The second syndrome is an irritant dermatitis and follows the penetration of small spicules of silica or
calcium carbonate into the skin. Most sponges have spicules; toxic sponges may possess crinotoxins that enter
microtraumatic lesions caused by the spicules.
In severe cases, surface desquamation of the skin may follow in 10 days to 2 months. No medical
intervention can retard this process. Recurrent eczema and persistent arthralgias are rare complications.
Treatment
Because distinguishing clinically between the allergic and spicule-induced reactions is usually
impossible, it is reasonable to treat for both. The skin should be gently dried. Spicules should be removed, if
possible, using adhesive tape, a thin layer of rubber cement, or a facial peel. As soon as possible, dilute (5%)
acetic acid (vinegar) soaks for 10 to 30 minutes three or four times a day should be applied to all affected
areas. Isopropyl alcohol 40% to 70% is a reasonable second choice. Although topical steroid preparations may
help to relieve the secondary inflammation, they are of no value as an initial decontaminant. If they precede
the vinegar soak, they may worsen the primary reaction. Delayed primary therapy or inadequate
decontamination can result in the persistence of bullae, which may become purulent and require months to
heal.
Erythema multiforme may require the administration of a systemic glucocorticoid, beginning with a
moderately high dose (prednisone 60 to 100 mg) tapered over 2 to 3 weeks. Anecdotal remedies for the
management of sponge envenomation that have been suggested without demonstration of efficacy include
antiseptic dressings, broad-spectrum antibiotics, methdilazine, pyribenzamine, phenobarbital,
diphenhydramine, promethazine, and topical carbolic oil or zinc oxide cream.
After the initial decontamination a mild emollient cream or steroid preparation may be applied to the
skin. If the allergic component is severe, particularly if there is weeping, crusting, and vesiculation, a systemic
glucocorticoid (prednisone 60 to 100 mg, tapered over 2 weeks) may be beneficial. Severe itching may be
controlled with an antihistamine.
Because
Clostridium tetani has been cultured from sea sponges, they should not be used to pack
wounds. Proper antitetanus immunization should be part of sponge dermatitis therapy. Frequent follow-up
wound checks are important because significant infections sometimes develop. Infected wounds should be
cultured and managed with antibiotics. If sponge poisoning induces an anaphylactoid reaction, standard
resuscitation using epinephrine, bronchodilators, corticosteroids, and antihistamines should be undertaken.
As mentioned previously, sponge diver's disease is not caused by any toxin produced by the sponge,
but rather is a stinging syndrome related to contact with the tentacles of the small coelenterate anemone
Sagartia rosea (family Sagartiidae) or anemones from the genus Actinia (family Actiniidae) that attach to the
base of the sponge. Treatment should include that for coelenterate envenomation.
Prevention
All divers and net handlers should wear proper gloves. Sponges should not be broken, crumbled, or
crushed with bare hands. If the victim brings a specimen, the physician should take care to document its
appearance. Dried sponges may remain toxic.
COELENTERATES (CNIDARIA)
Coelenterates are an enormous group, comprising approximately 10,000 species, at least 100 of which
are dangerous to humans. Coelenterates that possess the venom-charged stinging cells called nematocysts are
known as cnidaria (nettle); those without nematocysts are acnidaria. For practical purposes the cnidaria can be
divided into three main groups: (1) hydrozoans, such as the Portuguese man-of-war; (2) scyphozoans, such as
true jellyfish; and (3) anthozoans, such as soft corals (alcyonarians), stony corals, and anemones. Gorgonians
(order Gorgonacea, class Anthozoa, subclass Alcyonaria) secrete mucinous exudates having toxic effects in
experimental animals that can be characterized as hemolytic, proteolytic, cholinergic, histaminergic,
serotonergic, and adrenergic. Fenner divides jellyfishes into three main classes: schyphozoans (true
jellyfishes), with tentacles arising at regular intervals around the bell; cubozoans (e.g., "box" jellyfishes), with
tentacles arising only from the corners these may be further divided into carybdeids (e.g., Irukandji), with
only one tentacle [except in rare cases] arising from each lower corner of the bell, and chirodropids, which
have more than one tentacle in each corner of the bell; and other jellyfishes, such as the hydrozoans (e.g.,
Physalia species).
Morphology, Venom, and Venom Apparatus
