Box jellyfish envenomation: Difference between revisions

Revision as of 17:14, 28 September 2019

Box jellyfish

Nematocyst stages of discharge

Cnidarian invertebrates distinguished by their cube-shaped medusae
Chironex fleckeri or sea wasp is cause of most deaths
Largely restricted to the Indo-Pacific Ocean/Australian waters but various species can be found widely
Most stings are benign (requiring local treatment only), only a few species have been implicated in human deaths

Specific venom components unclear
Thought to affect sodium/potassium/calcium channels
Chironex fleckeri venom causes cell membranes to become porous allowing K+ influx/hyperkalemia

Stings associated with immediate pain, lasting up to 8 hours, and linear welts in a cross-hatched pattern
- May progress to blisters/necrosis
25-30% may still have tentacles attached
Systemic envenomation (usually >10% BSA) can manifest as cardiac arrhythmias, respiratory dysfunction, death
- usually manifests within 5 minutes of sting
delayed hypersensitivity reactions occur in >50%
- Itching, redness at sting sites 7-14d after initial incidence

Pour liberal amounts of vinegar
Remove any tentacles
- tentacles separated from medusae can still emit venom
Pain control
Supportive measures for minor envenomations
- Ice recommended but heat may actually work better
Antihistamines and steroids for hypersensitivity reaction
Do NOT pressure bandage
Antivenom for life-threatening envenomations
- Bovine IgG Fab with 20,000 units/ampule

Cardiac arrest
- undiluted antivenom administered as an IV Push: up to 6 vials
- if no response then give magnesium IV
Hypotension, tachycardia, shock, arrhythmia
- dilute 3 amps antivenom in 100mL NS and run over 20 minutes
- can repeat for a total of 6 vials
Intractable pain
- give 1 amp diluted in 100mL NS run over 20 minutes

Anti-venom can cause serum sickness 4-14 days after administration

Bastian Bentlage, Paulyn Cartwright, Angel A. Yanagihara, Cheryl Lewis, Gemma S. Richards and Allen G. Collins.Evolution of box jellyfishes (Cnidaria: Cubozoa), a group of highly toxic invertebrates. Proceedings of the Royal Society, November 18, 2009 DOI:10.1098/rspb.2009.1707
Currie BJ, Jacups SP. Prospective study of Chironex fleckeri and other box jellyfish stings in the “Top End” of Australia’s Northern Territory. Med J Aust 2005; 183: 631-636
Hughes RJ, Angus JA, Winkel KD, Wright CE. A pharmacological investigation of the venom extract of the Australian box jellyfish, Chironex fleckeri, in cardiac and vascular tissues. Toxicol Lett. 2012 Feb 25;209(1):11-20. Epub 2011 Dec 2.
http://www.toxinology.com/generic_static_files/cslavh_antivenom_boxjelly.html

Authors:

@@ Line 3: / Line 3: @@
 [[File:Nematocyst discharge.png|thumb|Nematocyst stages of discharge]]
 *Cnidarian invertebrates distinguished by their cube-shaped medusae
-*''Chironex fleckeri'' or [[sea wasp]]is cause of most deaths
+*''Chironex fleckeri'' or [[sea wasp]] is cause of most deaths
 *Largely restricted to the Indo-Pacific Ocean/Australian waters but various species can be found widely
 *Most stings are benign (requiring local treatment only), only a few species have been implicated in human deaths