the administration of corticosteroids. An initial loading dose of prednisone (40 to 60 mg for adults: 2 to 5
mg/kg, not to exceed 50 mg, for children) should be administered and maintained daily until symptoms
markedly resolve. The corticosteroid should be tapered over a 2- to 3-week course to avoid induction of
adrenal insufficiency. Aspirin or other nonsteroidal antiinflammatory agents are rarely helpful and may be
contraindicated because of circulating immune complex-induced platelet dysfunction.
Stinging Animals
The stinging animals constitute a large collection of marine organisms containing invertebrates and
vertebrates, ranging from primitive to extremely sophisticated organisms. Aggregated, stinging animals pose
the most frequent hazards for swimmers and divers.
Invertebrates
SPONGES
Life and Habits
There are approximately 5000 species of sponges (phylum Porifera; predominately class
Desmospongiae), which are supported by horny, but elastic, internal collagenous skeletons of "spongin,"
some forms of which we use as bath sponges. Sponges are without digestive, excretory, respiratory,
endocrine, circulatory, and nervous systems. Embedded in the connective tissue matrices and skeletons are
spicules of silicon dioxide (silica) or calcium carbonate ("calcite"), by which some sponges can be definitively
identified. In general, sponges are stationary acellular animals that attach to the sea floor or coral beds and
may be colonized by other sponges, hydrozoans, mollusks, coelenterates, annelids, crustaceans, echinoderms,
fishes, and algae. These secondary coelenterate inhabitants are responsible for the dermatitis and local
necrotic skin reaction termed sponge diver's disease (maladie des plongeurs). In recognition of a medicinal
property, the ancient Greeks burnt sea sponges and inhaled the vapors in prophylaxis against goiter. Sponges
harbor various biodynamic substances, with possible antineoplastic, antibacterial, growth-stimulating,
antihypertensive, neuropharmacologic, psychopharmacologic, and antifungal properties. A number of sponges
produce crinotoxins that may be direct dermal irritants, such as subcritine, halitoxin (Haliclonia species), p-
hydroxybenzaldehyde, and okadaic acid. These may be present in surface or internal secretions. Murine
monoclonal antibodies against okadaic acid intended for use in an assay system for the detection of diarrhetic
shellfish poisoning have been prepared from the sponge Halichondria okadai.
Clinical Aspects
Two general syndromes, with variations, are induced by contact with sponges. The first is a pruritic
dermatitis similar to plant-induced allergic dermatitis, although the dermatopathic agent has not been
identified. Rarely, erythema multiforme or an anaphylactoid reaction may be present. A typical offender is the
friable Hawaiian or West Indian fire sponge (Tedania ignis), a brilliant yellow-vermilion-orange or reddish-
brown organism with a crumb-of-bread appearance found off the Hawaiian Islands and the Florida Keys.
This sponge grows in thick branches, which are easily broken off, extending from a larger base. Other culprits
include Fibula (or Neofibularia) nolitangere, the "poison bun sponge" (and the related sponge N. mordens),
and Microciona prolifera, the red moss sponge (found in the northeastern United States). F. nolitangere is
found in deeper water and grows in clusters, with holes (oscula) large enough to admit a diver's finger. It is
brown) and bready in texture, so it may crumble in the hands.
Within a few hours, but sometimes within 10 to 20 minutes, after skin contact the reactions are
characterized by itching and burning, which may progress to local joint swelling, soft tissue edema,
vesiculation, and stiffness, particularly if small pieces of broken sponge are retained in the skin near the
interphalangeal or metacarpophalangeal joints. Most victims of sponge-induced dermatitis have hand
involvement, since they handle sponges without proper gloves. In addition, abraded skin, such as that which
has been scraped on stony coral, may allow more rapid or greater absorption of toxin(s). When the sponge is
penetrated, torn, or crumbled, the skin is exposed to the toxic substances. Untreated, mild reactions subside
within 3 to 7 days. When large skin areas are involved the victim may complain of fever, chills, malaise,
dizziness, nausea, muscle cramps, and formication. Bullae induced by contact with Microciona prolifera may
become purulent. Systemic erythema multiforme or an anaphylactoid reaction may develop a week to 14 days
after a severe exposure. The skin may become mottled or purpuric, occasionally after a delay of up to 10
days.
