Search

Jellyfish Stings

Eligible for FibonacciCME Credit

Members: Log into APP for Online CME Test


By Stuart M. Caplen, M.D.


Jellyfish are free-swimming marine animals found in waters all over the world. They have stinging tentacles used to capture prey, and some species can deliver a painful sting to humans. It is estimated there are approximately 150 million jellyfish stings a year, typically near coastal beaches.[1]


Taxonomy [1]


Jellyfish come from the class Scyphozoa or true jellyfish which includes Cyaneidae and Pelegiidae. Other jellyfish-like members of the Cnidarians phylum have venomous tentacles but taxonomically are not considered true jellyfish. These include Staurozoa or stalked jellyfish, Cubozoa or box jellyfish, Hydrozoa of which the Physalia physalis or Portuguese man-of-war (PMOW) is a member. The PMOW and the Physalia utriculus (Bluebottle) are classified as siphonophores or animals made up of a colony of organisms working together. Both of the Physalia species have gas filled bladders that float above the water.[2] For linguistic simplicity jellyfish and jellyfish-like organisms will be referred to as jellyfish in this article.


From: Cegolon et al.

How Jellyfish Sting and Adverse Effects of Envenomation


Some jellyfish have a jellylike substance surrounding internal structures, others have a gas bladder or an umbrella-shaped bell. The tentacles are of varying size, ranging from a few millimeters to over 40 meters in length depending on the species. One type of cell in the tentacle is called the nematocyst which is a capsule containing a tightly coiled filament immersed in venom. Tentacles can contain thousands of nematocysts. Jellyfish venom discharge is triggered by mechanical stimuli, such as rubbing against a person or fish. These stimuli lead to the uncoiling of the filament, which can penetrate tissue, and cause the nematocyst to discharge venom into or onto whatever has caused the activation. Nematocysts can function even when separated from the jellyfish or if the jellyfish is dead.[1]


The most common adverse effect of jellyfish stings is a skin reaction. The toxin carried in the tentacles can produce linear, urticarial, painful, or erythematous lesions initially. Stings can also be inconspicuous marks with red flaring, goosebumps, wheals, or just sweating at the site.[3] Later on, the injured areas can become vesicular, hemorrhagic, or even necrotic.[4] The tentacles can become adherent to the skin and potentially cause more venom to be released, even if the jellyfish body is no longer attached. The wounds eventually scab over and may leave permanent scars. Delayed eczematous skin reactions have also been observed in victims days to months after exposure.[4]


Conjunctivitis, iritis and corneal ulcerations may occur with ocular stings.[4]


Seabather's eruption is a pruritic dermatitis due to jellyfish larvae that get inside a swimsuit and can cause repeated symptoms if the swimsuit is worn again without proper washing.[4]



Box Jellyfish Linear Lesions



More about prevention, treatment, first aid recommendations, and some common jellyfish ... read more

 

CONCLUSION:

Read the conclusion of Jelly Fish Stings on FibonaccMD.app



 

#CME #FibonacciCME


Members: take the CME test


Not a APP member? Learn About Our Membership and FREE Trial


 


ABOUT THE AUTHOR


Stuart M. Caplen, MD, FACEP, MSM

Dr. Caplen is a retired emergency medicine physician and former emergency department medical director, who also has a Master of Science in Management degree, and green belt certification in Lean/Six Sigma.


Editor’s note: When I was twelve years old I remember very clearly the stings of the PMOW. Although I do not remember exactly my treatment. I do remember the lifeguard debating between vinegar and cream. I may have received both! Rich Strongwater, M.D.


References:

  • American Red Cross Scientific Advisory Council Advisory Jellyfish Stings, June 2016. Retrieved from: redcross.org PDF

  • AUSTRALIAN RESUSCITATION COUNCIL, GUIDELINE 9.4.5, ENVENOMATION - JELLYFISH STINGS, , July 2010. Retrieved from: secureservercdn.net PDF

  • Boer Kimball A, Efficacy of a Jellyfish Sting Inhibitor in Preventing Jellyfish Stings in Normal Volunteers, Wilderness & Environmental Medicine, Volume 15, Issue 2, June 2004, Pages 102-108. Retrieved from: sciencedirect.com

  • Boulware D, eMD, A Randomized, Controlled Field Trial for the Prevention of Jellyfish Stings With a Topical Sting Inhibitor, Journal of Travel Medicine, Volume 13, Issue 3, 1 May 2006, Pages 166–171, Retrieved from: doi.org

  • Carrette T, et al., Temperature effects on box jellyfish venom: a possible treatment for envenomed patients?, Med J Aust 2002; 177 (11): 654-655. retrieved from: www.mja.com.au/journal/

  • Cegolon L, Heymann WC, Lange JH, Mastrangelo G. Jellyfish stings and their management: a review. Mar Drugs. 2013;11(2):523-550. Published 2013 Feb 22. Retrieved from: www.mdpi.com

  • Fenner P, Awareness, Prevention and Treatment of world-wide marine stings and bites, International Life Saving Federation Medical/Rescue Conference Proceedings, September 1997. Retrieved from: www.ilsf.org PDF

  • Isbister G, et al., Hot water immersion v icepacks for treating the pain of Chironex fleckeri stings: a randomised controlled trial, Med J Aust 2017; 206 (6): 258-261. Retrieved from: mja.com.au/journal/

  • Lakkis N, Jellyfish Stings: A Practical Approach, Volume 26, ISSUE 3, P422-429, September 01, 2015. Retrieved from: wemjournal.org

  • Li L, et al., Interventions for the symptoms and signs resulting from jellyfish stings, Cochrane Database of Systematic Reviews, John Wiley and Sons, Dec 9, 2013.

  • Loten, C.; Stokes, B.; Worsley, D.; Seymour, J.; Jiang, S.; Isbister, G. A randomised controlled trial of hot water (45 °C) immersion versus ice packs for pain relief in bluebottle stings. Med. J. Aust. 2006, 184, 329–333

  • Portuguese Man-of-War, National Geographic. Retrieved from: nationalgeographic.com

  • Ramasamy, S.; Isbister, G.K.; Seymour, J.E.; Hodgson, W.C. The in vivo cardiovascular effects of box jellyfish Chironex fleckeri venom in rats: Efficacy of pre-treatment with antivenom, verapamil and magnesium sulfate. Toxicon 2004, 43, 685–690. sciencedirect.com

  • Seymour J, Are we using the correct first aid for jellyfish?, Med J Aust 2017; 206 (6): 249-250. Retrieved from: mja.com.au/journal/

  • Yanagihara A, et al., Experimental Assays to Assess the Efficacy of Vinegar and Other Topical First-Aid Approaches on Cubozoan (Alatina alata) Tentacle Firing and Venom Toxicity, Toxins, January 11, 2016. retreived from mdpi.com PDF

  • Yanagihara A, Wilcox C, Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations, Toxins, 2017 Mar; 9(3): 105. retrieved from: ncbi.nlm.nih.gov

  • Ward N, et al., Evidence-Based Treatment of Jellyfish Stings in North America and Hawaii, Annals of Emergency Medicine, June 08, 2012. retrieved from: annemergmed.com

  • Welfare P, et al., An in-vitro examination of the effect of vinegar on discharged nematocysts of Chironex fleckeri, Diving Hyperb Med, Vol 44 No. 1, 2014. Retrieved from: eubs.org


#EmergencyMedicine


LEARN MORE SCIENCE

FibonacciMD.app

Medical search COMPENDIUM

ANNOTATE your EMR, PDFs, and docs

Online FibonacciCME credits.



#CME #FibonacciCME

DISCLAIMER

IMIT takes pride in its work, and the information published on the IMIT Platform is believed to be accurate and reliable. The IMIT Platform is provided strictly for informational purposes, and IMIT recommends that any medical, diagnostic, or other advice be obtained from a medical professional. Read full disclaimer.