Trachinus draco, also known as greater weever, is a venomous fish species that belongs to the Trachinidae family and is found in the northeastern Atlantic and Mediterranean. It is responsible for many European fish envenomations, particularly among fishermen, divers, and swimmers. This work aims to fully review the current knowledge regarding pathophysiology, symptomatology, treatment, and forensic aspects of greater weever stings. Trachinus draco venom, which is primarily delivered through spines, often results in excruciating pain, local inflammation, and in severe cases, even systemic symptoms and death may occur. The diagnosis is usually clinical but can be aided by geographical and circumstantial clues. The treatment relies primarily on hot water immersion, analgesics, and wound care to relieve pain and prevent late complications, although it is best to avoid envenomation altogether through preventive measures like the use of protective gear and cautionary behavior. With an increase in the popularity of water-related activities and tourism, a review that consolidates all relevant clinical and forensic information regarding greater weever envenomations becomes increasingly important in order to reduce the incidence of stings and envenomation complications throughout the world and to promote further research in this area.

We report a case of a 42-y-old female patient who sustained a sting to the neck from a Trachinus draco fish. She subsequently developed complications including arytenoid membrane edema secondary to either the local anesthetic agent administered to the wound or the dracotoxin itself. The patient was examined in the emergency department after the sting. Local anesthesia with lidocaine was administered to the areas of injury at another hospital before presenting to our hospital emergency department. The patient reported that her pain partially decreased but hoarseness developed and she had difficulty breathing after the local anesthetic was administered. Laryngeal examination by our hospital's otolaryngologist revealed edema of the patient's right arytenoid membrane without evidence of vocal cord swelling. Computed tomography of the neck revealed edema in the right arytenoid membrane on the side of the neck where the local anesthetic had been injected. The patient, who was given supplementary treatment, was discharged without any complications on the seventh day of hospitalization. The principle treatment for these types of stings includes immersion in hot water, analgesic therapy, and observation for signs of local and systemic envenomation. We recommend using caution when injecting local anesthetic agents in the neck because of underlying vital structures.

In comparison with other animal venoms, fish venoms remain relatively understudied. This is especially true for that of the lesser Echiichthys vipera and greater weever fish Trachinus draco which, apart from the isolation of their unique venom cytolysins, trachinine and dracotoxin, respectively, remain relatively uncharacterised. Envenomation reports mainly include mild symptoms consisting of nociception and inflammation. However, like most fish venoms, if the venom becomes systemic it causes cardiorespiratory and blood pressure changes. Although T. draco venom has not been studied since the 1990's, recent studies on E. vipera venom have discovered novel cytotoxic components on human cancer cells, but due to the scarcity of research on the molecular make-up of the venom, the molecule(s) causing this cytotoxicity remains unknown. This review analyses past studies on E. vipera and T. draco venom, the methods used in the , the venom constituents characterised, the reported symptoms of envenomation and compares these findings with those from other venomous Scorpaeniformes.

The greater weever (Trachinus draco) is the only venomous fish in Denmark, and if stung by the weever the venom may cause symptoms such as pain, headache, nausea, dizziness and in severe cases systemic allergic reaction or tissue necrosis. The venom is heat-labile and should therefore be treated with warm water to the afflicted area. We report a case of a patient who was stung in the second finger and because of the treatment, he got a second-degree burn, that may have enhanced the effect of the venom, thus resulting in partial finger amputation.

Poland's access to the EU causes that there is the risk of poisoning from sources outside Poland. This is confirmed by the case reported below. The Weeverfish Trachinus draco lives in the coastal waters of West Africa and Europe (including those of the Mediterranean Sea) and belongs to the most poisonous fish species. The venom of Trachinus draco contains proteins that cause cellular membrane depolarisation, and haemolysis. A 35-yr. man was admitted to the Toxicological Department of the Nofer Institute of Occupational Medicine for symptoms, such as: a strong pain, swelling and reddening of the left leg, that had appeared after contact with an unidentified fish when he had been enjoying a bath in the Mediterranean Sea. In the additional examinations, slight abnormalities were detected only in the results of blood agglutination test. The patient was discharged from the hospital 7 days later in good condition.

Dracotoxin, a protein possessing toxic, membrane depolarizing and hemolytic activities, was isolated from the crude venom of the greater weever fish Trachinus draco. The purification involved ammonium sulfate precipitation of crude venom followed by gel filtration on a high performance liquid chromatograph column. About 300 micrograms of dracotoxin was obtained from 18 mg of crude venom proteins extracted from one average size fish. Dracotoxin consists of a single polypeptide of about 105,000 mol. wt. It hemolyzed rabbit erythrocytes with an EC50 of 3 ng/ml. Rabbit erythrocytes possessed binding sites for dracotoxin on their surface. Preincubation of dracotoxin with rabbit ghosts increased its EC50 value for rabbit erthrocytes from 3 to 25 ng/ml. Incubation of dracotoxin with enriched glycophorin fraction from rabbit erythrocytes also led to an increase in the EC50 to 70 ng/ml. The high specificity of dracotoxin for rabbit erythrocytes resembles that of staphylococcal alpha-toxin. Dracotoxin, however, caused hemolysis even at 4 degrees C and did not interact with cholesterol indicating substantial differences between the two hemolysins. Dracotoxin represents a major toxic component of T. draco venom.