![]() verrucosa based on collated sighting data. Shades indicate the hypothesized distribution of both S. Circle size depicts the accuracy of the reported location for example, large circles depict reports where only the country name was given, and small circles depict reports where the precise location was stated. Points with black outlines represent sightings where coordinates were provided. Although there have been some suggestions of Synanceia species present in the Florida Keys and the Caribbean Sea, no further evidence was found in the literature to support this.įigure 1. Distribution of five different species of stonefish of the genus Synanceia. horrida, but more specimens were required for validation. platyrhyncha was located, and upon further examination, Eschmeyer and Rao (1973) stated that S. ![]() platyrhyncha have been observed only occasionally ( Figure 1 and Table A2). nana appears to be confined to the waters of the Persian Gulf and the Red and Arabian Seas, whereas S. horrida (estuarine stonefish) has the second largest distribution, with confirmed sightings from mid to northern Australia and throughout Malaysia, Indonesia, Singapore, Thailand and the Philippines. verrucosa (reef stonefish) has the broadest distribution, with confirmed sightings off the coasts of Turkey, Mozambique, Sri Lanka, Singapore, Japan and Australia and throughout the islands of the Pacific Ocean to French Polynesia. ![]() Species of the Synanceia genus have a broad overlapping distribution throughout the shallow waters of tropical and temperate areas of the Indo-Pacific ( Figure 1 and Table A2). Geographic Distribution of Synanceia spp. Thus, species differentiation by clinical presentation is currently not viable, and it is not known if venom effects differ across the genus. To date, there has been no research comparing or contrasting the effects of venom from different species of stonefish following envenomation. Caution in interpreting these numbers is further advised as generally, while case reports may state that the victim was stung by a Synanceia species, there is frequently no confirmation or validation of which marine creature caused the sting. Stonefish envenomation case reports from literature to date are reviewed and summarized in Table A1. Only rarely is the animal brought to the medical center, hindering the actual identification of the offending animal. Another confounder is that the diagnosis of a stonefish sting usually relies on the presence of puncture wounds and the clinical and systemic features that follow envenomations. This makes it difficult to precisely quantify the number of victims and the global impact of stonefish envenomation on an annual basis. While these reports highlight the burden of fish stings in the Indo-Pacific region, stonefish envenomation is grossly underreported in the literature. In more severe cases, hospitalizations can last for over a week, and surgical interventions may be necessary in some instances. The majority of the cases were regarded as mild envenomation, with average hospital stays ranging from hours to days. These studies also report that victims usually sought medical assistance within 2 h of being stung due to intense pain. Additionally, stonefish have been responsible for a high number of stings in Singapore, and there are concerns that the number of stings will grow in Japan due to warmer ocean temperatures and increasing tourism. A recent report by the Australian Institute of Health and Welfare stated that of all hospitalizations due to injury from contact with venomous marine plants and animals from 2017–2018, 81% were caused by stinging fish, where 30 out of 320 cases (9.3%) were due to stonefish envenomation. Stonefish were the second most common fish involved in human envenomations in Hong Kong and were responsible for one-third of all fish envenomations in Australia in 2008. Statistics from independent retrospective clinical studies of stonefish stings from hospitals in the Indo-Pacific region showed that most envenomations occurred in young adult males with occupational or recreational exposure to stonefish habitat.
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