Jellyfish Sting Newsletters: Number 32 - January 2005
Significant Papers Published
Carrette TJ, Seymour J. A rapid and repeatable method for venom extraction from cubozoan nematocysts. Toxicon 44;135-139, 2004.
A new standardized technique for the recovery of venom from nematocysts of cubozoans is investigated to decrease the variation displayed between authors due to differing extraction techniques. The use of a mini bead mill beater, as investigated in this trial, allows for the rapid extraction of venom from nematocysts and is devoid of the previously isolated problems experienced with other methods of venom isolation, such as excessive heat build up.
This "bead" technique does not avoid the absorption problem of the toxins to glass. We will only know the "best" preparation system by struggling on with comparative studies. When we can synthesize the active principles we can work backwards to see what is the best method.
The best method of purifying nematocysts is flow cytometry fluorescent automated cell sorter which we utilized with Cassiopea (Comp Biochme. Physiol 2001; 128C:65-73).
Ishikawa T, Vucenik I, Shamsuddin A, Niculescu F, Burnett JW. Two new actions of sea nettle (Chrysaora quinquecirrha) nematocyst venom: studies on the mechanism of actions on complement activation and on the central nervous system. Toxicon 44;895-899, 2004.
Chrysaora quinquecirrha (sea nettle) nematocyst venom is lethal to rainbow killifish (Adina xenica) when injected intraperitoneally or topically to the exposed brain or denuded epithelium. The latter two routes are not rapid. The lethal activity is thermostable requiring 100oC heat for inactivation. This paper reports here for the first time that the venom also activates the complement system with the subsequent formation of the C5b-9 terminal complement complex. The events are associated with both a strong chemoattractant release and the tissue damage. These are also, at least in part, responsible for the pathogenesis of some clinical signs and symptoms associated to the jellyfish stings.
Seymour JE, Carrette TJ, Sutherland PA. Do box jellyfish sleep at night? Med J Australia 181:707, 2004.
Chironex fleckeri with attached transmitters were found to travel 210 m/hr between 0600-1500 but only 10 m/hr otherwise. During the relative inactive period there are no bell pulsations and the animals are relatively inactive on the sea floor. Shining light upon or causing vibration nearby the resting creature gives a short burst of swimming action only. It looks like our creatures are diurnal!
Macrokanis CJ, Hall NL, Mein JK. Irukandji syndrome in northern Western Australia: an emerging health problem. Med J Australia 181;699-702, 2004.
The rate of envenomation in northern WA is likely to be the highest currently documented in Australia. There is syndromic variability when compared with the north Queensland experience. This implies different causative jellyfish species that are not yet identified. Strings in Broome can be severe and life threatening.
This group reported three cases treated in Broome with MgSO4 as a bolus or infusion before receiving opiates for pain relief. Initially the response was dramatic but breakthrough pain occurred in all patients after 15-35 minutes.
Xian W, Kang B, Liu R. Jellyfish blooms in the Yangtze estuary. Science 307;41, 2005.
The species of jellyfish predominant in the Yangtze river estuary immediately after the completion of the Three Gorges Dam in 2003 was Rhopilema esculenta. This species was replaced in abundance by Cyanea capillata and that in turn by a bloom of Sanderia malayensis in 2004. These changes may signal an environmental change in this ecosystem.
Nomura JT, Sato RL, Ahern RM, Snow JL, Kwaye TT, Yamamoto LG. A randomized paired comparison trial of cutaneous treatments of acute jellyfish (Carybdea alata) stings. Am J Emerg Med 20;624-626, 2002.
The objective of the study was to compare cutaneous treatments (heat, papain and vinegar) for acute jellyfish (Carbdea alata) stings. Healthy adult volunteer subjects received a single-tentacle jellyfish sting on each forearm. One forearm was treated with hot-water immersion (40-41oC). This was compared with the other forearm, which was randomized to a comparison treatment of papain meat tenderizer or vinegar. This study suggests that the most efficacious initial treatment for C. alata jellyfish envenomation is hot-water immerson to the afflicted site.
This study corroborates that of Thomas et al. Hawaii Med J 2001;60;100-107 showing a slight benefit of local heat for pain-relief of C. alata stings. We are hoping for a rapid acting, quickly penetrating xylocaine derivative for topical use.
Salam AM, Albinali HA, Gehani AA, Al-Suwaidi J. Acute myocardial infarction in a professional diver after jellyfish sting. Mayo Clinic Proc 78;1557-1560, 200.
This was an unknown jellyfish stinging the patients left forearm. The symptoms started four hours post-sting. Decompression sickness was excluded as well as possible.
John Williamson reviewed this paper also and states that unfortunately the declaration of a normal ascent does not exclude the possibility of air trapping and thus a gas embolus. However, the story tends to make it less likely here than another cause. He commented that the normotension would seem to make the "classical" Irunkandji reaction less likely.
Das MK, Das AK, Das Gupta S, Hazra SC. Poisonous jellyfish contact and paralytic ileus. J. Assoc. Phys. India 50;1329, 2002.
A sting delivered by an unknown jellyfish 250 miles southwest of Calcutta on the Indian Ocean. The ileus began 3 hours post-sting and lasted 5 days. The sting was on the shoulder, face, inner thighs and left wrist.
Ponampalam R. An unusual case of paralytic ileus after jellyfish evenomation. Emerg Med J 19;357-358, 2002.
Another case of ileus after an unknown jellyfish sting on the left forearm. Bloating began in a half hour lasting 4 days. The location was the eastern shores of mid—Sumatra in Medan.
Armoni M, Ohali M, Hay E, Bibi H. Severe dyspnea due to jellyfish envenomation. Pediatric Emergency Care 19;84-86, 2003.
A sting delivered by an unknown jellyfish in Israel occurred on the nose, oral mucosa, pharynx, lips, both hands, right arm and leg. Severe dyspnea from the mechanical problems of facial swelling lasted overnight.
Hays GC, Houghton JDR, Doyle T, Davenport J. Aircraft give a new view of jellyfish behaviour. Nature 426;383, 2003.
Low-flying aircraft are being used to survey wide areas and revealed huge numbers of Rhizostoma – roughly one per square metre - in Carmarthen and Tremadoc bays in Wales from April to November this year. What drives these jellyfish to aggregate in these two large bays is unknown. However, both of these Welsh bays are known hotspots for sightings of jelly-feeding leatherback turtles, suggesting that some top predators are able to take advantage of this annual jelly-feast.
Letter to the Editor
Burnett JW, Calton GJ. The case for verapamil use in alarming jellyfish stings remains. Toxicon 44;817-818, 2004.
Our letter to the editor about the case for verapamil in counteracting the cardiac problem seen in serious jellyfish stings was published in Toxicon 44:817-818, 2004. We commented on it during this past July Newsletter.
The reply which followed was unsatisfactory since it changed the subject and discussed verapamil’s use as an adjunct therapy with antivenom. We had hoped that those authors would have addressed their problems with drug underdoseage and not seeing that cardiotoxicity caused by the undertreated venom was still venom-induced cardiotoxicity not verapamil-induced difficulty. In order to say that the drug is ineffective you have to repeat the experiments as originally done. Additionally, there was no response to the query of why the drug was used with an inhalant anesthesia when the manufacturer says not to do that!
Griselda Avilasoria, a doctoral student, now at James Cook University in Townsville, Australia writes that she is establishing a cDNA library for C. barnesi (Irukandji jellyfish) and is testing it with C. fleckeri antivenom. We await her good results.
Vidal Haddad of Brazil writes that in the last six months he observed 13 cases of sea-bather’s eruption in Santa Catarina State in South Brazil. It is very curious that Linuche unquiculata does not develop the medusa stage in Brazilian waters, only the larvae planula.