Jellyfish Sting Newsletters: Number 30 - January 2004
Significant Papers Published
Armed and dangerous. NewScientist 34-37, 2003.
A lay person’s review of Chironex and box-jellyfish envenomation.
Grady JD, Burnett JW. Irukanji syndrome in south Florida divers. Ann. Emerg. Med. 2003; 42:763-766.
Irukandji syndrome is a constellation of delayed severe local and systemic symptoms occurring after a Carukia barnesi box jellyfish sting involving any exposed skin. These cases are limited to Australia, the habitat of that animal. Numerous other cases of an Irukandji-like syndrome after other small Carybdeid genus envenomations have been reported elsewhere in the world. There have yet been no reports of Irukandji-like syndrome occurring in contiental US coastal waters. We describe 3 cases of nocturnal marine envenomation causing such a syndrome occurring in US military combat divers off Key West, FL. It is unclear what species caused the injuries, but a member of the Carybdeid genus seems most likely.
Schwab IR, Coates MM. Is the brain overrated? Br J Ophthalmol 87:525, 2003.
This article describes the camera-style eyes found in cubozoans and contains a nice picture of the cubozoan on the cover. The authors speculate that this type of eye does not need a brain but perhaps the brain is an outpatching of that eye.
Brand DD, Blanquet RS, Phelan MA. Collagenous, thiol-containing proteins of cnidarian nematocysts: a comparison of the chemistry and protein distribution patterns in two types of cnidae. Comp. Biochem. Physiol. 106B’115-124, 1993.
Nematocysts structural proteins (NSP) from the sea anemones Aiptasia pallida and Metridium senile and the siphonophore Physalia physalis are primarily low molecular weight collagens linked by disulfide bonds. NSP patterns resolved by SDS-PAGE revealed a common, major collagen species (40 kDa) in each nematocyst type, together with other collagens and non-thiol-containing proteins. For each cnidarian, NSP glycosylation profiles were significantly different. Monoclonal antibodies against Aiptasia NSP demonstrated a differential distribution between the capsule wall and thread. NSP differences would account for the diversity of morphologic and functional types.
Williams EH, Jr., Bunkley-Williams L, Lilyestrom CG, Larson RJ, Engstrom NA, Ortiz-Corps EAR, Timber JH. A population explosion of the rare tropical/subtropical purple sea mane, Drymonema dalmatinum, around Puerto Rico in the Summer and Fall of 1999.
A population explosion of millions of the purple sea mane, Drymonema dalmatinum Haekel (Semaeostomeae: Cyaneidae; Fig. 1) occurred around Puerto Rico in the summer and fall of 1999. This animal was seen also off the US California coast in the summer of 2003.
Little M, Pereira P, Mulcahy R, Cullen P, Carrette T, Seymour J. Severe cardiac failure associated with presumed jellyfish sring. Irunkandji Syndrome? Anaesthesia and Intensive Care 31:642-647, 2003.
We present a retrospective review of twelve cases of Irunkandji syndrome associated with pulmonary oedema. This is a life-threatening envenoming due to a presumed jellyfish sting throughout Northern Australia, although only one case occurred outside North Queensland.
Patients presented with significant and ongoing pain, tachycardia and hypertension. Half the patients became hypotensive requiring inotropic support. Cardiac echocardiography revealed significant cardiac dysfunction. Six patients required ventilatory support. There was no death reported due to pulmonary oedema, but one patient died of intracerebral haemorrhage.
We believe patients may develop a toxin associated cardiomyopathy, and jellyfish other than Carukia barnesi may be responsible. As there is confusion with nomenclature, Carukia barnesi should be known as the Barnes jellyfish, and the diagnosis of cardiotoxic marine envenoming is suggested for any patient who has been stung by a jellyfish, develops no or minimal skin markings, and develops cardiogenic pulmonary oedema associated with Irukandji syndrome.
Kariotoglou DM, Mastronicolis SK. Sphingophosphonolipid molecular species from edible mollusks and a jellyfish. Comp. Biochem. Physiol. 136B:27-44, 2003.
The jellyfish Pelagia noctiluca can be rich in phosphonolipids. A suite of two minor ceramide 2-aminoethylphosphonates (CAEP-II, III) was quantitated in Pelagia at 2.0 and 1.3% of phospholipids. In CAEP-IIp, saturated fatty acids (FA) of 14, 16, 18 and 19 carbons amounted to 56.0%; 12.6% dihydroxy and 34.1% trihydroxy bases were also detected in CAEP-IIp. The Rf CAEP-IIIp< Rf CAEP-IIp owing to an increase of +8.5% of hydroxy FA and +12.3% of trihydroxy bases. The compositions of CAEP-IIM and CAEP-IIE appear to be specific but the major spingophosphonolipids appear not specific.
Little M, Seymour J. Another cause of “Irukandji stingings.” Med J Aust 179:654, 2003.
Evidence of an identified unnamed jellyfish causing Irukandji syndrome is presented. A 2 mm piece of tentacle was collected and it did not come for C. barnesi. No definitive species identification was made.
Fenner PJ, Lewin M. Sublingual glyceryl trinitrate as prehospital treatment for hypertension in Irukandji syndrome. Med J Aust 179:655, 2003.
Sublingual glyceryl treatment (GTN) reduces hypertension by vasodilation, and is now recommended for hypertension from dysreflexia in patients with spinal injury, in whom similar high levels of serum catecholamines occur. In 3 patients, 3 puffs of GTN interspaced by 5 minutes lowered their systemic blood pressure to acceptable levels. Further assessment of GTN use in patients with Irukandji syndrome is necessary, but we believe it should be considered as prehospital treatment under medical guidance.
Cardosa JLC, Franco FOdeS, Wen FH, Málagis CMSA, Haddad Jr. Animais Peçonhentos no Brasil Biologia, Clinica e Terapeutica dos-accidentes. FAPESP, Sarriceu 2003, Sao Paulo.
This is a very well done 468 page paperback book on the various venomous animals in Brazil. There are excellent pictures, some good therapeutic suggestions and it is well organized. It is a definite contribution medically and one in which the publishers can be proud of the artistic layout.
A letter from Portsmouth, UK from David Sinclair reports that a patient was stung with an unknown jellyfish in the Mediterranean early last summer. He returned to the UK after the eruption disappeared but then developed an upper respiratory infection which antedated the recurrence of a similar eruption in the same site as the previous envenomation. I personally saw a similar patient in early September who had been stung by an unknown jellyfish in Charleston, South Carolina. She returned to Baltimore in good condition but had a recurrence one week later after having a viral infection characterized by nausea, low grade fever, headaches and neck pain.
Marc Joyuse who suggests that Diphoterine, a polyvalent washing solution used for chemical burns, was effective in wasp stings. We have previously stated in Newsletter #23 - July 2000 that it had been used against in Mediterranean children. No other corroboratoring evidence of efficacy has been reported.
A letter from Victor Haddad, Jr. enclosed a paper on scorpion fishes he and his associates published in Toxicon 42:79-83, 2003. Dr. Haddad has been very active in jellyfish sting research in his country and has expanded his interests to these venomous fish.
My wife saw a Physalia physalis on Saturday, September 19, 2003 at Stone Harbor, New Jersey. This site is far north of the usual habitat of that animal because there the Gulf Stream is more than 50-miles at sea. However, this day was the day after Hurricane Isabel came ashore on North America approximately 100-200 miles below that site.
A letter from Dr. Tony Brownjohn of Darwin, Northern Territories, Australia, reports that a jellyfish has infested a man-made saltwater lake in his town. They think this is some form of Cassiopea and they have inquired on methods of pain relief for that particular animal.
Dr. Des Gurry, a pediatrician in Perth, Western Australia was interested in the jellyfish problems that he has in his region which consisted of Carybdea rastoni, Cassiopea xaymacana plus Physalia, Chrysaora, Cyanea and Pelagia. It seems he has quite an assortment of animals down there and gets called upon to see the children who are stricken.
A jellyfish swarm closed a Cozumel beach for a short time last winter.
I saw a young twenty-year old male swimmer, stung in the left chest, arm and mouth presumably by Physalia physalis on January 8, 2003 off Ft. Lauderdale Florida, who had partial paralysis of his tongue for 45 minutes with dysphonia.