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Major box jellyfish
The major box jellyfish is the most
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dangerous jellyfish in Australia and | |||
is often referred to as the world ’ s | |||
most venomous animal . In the past | |||
30 years , there have been more than | |||
70 deaths from C . fleckeri stings , and | |||
almost all of these have been children . 3 These jellyfish are distributed in the far north of Australia , and | |||
many stings occur in remote areas | |||
with little access to medical care . 3 | |||
Most stings are minor , but severe | |||
and life-threatening stings occur | |||
with a large area of skin contact with | |||
the tentacles . C . fleckeri have multiple | |||
tentacles attached to each of the | |||
four corners of their box shape . This | |||
makes it possible for several metres of | |||
tentacle contact to occur , resulting in | |||
severe envenoming . Just over 1m of | |||
tentacle contact has resulted in death | |||
in a child . | |||
CLINICAL EFFECTS | |||
Most C . fleckeri stings are similar to |
those from other jellyfish tentacle stings , with intense local pain and linear raised erythematous reactions ( see table 1 ). However , there are often |
Figure 2 . Bluebottle sting around two hours after the sting . |
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multiple sting marks that characteristically |
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appear as red or dark purple whip-like lesions ( see figure 3A ). |
Box 1 . Major clinical syndromes with jellyfish stings |
TREATMENT Patients with severe chironex enven- |
The major issue in less severe envenoming is local pain , and ice |
The severity and duration of the pain is generally much worse than with other jellyfish stings , such as a bluebottle . In addition , local necrosis can occur with C . fleckeri stings , but this rarely causes permanent injury or scarring . In more than half of cases , |
• Linear tentacle-like stings : — Stings result from contact with the tentacles . — This causes immediate local pain , lasting minutes to hours . — Linear erythematous or urticarial eruptions . — Non-specific systemic effects — including nausea , vomiting and malaise — are uncommon . |
oming rarely arrive at hospital before they develop cardiovascular collapse , so pre-hospital resuscitation is key . Early institution of CPR by family or bystanders appears to be associated with survival in most cases . In all patients with severe envenom- |
packs are the recommended initial treatment . In a randomised controlled trial , hot water immersion was shown not to be superior to ice packs in chironex stings but may provide symptomatic relief . 4 In cases of more severe pain , adminis- |
a delayed itchy papular urticarial rash develops in the same linear pattern of the sting marks after these have resolved ( see figure 3B ). Severe envenoming is rare and results in life-threatening effects that are characterised by rapid onset of cardiovascular collapse and death within 20-30 minutes . |
• Irukandji-like stings : — Minimal local pain and erythema . — Delayed ( 20-30 minutes ) severe generalised pain , including abdominal , back , chest and muscular pain . — Usually associated with sympathomimetic effects , such as nausea , vomiting , headache , tachycardia , anxiety , agitation and hypertension . — Myocardial injury and pulmonary oedema may rarely occur as a result of the sympathomimetic effects . |
ing , basic life support should proceed simultaneously with removal of tentacles . Wash the tentacles off with sea water or carefully remove them by hand . Cover sting sites with vinegar after tentacle removal . The aim of the vinegar is to stop further nematocyst discharge and prevent severe envenoming occurring , not to treat the pain . |
ter oral or parenteral opiate analgesia . Skin reactions usually resolve without any treatment ; however , in more severe cases with necrosis , use local dressings — similar to burns dressings .
Systemic envenoming almost never develops in patients after they present to hospital . PAGE 20
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