QJM Advance Access originally published online on May 10, 2006
QJM 2006 99(6):425-427; doi:10.1093/qjmed/hcl057
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Correspondence |
Jellyfish responsible for Irukandji syndrome
Sir,Irukandji syndrome is a distressing array of symptoms following a jellyfish sting.1 Generally, symptoms develop 20–60 min after the sting, and include back pain, nausea, abdominal cramps, sweating, hypertension, tachycardia and a feeling of impending doom.1–3 The sting usually leaves only mild local signs. In a series of 116 cases presenting to Cairns Base Hospital in one year, 64% required hospital admission and there was one death.2 Patients suffer severe pain, as demonstrated by the adult patients in this series requiring a mean dose equivalent to 42 mg of morphine.2 There have been case reports of patients developing life-threatening cardiac failure requiring intubation and inotropic support.3 In Huynh's series, 22% had evidence of myocardial injury, with an elevated troponin.2 Reports of Irukandji syndrome have come from Australia, Hawaii, Florida, French West Indies, Bon Air, Caribbean, Timor Leste and Papua New Guinea.1 The syndrome may well occur in many other parts of the world, but not be recognized.
Only two jellyfish have previously been definitively shown to cause Irukandji syndrome.1,4 In 1961, Barnes captured two small jellyfish (later named Carukai barnesi in his honour) in Palm Cove, Australia, and demonstrated this to be the casual agent by stinging the local lifeguard, his 9-year-old son and himself. All three developed Irukandji syndrome.1 Despite reports of Irukandji syndrome from many locations only one other, as yet unnamed, jellyfish has been identified as causing Irukandji syndrome.4 Very little is known about the venom or ecology of these jellyfish.
We now report five further cases of identified cubozoan jellyfish that we believe can cause Irukandji syndrome (Table 1), namely Alatina nr mordens, Carybdea alata, Malo maxima, Carybdea xaymacana and an as-yet unnamed ‘fire jelly’.
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Accurate identification of creatures responsible for human envenoming is essential. In Australia, the white-tailed spider, Lampona sp, was incorrectly identified as being responsible for necrosing ulcers. This led to much anxiety, misdiagnosis and incorrect treatment of patients, until a prospectively designed study demonstrated that this spider's bite caused only minimal local symptoms.5 There have been very few data on jellyfish stings that correlated clinical syndromes with accurate identification of the offending jellyfish; published studies have often assumed that if a cubozoan jellyfish is found in a region, it is responsible for the envenoming syndrome,6 but with little data to support such assumptions. If research is to be performed on both the ecology and venom of the animal, it is essential the correct creature is identified.
We know little about the lifecycle of these jellyfish, and currently there is no antivenom. We hope that the recognition that Irukandji syndrome is due to many jellyfish worldwide, will spur further research into identifying the ecology of the jellyfish and the venom components responsible, and hopefully produce an effective treatment.
Sir Charles Gairdner Hospital University of Western Australia Perth Department of Emergency Medicine Cairns Base Hospital Cairns James Cook University Cairns School of Tropical Biology James Cook University Cairns Australia
email: mark.little{at}health.wa.gov.au
References
1. Barnes JH. Cause and effect in Irukandji stingings. Med J Aust 1964; 14:897–904.[Medline]
2. Huynh TT, Seymour J, Pereira P, et al. Severity of Irukandji syndrome and nematocyst identification from skin scrapings. Med J Aust 2003; 178:38–41.[Medline]
3. Little M, Pereira P, Mulcahy R, et al. Severe cardiac failure associated with preseumed jellyfish sting. Irukandji syndrome? Anaesth Intensive Care 2003; 31:642–7.[Medline]
4. Little M and Seymour JS. Another cause of ‘Irukandji stingings’. Med J Aust 2003; 179:654.[Medline]
5. Isbister GK and Gray MR. White-tail spider bite: a prospective study of 130 definite bites by Lampona species. Med J Aust 2003; 179:199–202.[Medline]
6. Gershwin LA. Two new species of jellyfishes (Cnidaria: Cubozoa: Carybdeida.) from tropical Western Australia, presumed to cause Irukandji Syndrome. Zootaxa 2005; 1084:1–30.
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