ability of stony corals is minor; coral cuts can be severe due to a combination of lacerations, nematocyst venom, foreign debris in the wound, and secondary bacterial infection The clinical picture is one of stinging sensation followed by wheal formation and itching If the wound is untreated, an ulcer with an erythematous base may form within a few days Cellulitis, lymphangitis, fever, and malaise may occur Treatment consists of cleaning the wound and irrigation with copious amounts of saline, removal of foreign particles, and debridement Marine bacteria that can inoculate wounds are generally heterotrophic, motile, and facultatively anaerobic, gram-negative rods Organisms include Vibrio species, Erysipelothrix rhusiopathiae, and Mycobacterium marinum Wounds should be left open Broadspectrum antibiotic therapy, particularly tetracycline, at a dosage of 40 mg/kg/day in four divided doses, has been advocated but should not be used routinely in children younger than years For children younger than years, cephalexin (50 mg/kg/day in four divided doses) or trimethoprim-sulfamethoxazole (10 mg TMP/kg/day divided in two doses) should be used Phylum Echinodermata Phylum Echinodermata includes starfish, sea urchins, and sea cucumbers Of the three classes, only the Echinoidea (sea urchins) have clinical relevance for U.S children The long-spined urchins (e.g., Diadema) are dangerous to handle They not appear to possess venom like tropical urchins, but the spines, composed of calcium carbonate, easily pierce the skin, wet suits, and sneakers and can lodge deep into flesh Most injuries occur during wading in shallow water Penetration of skin by spines is accompanied by intense pain followed by redness, swelling, and aching The venom has hemolytic, myonecrotic, hepatotoxic, and anticoagulant properties Complications include tattooing of the skin, joint arthritis, secondary infection, and granuloma formation Management All spines should be removed as completely as possible using local anesthetic if needed Radiography and ultrasound may be used for spine localization and removal Any spines not reachable will be absorbed in time, but granulomas from retained spine fragments may require excision Soaking in warm water may be helpful for pain Systemic antistaphylococcal antibiotics should be used if signs of infection develop In case of reactive neuropathy, systemic corticosteroids are recommended MARINE VERTEBRATES Stingrays