title: Cone shell envenomation: epidemiology, pharmacology and medical care.
abstract: The marine environment presents much danger, specifically in regards to the numerous venomous inhabitants within tropical and subtropical waters. The toxins from one such group of venomous marine snails, commonly referred to as 'cone snails', have been well documented in causing human fatalities. Yet information regarding medical treatment for cone snail envenomation is limited and poorly accessible. To correct this, medical and scientific expertise and literary review on Conus provide a basic and comprehensive directive focused on the medical treatment and post-mortem investigative analysis of cone snail envenomation. We emphasize what we expect to be the most lethal feeding group of Conus and provide a brief background to the epidemiology of their stings. We describe the venom apparatus of Conus and its utility of rapid venom delivery. We have compiled the documented incidences of Conus envenomation to offer thorough reference of known signs and symptoms - this too drawing on personal experiences in the field. We have also made available a brief background to the biochemistry and pharmacology of Conus venoms to highlight their complex nature.
authors.affiliation: Department of Molecular Biosciences and Bioengineering, University of Hawaii, Honolulu, HI, USA.
authors.forename: Zan A
authors.initials: ZA
authors.lastname: Halford
authors.affiliation: Department of Molecular Biosciences and Bioengineering, University of Hawaii, Honolulu, HI, USA.
authors.forename: Peter Yc
authors.initials: PY
authors.lastname: Yu
authors.affiliation: Directorate of Army Health, Department of Defense, Canberra, ACT, Australia, formerly Director of Army Health, Department of Defense, Canberra, Australia.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Likeman
authors.affiliation: Department of Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Hawley-Molloy
authors.affiliation: Hawaii Emergency Physicians Associated, 407 Uluniu St, Suite 411, Kailua, HI.
authors.forename: Craig
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Department of Molecular Biosciences and Bioengineering, College of Tropical Agriculture and Human Resources, University of Hawaii HI, 96822, USA, E-mail: jbingham@hawaii.edu.
authors.forename: Jon-Paul
authors.initials: JP
authors.lastname: Bingham
mesh_terms: D000818:Animals; D001344:Autopsy; D001733:Bites and Stings / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D052078:Conus Snail / Q000033:anatomy & histology / Q000145:classification; D005392:First Aid / Q000379:methods; D006801:Humans; D015994:Incidence; D008020:Life Support Care; D008978:Mollusk Venoms / Q000737:chemistry / Q000494:pharmacology / Q000506:poisoning*
chemical_list: D008978:Mollusk Venoms
keywords: First aid; deaths; envenomation; pharmacology – marine; review article; symptoms; toxins; treatment