Marine animal bite or sting

Definition
Venomous marine animal bites or stings may cause skin irritation, rash or a puncture wound. Injuries may range from mild to serious, sometimes accompanied by systemic that affect the whole body such as anaphylaxis (a potentially life-threatening allergic reaction). Proper wound care is essential if you've been bitten or stung by a marine animal. Sometimes this helps prevent more serious reactions and infection.

Skin irritation wounds
Stings from various marine animals may cause skin irritation or a rash. Because many marine animals are jelly-like and may go unnoticed in the water, you may not know what caused the sting.
Coelenterates cause the largest number of venomous stings. They include animals such as the Portuguese man-of-war, jellyfish, hydroids, sea nettles, sea wasps, sea anemones and corals. Some species of coelenterates are more poisonous than others. The stinging cells of these animals (known as nematocysts) are typically located on the animal's tentacles. Each tentacle may contain many thousands of these tiny stinging cells. When you come in contact with a tentacle, the nematocysts can penetrate your skin and inject venom. Even broken tentacles that have washed onto shore can release venom for weeks.

Sea sponges and bristleworms don't have nematocysts, but contact with them may also cause a painful rash. Sea sponges are attached to shells, stones or other solid objects on the ocean bottom. They are not aggressive, so contact with them is deliberate or accidental. Bristleworms are not aggressive, but will bite when handled. They are found under rocks and corals.

Symptoms of skin irritation wounds
A marine animal sting causes immediate pain at the site of contact and a red, hive-like rash along a line where the tentacle made contact with the skin. The rash may appear within minutes to hours of the sting. A severe sting can even cause necrosis (death) of the skin tissue. Systemic symptoms may occur up to eight hours later, including:

muscle spasms, cramps or pain
nausea or vomiting
difficulty swallowing
increased salivation or sweating
eye irritation
headache
dizziness
difficulty walking
seizure
coma
respiratory failure
Allergic reactions, including anaphylaxis, are also possible.

In addition to the sting, contact with some corals can cut your skin and leave small pieces of coral behind. These injuries heal slowly and can easily become infected. Medical care is often necessary.

Bristleworms and sponges cause skin irritation when bristles or small pieces of the sponge break off and remain in the skin. Bristleworms can also bite, and sponges may have a toxin that causes skin irritation. The resulting itchy rash may later become painful and swollen. Systemic symptoms are possible, including fever, chills, a general feeling of illness, nausea and muscle cramps.

Seabather's eruption (sea lice) is an intensely itchy, red skin rash that is raised or blistery. It develops within a few minutes to 24 hours after contact with the eggs of a thimble jellyfish. The eggs usually lodge on skin that was covered, such as the skin under a bathing suit or on feet covered by swim fins. The rash lasts for a few days to two weeks and resolves on its own. In the United States, the condition is most common off the east coast of Florida, but can occur elsewhere. It's most prevalent from March to August, with peak outbreaks in May and June. Systemic symptoms are possible, including headache, chills, a general feeling of illness and eye irritation.

Treatment of skin irritation wounds
For jellyfish, Portuguese man-of-war or other possible coelenterate stings, immediately rinse the wound with seawater or salt water. (Freshwater can increase the pain.) Do not rub the area. After rinsing, thoroughly flush the wound with about 2 liters (a little less than 2 quarts) of vinegar, leaving the vinegar on the sting for at least 30 minutes or until you're no longer in pain. The vinegar may prevent further spread of the venom into your bloodstream. An exception to this occurs in the Chesapeake Bay area, where the most common jellyfish is the sea nettle. Its venom is resistant to vinegar. If you're stung by a sea nettle, use a solution of seawater and baking soda instead.

After flushing the wound, remove any remaining tentacles. Be sure to wear gloves during the removal process. Scrape them off with a sharp object such as a clamshell, credit card, comb or stick. Or, apply shaving cream or a paste made from baking soda, flour or talc, then shave the area with a standard razor. Watch for symptoms of a systemic reaction for at least eight hours after the sting.

For sponge or bristleworm stings, gently dry the area. Then remove the small, embedded pieces by applying tape to the area and stripping it off. You may also try a facial peel or rubber cement. Then, apply vinegar soaks to the area for up to 30 minutes, three to four times a day. Hydrocortisone cream or lotion can also be applied to the area.

The reaction from seabather's eruption (sea lice) can be minimized by removing the bathing suit (or clothes) and rinsing off in the shower once out of the ocean. Hydrocortisone lcream or lotion, or an oral antihistamine, may relieve the itching. Wash and dry the swimsuit or any clothes you wore during the exposure before wearing them again.

Medical care for skin irritation wounds may be necessary, especially if you have systemic symptoms, severe skin symptoms or a skin infection. You may also need a tetanus shot. People who have weak immune systems or a chronic illness should seek medical evaluation and treatment.


Puncture wounds
Venomous puncture wounds may be inflicted by various marine animals, including the stingray, lionfish, stonefish, other scorpion fish, catfish, starfish, sea urchin, sea snake and cone snails.
Symptoms of puncture wounds
Stingrays are not aggressive toward humans. The injury usually comes from accidentally stepping on them when they are half buried in the sand or mud. The stingray inflicts its venomous sting with spines located in its tail. The spine may remain in the resulting jagged laceration or puncture wound, sometimes accompanied by swelling, bleeding and severe pain that lasts from several hours to two days. Systemic symptoms are possible, including weakness, vomiting, sweating, dizziness, headache, muscle cramps, paralysis and hypotension (low blood pressure). In some cases, a stingray sting is fatal.

Several bony fish, including catfish, lionfish, stonefish and other scorpion fish, can inflict puncture wounds with their spines. These stings can cause severe persistent pain and systemic symptoms similar to those of the stingray.

Starfish, sea urchins, sea cucumbers and other echinoderms are slow-moving and nonaggressive. Injury is usually accidental (from stepping on them) or from careless handling. They deliver their venom with spines that can sometimes remain in the painful, swollen wound. Systemic symptoms are possible, including nausea and vomiting.

There are more than 50 types of sea snakes living in the Pacific and Indian Oceans. In the United States, the pelagic sea snake (or yellow-bellied sea snake -- Pelamis platurus) can be found in the coastal waters of Hawaii. Sea snakes can also be found along the coast from the Baja Peninsula to Ecuador. They are 3 to 4 feet long and dark brown or black with a bright yellow belly. Sea snakes have flattened tails and valve-like nostril flaps. Although the venom is highly toxic, only about 20 percent of sea snake bites result in serious symptoms.

A sea snake bite is usually painless and often goes unnoticed. If pain or swelling develops at the bite site, it's minimal. The fang marks, sometimes only the size of pinprick, may be difficult to see. Occasionally, teeth are left in the wound. Systemic symptoms usually begin within two hours, but may occur as soon as five minutes or as long as eight hours later. If you're bitten by a sea snake, seek immediate medical care. You should be observed by medical personnel for at least eight hours.

Cone snails are found more often in deeper water, so swimmers or snorkelers are not likely to come in contact with them. They inflict a poisonous sting with a dart-like stinger when they're handled or stepped on. This puncture wound may resemble a wasp sting and is treated like a sea snake bite. If a cone snail stings you, seek immediate medical care.

Treatment of puncture wounds
If you have a puncture wound, consult a doctor as medical treatment for the puncture wound may be necessary. The wound may require flushing or antibiotics. You may also need a tetanus shot. People who have weak immune systems or a chronic illness should seek medical evaluation and treatment, as well.

Immediate care is important if:

You've been bitten by a sea snake or cone snail.
You're bleeding profusely.
The wound is deep.
The wound affects movement, circulation or feeling.
You have systemic symptoms.
Some bleeding from a puncture wound may help remove foreign matter from the wound. However, if the wound is bleeding profusely or spurting blood, it's best to apply pressure. Do not attempt to remove any large or deeply imbedded objects from the wound.

For puncture wounds from marine animals such as stingrays, bony fish, starfish, sea urchins and sea cucumbers, rinse the wound immediately with water. To deactivate the venom, immerse the affected area in nonscalding hot water for 30 to 90 minutes or until the pain subsides. (Carefully test the temperature of the water to prevent burns.) If possible, continue to soak the area while en route to medical care.

After a sea snake bite, remain as quiet and still as possible. Immobilize the area of the bite, keeping it at heart level, if possible. It's best to wash the bite site with soap and water. If this is not possible, wipe the area off. If the bite is on your arm or leg, remove any rings, bracelets or restrictive clothing. Splint the extremity by applying mild pressure to the bite site and wrapping the area with several elastic bandages or torn clothing.

After a puncture wound, keep the following precautions in mind.

Do not apply a tourniquet to the area. Sudden removal of the tourniquet could create an abrupt venom release.

Do not apply ice to the area. Studies have shown that cooling a bite is potentially harmful.

Do not try to incise the wound or suction out the venom.

Do not drink alcohol or take stimulants or aspirin until you're evaluated by medical personnel.

If you're bitten by a sea snake, do not try to kill or capture the snake. If the snake has already been killed, it can be taken to the medical facility to aid in identification, but do not pick it up with your hands. Use extreme caution because the snake's biting reflex can continue for up to an hour after its death or decapitation.

Complications of marine bites and stings
Due to the abundance of microbes found in water, many wounds from marine animals can easily become infected, especially if the wound involves a joint, foreign bodies (spines, teeth, etc.) remain in the wound, the laceration is large, or the puncture wound is deep. People who have a weak immune system or a chronic illness also have a higher risk of infection.

Pregnancy-specific information
If you're stung by a marine animal during pregnancy, the immediate treatment is the same as described above. Consult your doctor after the incident for additional recommendations.

Senior-specific information
Growing older is not a risk factor for marine bites and stings.

Prevention
To prevent marine bites and stings, avoid infested water. In swimming areas, learn about potentially hazardous marine life and observe posted warning signs and flags. It's best to swim only in areas staffed by a lifeguard. Remember that dead animals or tentacles that wash ashore may still be venomous.