QJM Advance Access originally published online on October 12, 2006
QJM 2006 99(11):802-803; doi:10.1093/qjmed/hcl104
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Correspondence |
Jellyfish responsible for Irukandji syndrome
Sir,A recent letter from Little et al.1 makes several doubtful claims to be the first to describe the Irukandji syndrome in several species of cubozoans that have been described previously.
The ‘fire jelly’ they mention is more commonly known as the ‘Morbakka’ in Australia.2 I first described Irukandji-syndrome-type symptoms from this jellyfish in 1985,3 although these were far less intense than the classic Irukandji syndrome typically associated with Carukia barnesi. These symptoms occurred in approximately 10% of stings, as well as the sting itself causing quite intense skin burning and a fiery rash (hence ‘fire jelly’).
The usual or classical symptoms of Irukandji (Carukia barnesi) envenomation cause severe low back pain, progressing to cramping in the arms and legs, nausea, vomiting, headache, anxiety, restlessness and ‘a feeling of impending doom’. They are brutal, but not life-threatening.4 In contrast, ‘Irukandji-like syndrome’ has since been used to refer to those stings that are less severe than those typically associated with the classic Irukandji syndrome.
I first used the term 'Irukandji-like syndrome' to describe these milder systemic symptoms in Williamson et al.,5 describing it as occurring in Morbakka, as well as several various species of jellyfish world-wide. Other Irukandji-like syndrome cases were then described by Cheng et al. in 1999,6 and Yoshimoto and Yanagihara in 20027 after envenomation by the Hawaiian box jellyfish, known as at that time as Carybdea alata, although recently renamed Alatina moseri.8 At the time Gershwin reported that the Irukandji, or Irukandji-like syndrome had been caused by Alatina moseri,8 and later that it had been caused by Alatina mordens and Malo maxima,9 now claimed again by the present authors.
However, it is interesting that the authors link Morbakka with a more severe case of Irukandji syndrome. I would be interested to know the evidence that this species was responsible (e.g. what did the recovered nematocysts look like?). As Irukandji stings can go unnoticed until the onset of symptoms some 30 min or so later, the specimen captured may not necessarily be the one that caused this more severe syndrome. This single event is discordant with numerous previous cases from the Queensland and New South Wales coastline,5 and other records collected and held by the author (1984–2002).
If life-threatening Irukandji syndrome is indeed caused by Morbakka, this would have serious implications for beaches throughout Queensland and New South Wales, where Morbakka may be relatively common, and is traditionally described and accepted as mild. Severe Irukandji syndrome may include severe local skin pain with rapid development of even more the usual severe systemic symptoms, and often cause life-threatening hypertension10 and occasionally, acute and critical heart failure.11 Severe hypertension caused the demise of two patients in 2002 after intra-cranial haemorrhage.12
James Cook University
School of Public Health
Tropical Medicine and Rehabilitation Sciences
Queensland
Australia
email: pjf{at}occupationalhealthmackay.com.au
References
1. Little M, Pereira P, Carrette T, Seymour J. Jellyfish responsible for Irukandji syndrome. Q J Med 2006; 99:425–7.
2. Southcott RV. The ‘Morbakka’. Med J Aust 1985; 143:324.[ISI][Medline]
3. Fenner PJ, Fitzpatrick PF, Hartwick RJ, Skinner R. ‘Morbakka’, another cubomedusan. Med J Aust 1985; 143:536–5.[ISI][Medline]
4. Barnes JH. Cause and effect in Irukandji stingings. Med J Aust 1964; 1:897–904.
5. Williamson J, Fenner P, Burnett J, Rifkin J. Venomous and Poisonous Marine Animals: a Medical and Biological Handbook1996;NSW University Press Sydney.
6. Cheng AC, Winkel KD, Hawdon GM, McDonald M. Irukandji-like syndrome in Victoria. Aust NZ J Med 1999; 29:835.[ISI][Medline]
7. Yoshimoto CM and Yanagihara AA. Cnidarian (coelenterate) envenomations in Hawai’i improve following heat application. Trans R Soc Trop Med Hyg 2002; 96:300–3.[CrossRef][ISI][Medline]
8. Gershwin L. Carybdea alata auct. and Manokia stiasnyi, reclassification to a new family with description of a new genus and two new species. Memoirs Queensland Museum 2005; 51:501–23.
9. Gershwin L. Two new species of jellyfishes (Cnidaria: Cubozoa: Carybdeida) from tropical Western Australia, presumed to cause Irukandji Syndrome. Zootaxa 2005; 1084:1–30.
10. Fenner PJ, Williamson J, Callanan VI, Audley I. Further understanding of, and a new treatment for, ‘Irukandji’ (Carukia barnesi) stings. Med J Aust 1986; 145:572–4.
11. Fenner PJ, Williamson JA, Burnett JW, Colquhoun DM, Godfrey S, Gunawardane K, Murtha W. The ‘Irukandji syndrome’ and acute pulmonary oedema. Med J Aust 1988; 149:150–6.[ISI][Medline]
12. Fenner PJ and Hadok JC. Fatal envenomation by jellyfish causing Irukandji syndrome. Med J Aust 2002; 177:362–3.[ISI][Medline]
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