As regular readers of ‘Life in the Fast Lane’ well know, we really like envenomings… especially marine envenomings… and especially jellyfish…
(Check out our toxicology home page).
If you’re also interested in jellyfish you might want to know that this has just been epublished in the Annals of Emergency Medicine (excuse the flagrant self-advertising):
Irukandji Syndrome Case Series From Australia’s Tropical Northern Territory
Nickson CP, Waugh EB, Jacups SP, and Currie, BJ.Study objective
We describe Irukandji syndrome (a painful hypercatecholaminergic condition caused by jellyfish envenoming) in Australia’s Northern Territory.
Methods
We collected prospectively a standardized data set on patients presenting to health facilities in the Northern Territory. Additional cases were identified retrospectively. Data collected included demographic, geographic, seasonal, and environmental features, as well as sting details, clinical manifestations, investigations, management, and outcomes.
Results
From 1990 to 2007, Irukandji syndrome affected 87 people. Age ranged from 1 to 51 years (64% male victims; 41% children [63% indigenous]). Activities associated with stings included snorkeling or scuba diving (35%) and swimming (29%). Stings commonly occurred in water greater than 2 m deep (63%), with fine weather (73%) and still or light breeze (70%). Seasonal variation was bimodal; peaks in May and October corresponded to prevailing offshore winds in the Darwin and Gove areas, respectively. Pain was severe (65%), with rapid onset (<30 minutes in 79%). Sting lesions (visible in 63%) were mild, and nematocysts (detected in 7 cases) had variable morphology. Systemic features were common, including hypertension and ECG abnormalities. Severe complications included troponin-level increases (2 cases) and cardiomyopathy with ventricular tachycardia (1 case), but no fatalities. Management included vinegar as first aid (66%), parenteral opioids (70%) (range 2 to 82.5 mg morphine equivalents in adults), and magnesium sulfate (3 cases). Hospital admission (49%) and aeromedical retrieval (16%) were commonplace.
Conclusion
Irukandji syndrome in the Northern Territory was clinically consistent with previous studies but had distinct seasonal, geographic, and environmental features. Indigenous children in remote coastal communities are at risk, and there is room for improvement in prevention and management.
The fulltext paper (pdf) can be downloaded here. We overlooked previous reports of priapism – we discuss these and the possible mechanism here, in a letter to the Annals of Emergency Medicine .
Visit these ‘Life in the Fast Lane’ links to learn more about Irukandji syndrome:
About Chris Nickson
