaking in hot water, removing spines, and providing symptomatic treatment.
151
What type of hypersensitivity reaction occurs after a sea urchin sting, and how is it managed?
This is a delayed-type hypersensitivity reaction. Management includes soaking in hot water, removing spines, and providing symptomatic treatment.
152
What are the systemic symptoms associated with exposure to Microciona prolifera (Red sponge)?
Systemic symptoms include:
- Itching, prickling, stinging, or burning that appear within minutes of exposure.
- Pain, swelling, and stiffness.
- Fingers may become immobile within 24 hours if involved.
153
What immediate reactions can occur from a sea urchin sting?
Immediate reactions include:
1. Localized severe burning pain at the wound site.
2. Rapid redness and swelling, which may bleed profusely.
3. Black or purple discoloration at the site of spine penetration, likely disappearing within 48-72 hours.
4. Paresthesias.
5. Systemic symptoms in venomous species.
154
What are the steps for managing a sea urchin sting?
Management steps include:
1. Soak the affected area in hot water for 30-90 minutes.
2. Apply 1-2% lidocaine without epinephrine.
3. Remove any spines present.
155
What should be removed from a sea urchin sting?
Remove any spines present.
156
When should antibiotics be administered for a secondary infection?
Administer antibiotics for secondary infection if necessary.
157
What is provided as needed for tetanus prophylaxis?
Provide tetanus prophylaxis as needed.
158
What delayed type hypersensitivity reactions can occur after a sea urchin sting?
Delayed type hypersensitivity reactions include:
- Erythema and intense pruritus after the initial injury.
159
What are the characteristics of nodular reactions from sea urchin stings?
Nodular reactions are characterized by:
- Central umbilication or a keratotic surface.
- Localized to the area of spine penetration.
- Typically not painful.
160
What is the diffuse form of reaction to sea urchin stings?
The diffuse form typically involves:
- Fingers or toes, presenting as fusiform swelling of the affected digit.
- Pain and loss of function.
- Possible tenosynovitis.
161
What are the potential complications of a sting from a venomous sea urchin species?
Potential complications include:
- Severe systemic symptoms.
- Secondary infections due to open wounds.
- Pain that is disproportionate to the apparent injury due to venom effects.
162
What is the significance of pedicellariae in sea urchins?
Pedicellariae are:
- Spines and pincer-like organs that can contain venom in some species.
- They may cause severe pain that is disproportionate to the apparent injury.
163
What are the symptoms and complications associated with starfish envenomation from Acanthaster planci?
Symptoms include:
- Painful wound with **numbness** and **paresthesias**.
- Systemic symptoms are infrequent and short-lived.
- Similar to sea urchin wounds.
164
What are the treatment and prevention measures for sea cucumber contact dermatitis?
**Treatment:**
- Wash with soap and water to remove toxins.
- Treat as needed.
165
What is the first step in treating bristle worm dermatitis?
Wash with soap and water to remove toxin.
166
How should bristle worm dermatitis be treated?
Treat as mild contact dermatitis.
167
What are the prevention measures for bristle worm dermatitis?
Protect eyes and skin if in contact.
168
What are the symptoms of bristle worm dermatitis?
Erythematous papular or urticarial eruption at the site.
## Footnote
Symptoms include paresthesias, intense itching, or burning pain.
169
What are the treatment steps for bristle worm dermatitis?
1. Tape stripping
2. Application of ammonia soaks or alcohol
3. Water compress
170
What are the characteristics of leech bites?
Freshwater leech: painless attachment to host.
Saltwater leech: painful, similar to bee sting.
171
What symptoms are associated with leech bites?
Symptoms include bleeding from puncture marks, pain, swelling, redness, and severe pruritus.
172
What is the treatment for leech bites?
Induce leeches to fall off by applying a noxious agent (alcohol, vinegar, flame).
## Footnote
Severe ulcerations may result if leech is forcibly removed.
173
What is cercarial dermatitis and how is it treated?
Caused by parasitic flatworms of Schistosomatidae.
## Footnote
Symptoms include urticarial-like lesions and prickling sensation of the skin, lasting about half an hour after exposure to infested waters.
174
What is the treatment for cercarial dermatitis?
Symptomatic care, antipruritic lotion, and colloidal baths with starch or oatmeal.
175
What is the treatment for a painful, erythematous papular eruption after contact with a bristle worm?
Treatment includes tape stripping to remove bristles, application of ammonia soaks or alcohol, and water compresses.
176
What is the likely species and treatment for a painful puncture wound after a starfish sting?
The species is likely Acanthaster planci.
177
What species is likely associated with starfish envenomation?
The species is likely Acanthaster planci.
178
What are the symptoms and complications associated with starfish envenomation from Acanthaster planci?
- Painful wound with **numbness** and **paresthesias**.
- Systemic symptoms are infrequent and short-lived.
- Similar to sea urchin wounds.
179
What is the recommended treatment for complications arising from sea cucumber exposure?
1. Wash with **soap** and **water** to remove toxin.
2. Treat as mild contact dermatitis.
180
What are the symptoms of bristle worm dermatitis and how is it treated?
- Symptoms include:
- **Erythematous papular** or **urticarial eruption** at the site.
- **Paresthesias**, intense itching, or burning pain.
## Footnote
**Treatment steps:**
1. Tape stripping.
2. Application of **ammonia soaks** or **alcohol**.
3. Water compress.
181
What are the characteristics and treatment options for leech bites?
- **Freshwater leech:** Painless attachment to host.
- **Saltwater leech:** Painful, similar to bee stinging.
- Symptoms include bleeding from puncture marks, pain, swelling, redness, and severe pruritus.
182
What is the treatment for leech bites?
- Induce leeches to fall off by applying a noxious agent (alcohol, vinegar, flame).
- Severe ulcerations may result if leech is forcibly removed, leaving mouth parts behind in the bite site.
183
What is cercarial dermatitis and how does it manifest?
- Caused by parasitic flatworms of Schistosomatidae, with snails as the definitive host.
- Symptoms include urticarial-like lesions.
184
What are the symptoms of cercarial dermatitis?
Symptoms include urticarial-like lesions and a prickling sensation of the skin, lasting about half an hour after exposure to infested waters.
185
What are the treatment options for cercarial dermatitis?
**Symptomatic treatment:**
- Use of **antipruritic lotion**
- **Colloidal baths** with starch or oatmeal to alleviate symptoms.
186
What are the symptoms of Seabather's eruption (Marine dermatitis)?
**Symptoms:**
- Begins shortly after bathing in seawater (4-24 hours after exposure)
- Itchy or burning erythematous macules, papules, or wheals
- Progresses to vesicopapules which crust over and heal in 7-10 days
- Involves uncovered areas.
187
What are the treatment options for Seabather's eruption?
**Treatment:**
- Antipruritic lotion
- Colloidal baths with starch or oatmeal
- Antihistamines and topical steroids
- Systemic steroids in severe cases.
188
What are the clinical implications of cone snail envenomations?
**Clinical Implications:**
- Paresthesias of lips and mouth
- Localized muscular paralysis progressing to generalized weakness or paralysis
- Potential for respiratory distress and cardiopulmonary failure in severe cases.
189
What supportive treatments are available for cone snail envenomations?
**Supportive Treatment:**
- Compression dressing
- Local suction
- No antivenom available for cone shell toxin.
190
What are the key features of octopus bites from the Australian blue-ringed octopus?
- Two small puncture wounds which may bleed profusely.
- Toxin blocks peripheral nerve conduction, causing paralysis with subsequent respiratory failure.
191
What is the treatment for Australian blue-ringed octopus bites?
- Supportive treatment.
- No antivenom available.
192
What condition is caused by swimming in infested waters, presenting with erythematous papules and intense pruritus?
The condition is Cercarial dermatitis (Clam digger's itch), caused by parasitic flatworms.
## Footnote
Treatment includes antipruritic lotion, colloidal baths with starch or oatmeal, antihistamines, and topical steroids. Severe cases may require systemic steroids.
193
What condition occurs after bathing in seawater, causing itchy erythematous macules and papules?
The condition is Seabather's eruption caused by nematocysts trapped under swimwear.
## Footnote
Prevention includes showering immediately after swimming and removing swimwear. Treatment involves antipruritic lotion, colloidal baths, antihistamines, and topical steroids.
194
What is the treatment approach for systemic symptoms like nausea and respiratory distress after a cone snail sting?
The treatment is supportive, including compression dressing and local suction. There is no antivenom for cone snail toxin.
195
What condition is likely after exposure to seawater, causing severe pruritus and erythematous papules, and how is it differentiated from Cercarial dermatitis?
The condition is Seabather's eruption.
## Footnote
It is differentiated from Cercarial dermatitis by the exposure context and specific symptoms.
196
What is real dermatitis?
The condition is Seabather's eruption. It involves covered areas of the body and symptoms appear shortly after bathing.
197
What is cercarial dermatitis?
It involves uncovered areas and symptoms appear after leaving the water.
198
What is the treatment approach for a painful sting from a blue-ringed octopus?
The treatment is supportive, focusing on respiratory support as the toxin can cause paralysis and respiratory failure.
199
What is the treatment approach for systemic symptoms after a cone snail sting?
The treatment is supportive, including compression dressing and local suction. There is no antivenom for cone snail toxin.
200
What are the symptoms and treatment options for Seabather's eruption (Marine dermatitis)?
Symptoms include:
- Itchy or burning erythematous macules, papules, or wheals that begin shortly after bathing in seawater (4-24 hours after exposure).
- Progression to vesicopapules which crust over.
201
What is the progression of cone snail envenomations?
Progression to vesicopapules which crust over and heal in 7-10 days.
202
What systemic symptoms may occur with cone snail envenomations?
Systemic symptoms may occur, especially in children.
203
What are the treatment options for cone snail envenomations?
Treatment options include:
- Antipruritic lotion
- Colloidal baths with starch or oatmeal
- Antihistamines and topical steroids
- Systemic steroids in severe cases.
204
What are the clinical implications of cone snail envenomations?
Cone snail envenomations can lead to:
- Paresthesias of lips and mouth
- Localized muscular paralysis progressing to generalized weakness or paralysis, respiratory distress, and cardiopulmonary failure.
- Neurotoxic symptoms in severe cases.
205
What supportive treatments are available for cone snail envenomations?
Supportive treatment includes:
- Compression dressing
- Local suction
- No antivenom is available for cone shell toxin.
206
What are the key features of octopus bites?
Key features of octopus bites include:
- Two small puncture wounds that may bleed profusely.
- The toxin blocks peripheral nerve conduction, leading to paralysis and subsequent respiratory failure.
207
What management is involved for octopus bites?
Management involves:
- Supportive treatment
- No antivenom is available.
208
How does the presentation of Seabather's eruption differ from Cercarial dermatitis?
Seabather's eruption presents with:
- Symptoms beginning shortly after bathing in seawater (4-24 hours).
- Involves uncovered areas of the body.
209
What does Cercarial dermatitis present with?
Cercarial dermatitis presents with:
- Symptoms not noted until the bather has left the water.
- Involves covered areas of the body.
210
What is the strongest risk factor for developing Seabather's eruption?
The strongest risk factor for developing Seabather's eruption is a previous history of the condition, indicating a hypersensitivity response.
211
What are the four categories of stingrays?
The four categories of stingrays are: 1. Gymnurid (Butterfly rays) 2. Urolophid (Round stingrays) 3. Myliobatid (Bat or eagle rays) 4. Dasyatid (Proper stingrays) - **most dangerous group**
212
What type of injuries are commonly associated with candiru catfish?
Candiru catfish injuries primarily involve the **hand or upper extremity** and can lead to **urologic injuries** as they can enter the urethra.
213
What is the recommended treatment for candiru catfish injuries?
The recommended treatment is **surgery**.
214
What are the characteristics of scorpionfish stings?
**Scorpionfish (Scorpaena)**: - Intermediate severity - Long, heavy spines - Moderate sized venom glands
215
What are the characteristics of stonefish stings?
**Stonefish (Synanceja)**: - Most dangerous; severe - Pain disproportionate to apparent severity; immediate and intense - Initial sting may appear pale or cyanotic - Area around the wound may be anesthetic or hyposthetic - Erythema and edema giving appearance of cellulitis
216
What are the treatment recommendations for stonefish stings?
1. Wounds should be left open or closed loosely with tape or suture to allow adequate drainage or prevent abscess formation. 2. Irrigation with sterile saline or water (Sea water). 3. Soak in hot water for 30-90 minutes for pain relief.
217
What are the immediate management steps after stepping on a stingray?
Soak the affected area in hot water for 30-90 minutes for pain relief. Remove any foreign material, clean the wound, and administer tetanus prophylaxis.
218
What are the immediate steps for pain relief and wound care after a scorpionfish sting?
Soak the affected area in hot water for 30-90 minutes for pain relief. Clean the wound with sterile saline or seawater. Administer tetanus prophylaxis and consider antibiotics if necessary.
219
What complications should be monitored for after a scorpionfish sting?
Monitor for severe pain, erythema, and edema.
220
What are the four categories of stingrays and which group is considered the most dangerous?
1. Gymnuridae (Butterfly rays)
2. Urolophidae (Round stingrays)
3. Myliobatidae (Bat or eagle rays)
4. Dasyatidae (Proper stingrays)
## Footnote
The **Dasyatidae** group is considered the most dangerous due to their **retrosereated spines**.
221
What type of injuries are commonly associated with candiru catfish and what is the recommended treatment?
Injuries primarily involve the **hand or upper extremity**. They can cause **urologic injuries** as they can enter the **urethra**.
## Footnote
Recommended treatment includes **surgery** to address the injuries.
222
What are the characteristics and severity of injuries caused by scorpionfish and stonefish?
**Scorpionfish** injuries can cause severe pain and systemic effects, while **stonefish** injuries are known for their extreme toxicity and potential for severe complications.
223
What are the characteristics of scorpionfish injuries?
Intermediate severity with long and heavy spines and moderate sized venom glands.
224
What are the characteristics of stonefish injuries?
Most dangerous; severe pain that is disproportionate to apparent severity, immediate and intense.
225
What are the initial symptoms of a stonefish sting?
Initial sting may appear pale or cyanotic, with the area around the wound possibly being anesthetic or hyposthetic.
226
What additional symptoms may occur from a stonefish sting?
Erythema and edema may give the appearance of cellulitis.
227
What is the recommended first aid for wounds caused by scorpionfish and stonefish stings?
1. Irrigation with sterile saline or water (sea water).
2. Soak in hot water for 30-90 minutes for pain relief.
## Footnote
Wounds should be left open or closed loosely with tape or suture to allow adequate drainage or prevent abscess formation.
228
What is the clinical significance of the venom apparatus in stingrays?
The venom apparatus of stingrays contains toxins that can remain potent for 24-48 hours after the death of the fish, leading to severe lacerations and puncture wounds if stepped on accidentally.
229
What are the recommended treatments for fish bites from barracuda and moray eels?
1. Empiric antibiotic treatment to cover for vibrio and pseudomonas (ciprofloxacin or cefuroxime).
2. Tetanus prophylaxis is advised.
3. Prevention measures include avoiding bright shiny objects and avoiding swimming with open wounds or during menses.
230
What are the characteristics of stonefish venom and its management?
Stonefish have short and thick spines with very large and well-developed venom glands.
## Footnote
Management includes: 1. 1-2% lidocaine without epinephrine.
231
What is included in the management for pain relief?
1-2% lidocaine without epinephrine for pain relief.
## Footnote
Example: Administer 1-2% lidocaine without epinephrine.
232
What is the purpose of tetanus prophylaxis?
Tetanus prophylaxis is included in the management.
233
When should antibiotics be administered?
Antibiotics if the wound is more than 6 hours old, extensive, or involves deep puncture wounds to hands and feet.
## Footnote
Example: Covering for vibrio species.
234
What is available for stonefish stings?
Antivenin is available for stonefish stings.
235
What are the risks associated with waterborne infections from marine life?
Pathogenic organisms may be actively introduced into bite, sting, or laceration wounds by marine life.
236
How can preexisting wounds be affected?
Preexisting wounds may be passively infected when exposed to contaminated waters.
237
What are the immediate steps for pain relief and wound care after a stonefish sting?
Soak the affected area in hot water for 30-90 minutes for pain relief. Administer 1-2% lidocaine without epinephrine, provide tetanus prophylaxis, and consider antibiotics if the wound is older than 6 hours or involves deep punctures.
238
What is the recommended treatment for a patient bitten by a barracuda with V-shaped lacerations?
Empiric antibiotic treatment should cover Vibrio and Pseudomonas species, using ciprofloxacin or cefuroxime. Tetanus prophylaxis should also be administered.
239
What complications should be monitored for after a stonefish sting?
Monitor for severe pain, erythema, edema, and potential cellulitis. Administer antivenin if available, provide pain relief, and manage the wound appropriately.
240
What complications should be monitored for in stonefish injuries?
Monitor for severe pain, erythema, edema, and potential cellulitis.
241
How should complications from stonefish injuries be managed?
Administer antivenin if available, provide pain relief, and manage the wound appropriately.
242
What are the recommended treatments for stonefish injuries?
1. **Lidocaine** 1-2% without epinephrine for pain management.
## Footnote
Example: Lidocaine is used to alleviate pain in patients with stonefish injuries.
243
What is the second recommended treatment for stonefish injuries?
2. **Tetanus prophylaxis** as needed.
244
What is the third recommended treatment for stonefish injuries?
3. **Antibiotics** if the wound is >6 hours old, extensive, or involves deep puncture wounds to hands and feet, covering for vibrio species.
## Footnote
Options include third generation cephalosporins, gentamicin, tobramycin, TMP-SMX.
245
What is Antivenin used for?
Antivenin is available for stonefish stings.
246
What are the characteristics of injuries caused by barracuda?
Barracuda attacks typically result in V-shaped lacerations.
247
What injuries can moray eels cause?
Moray eels can cause deep puncture wounds and lacerations and tend to lock onto their prey.
248
What is the empirical antibiotic treatment for fish bites from barracuda and moray eels?
Empiric antibiotic treatment should cover for vibrio and pseudomonas species, with options including:
- Ciprofloxacin
- Cefuroxime
249
What preventive measures should be taken to avoid fish bites and related infections?
1. Avoid bright shiny objects in the water.
2. Avoid swimming if you have open wounds or are menstruating.
250
What are the risks associated with waterborne infections from marine life?
Pathogenic organisms may be actively introduced into bite, sting, or laceration wounds by marine life.
- Preexisting wounds may be passively infected when exposed to contaminated waters.
251
What are the cutaneous manifestations of allergies to fish and crustaceans?
The cutaneous manifestations include:
- Urticaria
- Angioedema
- Leukocytoclastic vasculitis
- Kelp - acneiform eruptions
## Footnote
Treatment: Antihistamines
252
What are the clinical features of scromboid food poisoning?
The clinical features of scromboid food poisoning include:
- Erythema and flushing of the face, neck, and upper trunk
- Pruritus
- Urticarial and angioedematous eruption
253
What are the symptoms associated with ciguaatera toxin ingestion?
Symptoms associated with ciguaatera toxin ingestion include:
## Footnote
(Additional information not provided)
254
What are the symptoms associated with ciguaatera toxin ingestion?
Symptoms include:
- **Generalized pruritus**
- **Diffuse erythematous macular and popular exanthems**
- **Progression to blister formation and desquamation**
255
What are the cutaneous manifestations associated with allergies to fish and crustaceans?
Cutaneous manifestations include:
- **Urticaria**
- **Angioedema**
- **Leukocytoclastic vasculitis**
- **Kelp - acneiform eruptions**
256
What is the treatment for ciguaatera toxin poisoning?
Treatment involves the use of **antihistamines**.
257
What is scromboid food poisoning and what are its clinical features?
Scromboid food poisoning occurs from the ingestion of spoiled fish (such as Tuna, Mackerel, Bonita) and is caused by **scombrotoxins**, which result from the breakdown of histidine into histamine and toxic by-products. Clinical features include:
- **Erythema and flushing of the face, neck, and upper trunk**
- **Pruritus**
- **Urticarial and angioedematous eruptions**
258
What are the clinical features of ciguaetera toxin poisoning?
Clinical features include:
- **Generalized pruritus**
- **Diffuse erythematous macular and popular exanthems**
- Progression to **blister formation and desquamation**
259
What preventive measures should be taken to avoid jellyfish stings while swimming?
Preventive measures include:
1. Swim only at patrolled beaches with trained lifeguards.
2. Avoid swimming in infested waters, especially after storms.
3. Beware of apparently dead or beached jellyfish.
4. Wear protective clothing such as a wetsuit or long-sleeved shirt and pants.
5. Use sunblock containing jellyfish and 'sea lice'.
260
What should be used to treat jellyfish stings from Physalia physalis?
Use sunscreen containing jellyfish and 'sea lice' repellent.
261
What areas should be avoided during high jellyfish infestation periods?
Bathing in areas closed during high jellyfish infestation periods.
262
What is the first step in treating jellyfish stings?
Rinse the area with vinegar or baking soda mixed with water for at least 30 seconds.
263
What can be used if vinegar is unavailable for treating jellyfish stings?
Papain can be applied as a powder or mixed in water.
264
What should be done if nothing else is available for rinsing jellyfish stings?
Rinse with seawater.
265
What should be avoided when treating jellyfish stings?
Avoid using fresh water, methylated spirits, or alcohol as they may cause further irritation.
266
What can be done after tentacles are removed from a jellyfish sting?
The area can be gently scraped with a razor or scalpel.
267
What is recommended for pain relief after a jellyfish sting?
Consider hot-water immersion rather than ice packs for pain relief.
268
What are the first-aid steps for treating jellyfish stings?
1. Remove or rescue the victim from the water.
2. Stabilize vital functions: Airway, breathing, circulation.
3. Immobilize the affected part to prevent further envenomation by adhering tentacles.
4. Identify the type of jellyfish sting by considering locale, time of year, and indigenous species.
5. To prevent further envenomation, disarm the nematocysts before removing the tentacles.
269
What precautions should be taken to prevent seabather's eruption?
1. Remove swimwear and shower as soon as possible after leaving the water.
2. T-shirts should not be worn in the water; women should wear a 2-piece suit to reduce surface area.
3. Bathing suits should be rinsed with soap and water and air-dried.
4. Wear snug-fitting collars and cuffs in wet suits to prevent larvae trapping.
270
What are the clinical features associated with Aeromonas hydrophilia infections?
- Cellulitis (may be bullous)
- Fasciitis
- Myonecrosis
- Bacteremia
271
What are the clinical features of infections caused by Vibrio vulnificus?
- Cellulitis, sometimes with bulla formation
- May progress to septicemia, especially in alcoholics, diabetics, and immunosuppressed patients
- Metastatic cellulitis, meningitis, and death may result from fulminant infections
272
What are the first steps in the first-aid treatment of jellyfish stings?
1. Remove or rescue the victim from the water.
2. Stabilize vital functions: Airway, breathing, circulation.
3. Immobilize the affected part to prevent further envenomation by adhering tentacles.
4. Identify the type of jellyfish sting by considering locale, time of year, and indigenous species.
5. To prevent further envenomation, disarm the nematocysts before removing the tentacles.
273
What precautions should be taken to prevent seabather's eruption?
1. Remove swimwear and shower as soon as possible after leaving the water.
2. T-shirts should not be worn in the water; women should wear a 2-piece suit to reduce surface area.
3. Bathing suits should be rinsed with soap and water and air-dried.
4. Wear snug-fitting collars and cuffs to prevent larvae trapping.
5. Avoid swimming in infested waters during outbreaks.
274
What are the clinical features of infections caused by Edwardsielle tarda?
Cellulitis
Abscess
Osteomyelitis
Bacteremia
275
What are the clinical manifestations of Erysipelothrix rhusiopathiae infections?
Slowly progressive cellulitis without adenopathy or lymphangitis, usually involving the hand.
Septic arthritis and subacute bacterial endocarditis may also occur.
276
What are the clinical features of Mycobacterium marinum infections?
Swimming pool granuloma
Fish fancier's finger
Chronic cellulitis
Culture-negative ulcers, often starting on the hand and leading to lesions in draining lymphatics.
277
What are the clinical features associated with Plesiomonas shigelloides infections?
Raw, red, and pock-marked lesions in fish
Rashes
Respiratory problems
Memory deficits
278
What are the clinical features of infections caused by Pseudomonas species?
Trench foot
Gram-negative toe web space infections
Swimmer's ear
Hot tub folliculitis
279
What are the potential complications of Vibrio vulnificus infections?
Cellulitis, sometimes with bullae formation
Progression to septicemia, especially in immunosuppressed patients
Metastatic cellulitis, meningitis, and death may result from fulminant infections.
280
What are the first steps in the first-aid treatment of jellyfish stings?
1. Remove the victim from the water.
2. Stabilize vital functions: Airway, breathing, circulation.
3. Immobilize the affected area to prevent further envenomation.
4. Identify the jellyfish species if possible.
5. Disarm nematocysts before removing tentacles.
