Jellyfish stings or envenoming can be classified into two major clinical syndromes.
|Linear/tentacle stings: |
Local pain of varying severity with a raised linear erythematous or urticarial lesion lasting a few hours to a day due to contact with one or more jellyfish tentacles. Rarely there may be non-specific systemic symptoms (nausea, vomiting, dizziness and malaise).
First described in Northern Australia with the Carukia barnesii jellyfish.1 The irukandji syndrome is characteristed by minimal local pain and local effects. After 20 to 30 minutes systemic effects develop including severe generalised pain, including abdominal, chest, back and large muscle pain. The pain is associated with nausea, vomiting and headache.2 Sympathomimetic-like effects can also occur including tachycardia, hypertension, anxiety and agitation. Severe irukandki syndrome can result in myocardial injury and pulmonary oedema occur.3
1. Barnes JH. Cause and effect in Irukandji stingings. Medical Journal of Australia. 1964; i: 897-904.
2. Huynh TT, Seymour J, Pereira P, Mulcahy R, Cullen P, Carrette T, Little M. Severity of Irukandji syndrome and nematocyst identification from skin scrapings. Medical Journal of Australia. 2003; 178 (1): 38-41.
3. Little M, Pereira P, Mulcahy R, Cullen P, Carrette T, Seymour J. Severe cardiac failure associated with presumed jellyfish sting. Irukandji syndrome? Anaesthesia and Intensive Care. 2003; 31 (6): 642-7.
Table 1. Common and important jellyfish worldwide including their distribution and clinical effects. Adapted from Isbister GK. Marine Envenomation and Poisoning. In: Medical Toxicology 3rd Ed. Dart RC. Lippincott Williams & Wilkins, Philadelphia 2004.
|Physalia spp.1-3||Portuguese man-o’-war (Atlantic), Pacific man-o’-war and blue bottles (Australia)||Variable severity from minor to severe pain lasting hours with linear erythematous or urticarial eruptions. Systemic symptoms are rare.|
|Olindias spp.2, 4||South America||Immediate local pain lasting hours and short linear or round urticaria lesions that last days.|
|Gonionemus spp.4||Similar effects reported in different species from Eastern Russia and Japan||Three clinical syndromes:
- Painful syndrome: an Irukandji like syndrome lasting 2-3 days - Respiratory form: acute allergic upper respiratory like effects lasting days. - Mixed form.
|Stinging and feather hydroids4, 5||Common tropical and temperate waters worldwide||Minor effects including local pain and in some which is followed in some cases by itching and painful urticaria lasting for up to a week|
|Millepora (fire coral)4||Worldwide in shallow waters||Similar effects to the feather hydroids, but less likely to cause the delayed urticarial effects.|
|Cubozoa (Box Jellyfish)||Bell or body shaped similar to a cube with tentacles attached to each of four corners|
|Chirodropidae4, 6, 7||Chironex fleckeri in Northern Australia, Chiropsalmus quadrigatus in the Indo-Pacific Region, and C. quadrumanus on the East coast of America down to South America.||Immediate severe local pain that may last hours and linear eruptions which last days and may cause necrosis is reported with all species. Systemic effects are rare but cardiac effects and death are reported mainly for C. fleckeri. In C. fleckeri stings delayed papular urticarial reactions can occur where the original sting mark was.|
|Carybdidae8-12||Indo-Pacific Region||The majority cause minor linear tentacle stings such as Carybdea alata which causes thousands of stings annually in Hawai, but no deaths. However, some cause the Irukandji syndrome (Carukia barnesi) characterized by delayed generalized pain associated with tachycardia, hypertension, sweating, piloerection, agitation and rarely pulmonary oedema.|
|Scyphozoa (True Jellyfish)|
|Chrysaora spp. (sea nettle)4, 13||Worldwide; C. quinquecirrha well known from North America (Chesapeake Bay); other species from east coast of South America and western Pacific Ocean in Japan and the Philippines||The majority cause immediate cutaneous pain that subsides over a few hours, similar to Physalia species.|
|Cyanea spp (Hair jellyfish)14, 15||Worldwide in colder oceans, but severe effects have only been reported in Australia and the United States.||Most cases result in short-lived moderate pain and eythema, and less commonly local blistering and non-specific systemic symptoms. Cyanea jellyfish can also cause corneal injuries.|
|Catostylus spp. (blubber jellyfish)4||Very common jellyfish; mainly Indo-Pacific region||Minor sting, not medically significant.|
|Pelagia spp.(mauve stingers)3, 4, 16||Worldwide distribution, but reports from the Mediterranean (P. noctiluca) and Australia.||Immediate, transient localized pain, associated with wheals, itching and oedema, which may blister and cause problems for weeks.|
|Aurelia spp. (Moon jellyfish)17, 18||Mediterranean, Atlantic Ocean and Australia||Local pain, mild to severe lasting less than 1 hour. Ulceration and hyperpigmentation have been reported.|
|Thimble jellyfish (Linuche unguiculata) - Sea bathers eruption19, 20||Mainly east coast of America||Intensely pruritic, maculopapular or vesicular eruption that effects skin surfaces covered by swimwear that develops 1 to 24 hours after exposure. Non-specific systemic symptoms have been reported in children.|
|Sea anemone4||Worldwide||Immediate local pain of variable severity.|
1. Stein MR, Marraccini JV, Rothschild NE, Burnett JW. Fatal Portuguese man-o'-war (Physalia physalis) envenomation. Annals of Emergency Medicine. 1989; 18 (3): 312-5.
2. Haddad V, Jr., da Silveira FL, Cardoso JL, Morandini AC. A report of 49 cases of cnidarian envenoming from southeastern Brazilian coastal waters. Toxicon. 2002; 40 (10): 1445-50.
3. Loten C, Stokes B, Worsley D, Seymour JE, Jiang S, Isbister GK. A randomised controlled trial of hot water (45 degrees C) immersion versus ice packs for pain relief in bluebottle stings. Med J Aust. 2006; 184 (7): 329-33.
4. Williamson JA, Fenner PJ, Burnett JW, Rifkin JF. Venomous and Poisonous Marine Animals. Sydney: University of New South Wales Press; 1996.
5. Marques AC, Haddad V, Jr., Esteves MA. Envenomation by a benthic Hydrozoa (Cnidaria): the case of Nemalecium lighti (Haleciidae). Toxicon. 2002; 40 (2): 213-5.
6. Currie BJ, Jacups SP. Prospective study of Chironex fleckeri and other box jellyfish stings in the “Top End” of Australia's Northern Territory. Medical Journal of Australia. 2005; 183 (11-12): 631-6.
7. Bengtson K, Nichols MM, Schnadig V, Ellis MD, Bengston K. Sudden death in a child following jellyfish envenomation by Chiropsalmus quadrumanus. Case report and autopsy findings. Journal of the American Medical Association. 1991; 266 (10): 1404-6.
8. Huynh TT, Seymour J, Pereira P, Mulcahy R, Cullen P, Carrette T, Little M. Severity of Irukandji syndrome and nematocyst identification from skin scrapings. Medical Journal of Australia. 2003; 178 (1): 38-41.
9. Barnes JH. Cause and effect in Irukandji stingings. Medical Journal of Australia. 1964; i: 897-904.
10. Little M, Pereira P, Carrette T, Seymour J. Jellyfish responsible for Irukandji syndrome. QJM. 2006; 99 (6): 425-7.
11. Little M, Pereira P, Mulcahy R, Cullen P, Carrette T, Seymour J. Severe cardiac failure associated with presumed jellyfish sting. Irukandji syndrome? Anaesthesia and Intensive Care. 2003; 31 (6): 642-7.
12. Ping J, Onizuka N. Epidemiology of jellyfish stings presented to an American urban emergency department. Hawaii Med J. 2011; 70 (10): 217-9.
13. Southcott RV. The Neurologic Effects of Noxious Marine Creatures. Topics on Tropical Neurology. Philadelphia: F.A. Davis Co.; 1975. p. 165-258.
14. Southcott RV, Coulter JR. The effects of the southern Australian marine stinging sponges, Neofibularia mordens and Lissodendoryx sp. Medical Journal of Australia. 1971; 2 (18): 895-901.
15. Mitchell JH. Eye injuries due to jellyfish ( Cyanea annaskala ). Medical Journal of Australia. 1962; 2: 303-5.
16. Maretic Z, Russell FE, Ladavac J. Epidemic of stings by the jellyfish Pelagia noctiluca in the Adriatic. Toxicon. 1979; 17 (Suppl.1): 115.
17. Burnett JW, Calton GJ, Larsen JB. Significant envenomation by Aurelia aurita, the moon jellyfish. Toxicon. 1988; 26 (2): 215-7.
18. Cleland JB, Southcott RV. Injuries to Man from Marine Invertebrates in the Australian Region. Canberra; 1965.
19. Segura-Puertas L, Ramos ME, Aramburo C, Heimer De La Cotera EP, Burnett JW. One Linuche mystery solved: all 3 stages of the coronate scyphomedusa Linuche unguiculata cause seabather's eruption. Journal of the American Academy of Dermatology. 2001; 44 (4): 624-8.
20. Wong DE, Meinking TL, Rosen LB, Taplin D, Hogan DJ, Burnett JW. Seabather's eruption. Clinical, histologic, and immunologic features. Journal of the American Academy of Dermatology. 1994; 30 (3): 399-406.