Truc T Huynh, Jamie Seymour, Peter Pereira, Richard Mulcahy, Paul Cullen, Teresa Carrette, Mark Little
Severity of Irukandji syndrome and nematocyst identification from skin scrapings.
Med J Aust. 2003 Jan 6;178(1):38-41.
Abstract/Text
OBJECTIVES: (1) To identify the causative jellyfish species by examining skin scrapings in patients presenting to Cairns Base Hospital with marine stings, and (2) to describe clinical outcomes of those with Irukandji syndrome and those in whom nematocysts were identified from skin scrapings.
DESIGN AND SETTING: (1) A retrospective case series of 128 patients, identified from Cairns Base Hospital emergency department records with discharge diagnoses of marine stings between 1 July 2001 and 30 June 2002. (2) A prospective study of skin scrapings from 50 patients presenting with marine stings from the same period.
MAIN OUTCOME MEASURES: Number of patients with Irukandji syndrome, their opioid requirements and cardiac findings (where available); identification of causative species from nematocysts isolated from skin scrapings.
RESULTS: 116 patients retrospectively identified with marine stings had Irukandji syndrome. Of 50 patients who had skin scrapings, 39 had nematocysts consistent with Carukia barnesi. Symptoms experienced ranged from local pain alone to severe Irukandji syndrome with elevated troponin I levels, changes on electrocardiogram, cardiac dysfunction on echocardiography, and high opioid dose requirements. One patient had an unidentified cnidome on his skin scraping. He developed severe Irukandji syndrome and subsequently died from its complications.
CONCLUSION: This is the first published report of Carukia barnesi being successfully identified from skin scrapings. Most patients with identifiable cnidomes experiencing Irukandji syndrome were stung by Carukia barnesi, which we show causes a wide range of illness, including cardiac dysfunction. Our finding of a cnidome not consistent with Carukia barnesi in the setting of Irukandji syndrome makes it possible that other species of jellyfish may also cause this syndrome.
Bart J Currie, Susan P Jacups
Prospective study of Chironex fleckeri and other box jellyfish stings in the "Top End" of Australia's Northern Territory.
Med J Aust. 2005 Dec 5-19;183(11-12):631-6.
Abstract/Text
OBJECTIVE: To describe the epidemiology and clinical features of box jellyfish envenoming in the Top End of the Northern Territory and, in particular, confirmed stings from the major Australian box jellyfish, Chironex fleckeri.
DESIGN: Prospective collection of clinical data and skin scrapings or sticky-tape tests for nematocyst identification from patients presenting to Royal Darwin Hospital and remote coastal community health clinics in the Northern Territory, spanning 10 950 km of coastline; analysis of tidal, weather and seasonal data.
PATIENTS: All patients with jellyfish sting details recorded between 1 April 1991 and 30 May 2004.
MAIN OUTCOME MEASURES: Demographic and clinical features, use of C. fleckeri antivenom, and associations between weather, seasonal and tidal factors and confirmed C. fleckeri stings.
RESULTS: Of 606 jellyfish stings documented, 225 were confirmed to have been caused by C. fleckeri. 37% of C. fleckeri stings were in children, 92% occurred during the "stinger season" (1 October to 1 June), 83% occurred in water 1 m or less deep, and 17% occurred while victims were entering the water. Stings were least common on outgoing tides (P < 0.001) and commonest between 15:00 and 18:00 (P < 0.001) and on days with wind speed less than that month's average (P < 0.001). Nearly all victims experienced immediate pain, but this could often be controlled with ice; only 30% required parenteral narcotics and 8% required hospital admission. Cardiorespiratory arrest occurred within several minutes of the sting in the one fatal case, involving a 3-year-old girl with only 1.2 m of visible tentacle contact. C. fleckeri antivenom was given to another 21 patients, none of whom had life-threatening features at the time they were given antivenom.
CONCLUSIONS: Most C. fleckeri stings are not life-threatening; patients who die usually have cardiopulmonary arrest within minutes of the sting. The potential benefit of antivenom and magnesium under these circumstances remains to be shown, but a protocol with their rapid use is recommended if cardiopulmonary arrest has occurred. Unfortunately, this is unrealistic for many rural coastal locations, and the priority remains prevention of stings by keeping people, especially children, out of the sea during the stinger season.
Alexa Boer Kimball, Karina Zuelma Arambula, Arlen Ray Stauffer, Valeh Levy, Valerie Weaver Davis, Michael Liu, Wingfield Ellis Rehmus, Amit Lotan, Paul S Auerbach
Efficacy of a jellyfish sting inhibitor in preventing jellyfish stings in normal volunteers.
Wilderness Environ Med. 2004 Summer;15(2):102-8.
Abstract/Text
OBJECTIVE: To evaluate the protective effects of a jellyfish sting inhibitor formulated in sunscreen lotion vs conventional sunscreen against Chrysaora fuscescens and Chiropsalmus quadrumanus jellyfish.
METHODS: Twenty-four healthy subjects at 2 research sites were randomly assigned to receive the jellyfish sting inhibitor (Nidaria Technology Ltd, Jordan Valley, Israel) to one forearm and conventional sunscreen to the other arm in a blinded fashion. Subjects were stung with jellyfish tentacles on each forearm for up to 60 seconds. Erythema and pain were assessed at 15-minute intervals over a 2-hour period.
RESULTS: In the C. fuscescens group, all 12 arms pretreated with conventional sunscreen demonstrated erythema, and all subjects noted subjective discomfort. In contrast, no arm pretreated with the jellyfish sting inhibitor had objective skin changes (P < .01). Two subjects noted minimal discomfort in the arm treated with the sting inhibitor (P < .01). In the C. quadrumanus group, discomfort was reported in 3 of the 12 inhibitor-treated arms compared with 10 of the 12 placebo-treated arms (P < .05). Erythema was noted on 1 arm treated with the inhibitor and 9 arms treated with the placebo (P < .01).
CONCLUSIONS: The jellyfish sting inhibitor prevented sting symptoms of C. fuscescens jellyfish in 10 of 12 subjects and diminished the pain of the jellyfish sting in the remaining 2 subjects. The jellyfish sting inhibitor also inhibited the more severe sting of the C. quadrumanus jellyfish in the majority of subjects. The jellyfish sting inhibitor does not eliminate the sting from C. fuscescens or C. quadrumanus jellyfish but significantly reduces the frequency and severity of stings.
David R Boulware
A randomized, controlled field trial for the prevention of jellyfish stings with a topical sting inhibitor.
J Travel Med. 2006 May-Jun;13(3):166-71. doi: 10.1111/j.1708-8305.2006.00036.x.
Abstract/Text
BACKGROUND: Jellyfish stings are a common occurrence among ocean goers worldwide with an estimated 150 million envenomations annually. Fatalities and hospitalizations occur annually, particularly in the Indo-Pacific regions. A new topical jellyfish sting inhibitor based on the mucous coating of the clown fish prevents 85% of jellyfish stings in laboratory settings. The field effectiveness is unknown. The objective is to evaluate the field efficacy of the jellyfish sting inhibitor, Safe Sea.
METHODS: A double-blind, randomized, placebo-controlled trial occurred at the Dry Tortugas National Park, FL, USA and Sapodilla Cayes, Belize. Participants were healthy volunteers planning to snorkel for 30 to 45 minutes. Ten minutes prior to swimming, each participant was directly observed applying a blinded sample of Safe Sea (Nidaria Technology Ltd, Jordan Valley, Israel) to one side of their body and a blinded sample of Coppertone (Schering-Plough, Kenilworth, NJ, USA) to the contralateral side as placebo control. Masked 26 g samples of both Safe Sea SPF15 and Coppertone SPF15 were provided in identical containers to achieve 2 mg/cm(2) coverage. Sides were randomly chosen by participants. The incidence of jellyfish stings was the main outcome measure. This was assessed by participant interview and examination as subjects exited the water.
RESULTS: A total of 82 observed water exposures occurred. Thirteen jellyfish stings occurred during the study period for a 16% incidence. Eleven jellyfish stings occurred with placebo, two with the sting inhibitor, resulting in a relative risk reduction of 82% (95% confidence interval: 21%-96%; p= 0.02). No seabather's eruption or side effects occurred.
CONCLUSIONS: Safe Sea is a topical barrier cream effective at preventing >80% jellyfish stings under real-world conditions.
R Hartwick, V Callanan, J Williamson
Disarming the box-jellyfish: nematocyst inhibition in Chironex fleckeri.
Med J Aust. 1980 Jan 12;1(1):15-20.
Abstract/Text
Laboratory tests indicate that methylated spirits, widely espoused as a first-aid treatment for jellyfish stings, causes massive discharge of nematocysts in living tentacles of the box-jellyfish, Chironex fleckeri. This action, together with demonstrated hazards of flammability and intoxication, casts doubt on this substance as a treatment for Chironex stings. In an attempt to find a substitute which will be effective in inactivating unfired nematocysts in the tentacles adhering to sting victims, a number of substances were tested in the laboratory. Weak solutions of acetic acid, as well as commerical vinegar, were found to inactivate the penetrating nematocysts of Chironex rapidly and completely. Most other substances tested proved less effective, and some actually stimulated the firing of nematocysts.
P J Fenner, J A Williamson, J W Burnett, J Rifkin
First aid treatment of jellyfish stings in Australia. Response to a newly differentiated species.
Med J Aust. 1993 Apr 5;158(7):498-501.
Abstract/Text
Vinegar has been shown to inhibit neomatocyst discharge in Chironex fleckeri, the deadly north Australian box-jellyfish, and application of vinegar has become accepted first aid, not only for box-jellyfish stings, but also for stings by other Australian jellyfish. However, in a newly differentiated species of Physalia in Australian waters, which causes severe envenomation, vinegar was found to cause discharge in up to 30% of neomatocysts. In treating these stings, the use of vinegar is not recommended as it may increase envenomation. Stings from the single-tentacled Physalia utriculus (the "bluebottle") are not severe, tentacles with unfired nematocysts rarely adhere to the victim's skin and vinegar dousing is not required. Vinegar treatment is therefore an unnecessary step in the first aid management of any Physalia sting but remains an essential first aid treatment for all cubozoan (box) jellyfish tested to date.
アメリカ心臓協会：心肺蘇生と救急心血管治療のためのガイドライン 2010. (2010 American Heart Association Guidelines for CPR and ECC).
AUSTRALIAN RESUSCITATION COUNCIL GUIDELINE 9.4.5 ENVENOMATION - JELLYFISH STINGS.
Min-Jung Pyo, Hyunkyoung Lee, Seong Kyong Bae, Yunwi Heo, Indu Choudhary, Won Duk Yoon, Changkeun Kang, Euikyung Kim
Modulation of jellyfish nematocyst discharges and management of human skin stings in Nemopilema nomurai and Carybdea mora.
Toxicon. 2016 Jan;109:26-32. doi: 10.1016/j.toxicon.2015.10.019. Epub 2015 Nov 2.
Abstract/Text
Even though jellyfish sting is common today, its first aid guideline has never been clear enough in a scientific point of view and the use of vinegar appears to be not accepted in common throughout the world. In the present study, to develop rational first aid guidelines for the stings of Nemopilema nomurai (scyphozoa) and Carybdea mora (cubozoa), the modulatory effects of various kinds of rinsing solutions have been assessed on nematocyst discharge and human skin tests. Among the solutions tested, vinegar (4% acetic acid) immediately caused significant nematocyst discharge in N. nomurai but not in C. mora. On the other hand, ethanol (70%) notably stimulated nematocyst discharge in C. mora and relatively less in N. nomurai. Moreover, isopropanol, a widely used solvent in pharmaceutical products, caused extensive nematocyst discharges in both N. nomurai and C. mora. Whereas, seawater did not elicit any nematocyst discharge in both jellyfish species. In human skin test, the rinsing with seawater also ameliorated the stinging-associated symptoms (pain and redness) in C. mora as well as N. nomurai. From this study, seawater appears not to induce any nematocyst discharge and can be safely used as a first aid rinsing solution for the jellyfish stings.
Copyright © 2015 Elsevier Ltd. All rights reserved.
Laura M Birsa, Peter G Verity, Richard F Lee
Evaluation of the effects of various chemicals on discharge of and pain caused by jellyfish nematocysts.
Comp Biochem Physiol C Toxicol Pharmacol. 2010 May;151(4):426-30. doi: 10.1016/j.cbpc.2010.01.007. Epub 2010 Jan 29.
Abstract/Text
Jellyfish tentacles in contact with human skin can produce pain swelling and redness. The pain is due to discharge of jellyfish nematocysts and associated toxins and discharge can be caused by a variety of mechanical and chemical stimuli. A series of tests were carried out with chemicals traditionally used to treat jellyfish stings e.g. acetic acid ammonia meat tenderizer baking soda and urea to determine if these chemicals stimulated or inhibited nematocyst discharge and if they brought relief to testers who were exposed to jellyfish tentacles. Chrysaora quinquecirrha (sea nettle) Chiropsalmus quadrumanus (sea wasp) and Physalia physalis (Portuguese man-of-war) were used in the study. It was found that many of the chemicals traditionally used to treat jellyfish stings stimulated nematocyst discharge and did not relieve the pain. However there was immediate relief when a common anesthetic lidocaine was sprayed on the skin of testers in contact with jellyfish tentacles. Initial exposure of tentacle suspensions to lidocaine prevented the nematocyst discharge by subsequent exposure to acetic acid ethanol ammonia or bromelain. Thus lidocaine in addition to acting as an anesthetic on skin in contact with jellyfish tentacles inhibited nematocyst discharge possibly by blocking sodium and/or calcium channels of the nematocytes.
Copyright 2010 Elsevier Inc. All rights reserved.
Jason T Nomura, Renee L Sato, Reina M Ahern, Joanne L Snow, Todd T Kuwaye, Loren G Yamamoto
A randomized paired comparison trial of cutaneous treatments for acute jellyfish (Carybdea alata) stings.
Am J Emerg Med. 2002 Nov;20(7):624-6. doi: 10.1053/ajem.2002.35710.
Abstract/Text
The objective of the study was to compare cutaneous treatments (heat, papain and vinegar) for acute jellyfish (Carybdea alata) stings. Healthy adult volunteer subjects received a single-tentacle jellyfish sting on each forearm. One forearm was treated with hot-water immersion (40-41 degrees C). This was compared with the other forearm, which was randomized to a comparison treatment of papain meat tenderizer or vinegar. Pain was measured at 0, 2, 4, 6, 8, 10, 15, and 20 minutes using a 10-cm visual analog scale (VAS). For 25 subject runs, the average VAS scores at t = 0 were 3.6 cm (hot water) and 3.7 cm (comparison treatment). At t = 4 minutes (2 minutes after treatment had started), the differences between hot-water and comparison group VAS scores were 2.1 cm versus 3.2 cm, respectively. The mean difference between hot-water and comparison treatments was 1.1 cm (95% confidence interval, 0.6 to 1.6). At t = 20 minutes (the end of the study period), the differences between hot-water and comparison group VAS scores were 0.2 cm versus 1.8 cm, respectively. The mean difference between hot-water and comparison treatments was 1.6 cm (95% confidence interval, 0.9 to 2.3). This study suggests that the most efficacious initial treatment for C alata jellyfish envenomation is hot-water immersion to the afflicted site.
Copyright 2002, Elsevier Science (USA). All rights reserved.)
Conrad Loten, Barrie Stokes, David Worsley, Jamie E Seymour, Simon Jiang, Geoffrey K Isbister
A randomised controlled trial of hot water (45 degrees C) immersion versus ice packs for pain relief in bluebottle stings.
Med J Aust. 2006 Apr 3;184(7):329-33.
Abstract/Text
OBJECTIVE: To investigate the effectiveness of hot water immersion for the treatment of Physalia sp. (bluebottle or Portuguese Man-of-War) stings.
DESIGN: Open-label, randomised comparison trial. Primary analysis was by intention to treat, with secondary analysis of nematocyst-confirmed stings. One halfway interim analysis was planned.
SETTING: Surf lifesaving first aid facilities at two beaches in eastern Australia from 30 December 2003 to 5 March 2005.
PARTICIPANTS: 96 subjects presenting after swimming in the ocean for treatment of an apparent sting by a bluebottle.
INTERVENTIONS: Hot water immersion (45 degrees C) of the affected part versus ice pack application.
MAIN OUTCOME MEASURES: The primary outcome was a clinically important reduction in pain as measured by the visual analogue scale (VAS). Secondary outcomes were the development of regional or radiating pain, frequency of systemic symptoms, and proportion with pruritus or rash on follow-up.
RESULTS: 49 patients received hot water immersion and 47 received ice packs. The two groups had similar baseline features, except patients treated with hot water had more severe initial pain (VAS [mean +/- SD]: 54 +/- 22 mm versus 42 +/- 22 mm). After 10 minutes, 53% of the hot water group reported less pain versus 32% treated with ice (21%; 95% CI, 1%-39%; P = 0.039). After 20 minutes, 87% of the hot water group reported less pain versus 33% treated with ice (54%; 95% CI, 35%-69%; P = 0.002). The trial was stopped after the halfway interim analysis because hot water immersion was shown to be effective (P = 0.002). Hot water was more effective at 20 minutes in nematocyst-confirmed stings (95% versus 29%; P = 0.002). Radiating pain occurred less with hot water (10% versus 30%; P = 0.039). Systemic effects were uncommon in both groups.
CONCLUSIONS: Immersion in water at 45 degrees C for 20 minutes is an effective and practical treatment for pain from bluebottle stings.
C S Thomas, S A Scott, D J Galanis, R S Goto
Box jellyfish (Carybdea alata) in Waikiki. The analgesic effect of sting-aid, Adolph's meat tenderizer and fresh water on their stings: a double-blinded, randomized, placebo-controlled clinical trial.
Hawaii Med J. 2001 Aug;60(8):205-7, 210.
Abstract/Text
The study measured the analgesic effects of three popular Hawaii remedies for stings from the box jellyfish, Carybdea alata. Analysis of data showed that aerosol sprays of Sting-Aid (an aluminum sulfate solution), Aldolph's meat tenderizer dissolved in water, and fresh water neither increased nor decreased the pain of box jellyfish stings more than the control (seawater).
J W Burnett, H Rubinstein, G J Calton
First aid for jellyfish envenomation.
South Med J. 1983 Jul;76(7):870-2. doi: 10.1097/00007611-198307000-00013.
Abstract/Text
To determine a reliable first aid topical remedy for jellyfish stings, we investigated several commonly available preparations to determine their ability to prevent nematocyst rupture from sea nettle (Chrysaora quinquecirrha) and Portuguese man-of-war (Physalia physalis) tentacles. The application of a baking soda slurry was a good inhibitor of nematocyst discharge for the nettle and vinegar was a good inhibitor for the man-of-war.
Heather Prestwich, Rachel Jenner
Best evidence topic report. Treatment of jellyfish stings in UK coastal waters: vinegar or sodium bicarbonate?
Emerg Med J. 2007 Sep;24(9):664. doi: 10.1136/emj.2007.052290.
Abstract/Text
Nicholas T Ward, Michael A Darracq, Christian Tomaszewski, Richard F Clark
Evidence-based treatment of jellyfish stings in North America and Hawaii.
Ann Emerg Med. 2012 Oct;60(4):399-414. doi: 10.1016/j.annemergmed.2012.04.010. Epub 2012 Jun 6.
Abstract/Text
We performed a systematic review of the evidence supporting various treatments for envenomation by jellyfish (cnidarian) and related organisms in North America and Hawaii. Our review produced 19 pertinent primary articles. Current research demonstrates variable response to treatment, often with conflicting results according to species studied, which contributes to considerable confusion about what treatment is warranted and efficacious. Our review suggests that vinegar causes pain exacerbation or nematocyst discharge in the majority of species. Hot water and topical lidocaine appear more widely beneficial in improving pain symptoms and are preferentially recommended. Unfortunately, they may be difficult to obtain at the site of envenomation, such as the beach or diving sites. In these instances, removing the nematocysts and washing the area with saltwater may be considered. If the envenomation is thought to be due to the bluebottle (Physalia), vinegar may be beneficial.
Copyright © 2012. Published by Mosby, Inc.
