Jellyfish injuries
Lakkana Thaikruea & Potjaman Siriariyaporn
It is widely known that box jellyfish are one of the most venomous marine animals in the world [1]. Envenomation involves the physical discharge of venom into tissues. The venom is a complex mixture of polypeptides and proteins, including hemolytic, cardiotoxic and dermatonecrotic toxins
Sensitive image, click to zoom and unblur
Near fatal case: a 26 year old American woman stung by a multiple tentacle box jellyfish on September 3rd 2010 at a beach on Pha-ngan island. She lost consciousness and revived following resuscitation. Vinegar was applied
The islands of Samui and Pha-ngan have the highest incidence of fatal and near fatal box jellyfish cases in Thailand. There is an urgent need for informed pre-clinical emergent care. Optimal pre-clinical care is an area of active research.
Near fatal case: a 45 year old British man, stung by a multiple tentacle box jellyfish on October 17th 2014 at Laem Som on Samui island. He had difficulty breathing and high heart rate. Vinegar was applied
All cases developed symptoms and signs immediately after being stung. More than half of the cases were unconscious. There were six fatal cases (46.7 %). The wound characteristics had an appearance similar to caterpillar tracks or step ladder-like burn marks. Almost all cases involved Chirodropidae. One fatal case received fresh water and ice packs applied to the wounds (16.7 %). Among the cases with known first aid, only one out of six fatal cases had vinegar applied to the wounds (16.7 %), while haft of six surviving cases received the vinegar treatment.
Near fatal case: a 31 year old Chinese man, stung by a multiple tentacle box jellyfish on September 12th 2015 at Chawang beach on Samui island. He lost consciousness and received vinegar and cardiopulmonary resuscitation at the hospital (10–15 min after stung). He was admitted into Intensive Care Unit and put on a respirator.
Box jellyfish
Nine lethal jellyfish stings were reported as confirmed cubozoan stings. Of these, 5 or 55 % were reported as confirmed Chirodropid stings, three were reported as suspected Chirodropid stings and one case was due to a either a chirodropid or a carybdeid sting.
First aid
Twelve cases were included in analysis where the first aid history was known. Of the six fatal cases, only one had vinegar poured on the injury (16.7 %) as first aid and one had fresh water poured on the wound followed by application of an ice pack (16.7 %). Among the six surviving cases, three received the vinegar treatment (50.0 %). One of them who was stung by Chirodropidae. He lost consciousness and was admitted to Intensive Care Unit, requiring use of a respirator. He received vinegar as first aid at the hospital after 10–15 min being stung (Fig. 4).
References
1.
Winkel KD, Tibballs J, Molenaar P, Lambert G, Coles P, et al. Cardiovascular actions of the venom for the Irukandji (Carkukia barnesi) jellyfish effects in human, rat, and guinea-pig tissues in vitro and in pigs in vivo. Clin Exp Pharmacol Physiol. 2005;32:777–88.
Article CAS PubMed Google Scholar 2.
Daubert G. Cnidaria envenomation. In: Emergency emedicine. 2010. http://emedicine.medscape.com/article/769538-overview. Accessed 15 June 2010.3.
Endean R, Monks SA, Cameron AM. Toxins from the box-jellyfish Chironex fleckeri. Toxicon. 1993;31:397–410.
Article CAS PubMed Google Scholar 4.
Chaousisa S, Smouta M, Wilsona D, Loukasa A, Mulvennab J, Seymour J. Rapid short term and gradual permanent cardiotoxic effects of vertebrate toxins from Chironex fleckeri (Australian box jellyfish) venom. Toxicon. 2014;80:17–26.
Tibballs J. Australian venomous jellyfish, envenomation syndromes, toxins and therapy. Toxicon. 2006;48:830–59.
Article CAS PubMed Google Scholar 6.
Bentlage B, Cartwright P, Yanagihara AA, Lewis C, Richards GS, et al. Evolution of box jellyfishes (Cnidaria: Cubozoa): a group of highly toxic invertebrates. Proc R Soc B. 2010;277:493–501.
PubMed Central Article CAS PubMed Google Scholar 7.
Flecker H. Injuries by unknown agents to bathers in North Queensland. Med J Aust. 1945;20:128–9.
Flecker H. Fatal stings to North Queensland bathers. Med J Aust. 1952;1:35–8.
Lumley J, Williamson J, Fenner P, Burnett J, Colquhoun D. Fatal envenomation by Chironex fleckeri, the north Australian box jellyfish: the continuing search for lethal mechanisms. Med J Aust. 1988;148:527–34.
CAS PubMed Google Scholar 10.
Mustafa MR, White E, Hongo K, Othman I, Orchard CH. The mechanism underlying thecardiotoxic effect of the toxin from the jellyfish Chironex fleckeri. Toxicol Appl Pharmacol. 1995;133:196–206.
Article CAS PubMed Google Scholar 11.
Thaikruea L, Siriariyaporn P. Situation of injurries and deaths in Thailand. In: Thaikruea L, editor. Injuries and deaths caused by box jellyfish and Portuguese man-of-war: treatment and prevention. Chiang Mai: Faculty of Medicine of Chiang Mai University Publishing; 2014. p. 23–42.
Google Scholar 12.
Thaikruea L, Siriariyaporn P, Wutthanarungsan R, Smithsuwan P. Review of fatal and severe cases of box jellyfish envenomation in Thailand. Asia Pac J Public Health. 2012. doi:10.1177/1010539512448210.
PubMed Google Scholar 13.
Markenson D, Ferguson JD, Chameides L, et al. Part 13: first aid: 2010 American Heart Association and American Red Cross International Consensus on First Aid Science With Treatment Recommendations. Circulation. 2010;122(suppl 2):S582–605.
Article PubMed Google Scholar 14.
Thaikruea L. Breaking news! Caution! Probable injuries and death caused by box jellyfish. 2015. http://www.oknation.net/blog/peeguay/2015/08/01/entry-1. Accessed 5 Sep 2015.15.
Thaikruea L, Siriariyaporn P. Severe dermatonecrotic toxin and wound complications associated with box jellyfish stings 2008–2013. J Wound Ostomy Continence Nurs. 2015;42:599–604.
Article PubMed Google Scholar 16.
Thaikruea L, Siriariyaporn P. Diagnosis and treatment. In: Thaikruea L, editor. Injuries and deaths caused by box jellyfish and Portuguese man-of-war: treatment and prevention. Chiang Mai: Faculty of Medicine of Chiang Mai University Publishing; 2014. p. 54–64.
Google Scholar 17.
Thaikruea L, Siriariyaporn P. In: Thaikruea L, editor. Injuries and deaths caused by box jellyfish and Portuguese man-of-war: treatment and prevention. Chiang Mai: Faculty of Medicine of Chiang Mai University Publishing; 2014.18.
Fenner PJ. Dangers in the ocean: the traveler and marine envenomation. I. Jellyfish. J Travel Med. 1998;5:135–41.
Article CAS PubMed Google Scholar 19.
Sonthichai C, Tikumrum S, Smithsuwan P, Bussarawit S, Sermgew T, O’Reilly M, et al. Jellyfish envenomation events in selected coastal provinces of Thailand 1998–2008. OSIR. 2009;2:9–12.
Google Scholar 20.
Thaikruea L, Siriariyaporn P. Prevention and surveillance for injuries and deaths caused by box jellyfish and Portuguese man-of-war. In: Thaikruea L, editor. injuries and deaths caused by box jellyfish and Portuguese man-of-war: treatment and prevention. Chiang Mai: Faculty of Medicine of Chiang Mai University Publishing; 2014. p. 65–82.
Google Scholar 21.
Welfare P, Little M, Pereira P, Seymour J. An in vitro examination of the effect of vinegar on discharged nematocysts of Chironex fleckeri. Diving Hyperb Med. 2014;44:30–4.
PubMed Google Scholar 22.
Yanagihara AA, Chen JJ. The effect of vinegar on discharged nematocysts of Chironex fleckeri. Diving Hyperb Med. 2014;44:172.
PubMed Google Scholar 23.
Ward NT, Darracq MA, Tomaszewski C, Clark RF. Evidence-based treatment of jellyfish stings in North America and Hawaii. Ann Emerg Med. 2012;60:15.
Auerbach PS. In reply to evidence-based treatment of jellyfish stings in North America and Hawaii. Ann Emerg Med. 2013;61(2):2.
Cegolon L, Heymann WC, Lange JH, Mastrangelo G. Jellyfish stings and their management: a review. 2013. doi:10.3390/md11020523. Accessed 7 July 2014.
Rights and permissions
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.