Blue Bottle stings in Australia

Bluebottle (Physalia)

The bluebottle jellyfish is responsible for thousands of stings on Australian beaches each year. Clinical features include intense local pain and dermal erythema. Hot water immersion provides safe symptomatic relief. Unlike Physalia stings in other parts of the world, major systemic envenoming does not occur.
blue-bottle-physalia
Clinical presentation and course
  • Stings are associated with immediate burning pain, typically lasting up to 2 hours, and linear or elliptical erythematous welts
  • Non‑specific systemic symptoms such as nausea, headache or malaise may occur.
 Bluebottle jellyfish sting


Management
  • Stings are mild, self‑limiting and respond to first‑aid measures
  • Reassure the patient
  • Place under a hot shower for 20 minutes (ideal temperature 45ºC). The shower should be hot but not scalding or uncomfortable
  • Administer simple oral analgesia such as paracetamol
  • Do not apply a pressure immobilisation bandage (PIB) or vinegar, as this may worsen local symptoms
  • Transport to hospital is not usually required

Antivenom

  • None available.

Differential diagnosis
  • Pain associated with irukandji syndrome is usually delayed, severe and generalised. Significant linear dermal markings or welts are notseen
  • Envenoming by the box jellyfish (Chironex fleckeri) is associated with immediate pain and obvious dermal markings (large welts). Tentacles may be seen adherent to the skin.
Handy tips
  • Ice packs until recently were the recommended first‑aid treatment for stings. The superiority of hot water has now been conclusively demonstrated.
  • Most patients do not require any care beyond first-aid

Loten C, Stokes B, Worsley D et al. A randomised controlled trial of hot water (45ºC) immersion versus ice packs for pain relief in bluebottle stings. Medical Journal of Australia 2006; 84(7):329–333. [Reference]

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Comments

  1. M Wali says

    Onions is the best cure for blue bottle sting.
    When applied to the skin they immediately heal the pain and the marks.
    I have tested it!

  2. tina says

    i recently got stung by a bluebottle jelly fish at sandgate beach in brisbane and was in so much pain that it traveled up to my grion causing shortness of breath and cardic taccardia and nothing was helping ,was given morpine by ambulance and taken to hsopital nothing was stopping the pain, it was so bad i wanted to cut my foot of. it took 12 hours before i started to get any relieve hot waater drugs ect they even gave me magnesiam through a iv the electric pluses made me shake and felt like i had a sever burn. its 2 days in and i have slight little shocks and the swelling has gone down but still have a pain.The area has red marks were i was stung..

  3. Reiner Schoenbrunn says

    Hi
    Hot showers are not readily available near most NZ beaches, nor can one quickly boil a billy…

    I usually carry some EMLA ointment in my beach pack which makes the area numb. That eases the pain of blue bottle stings within minutes and buys time to get off the beach to a shower or doctor. Got stung yesterday and know this is one way to cope. Cheers Reiner

  4. Edith says

    I was stung on Sunday at Freshwater Beach Sydney. I did not know about the hot water, and lifeguard not very helpful beyond saying to wash off with water, and wait for it to pass. The sting did within an hour or so, and I was able to shower about 1 1/2 later, but did not know about the heat/hot treatment. However now 2 days later, have significant welts especially in backs of knees and L hand (with which I tried to brush off tentacles).
    The redness and extension of the welts seems to be growing and I am feeling systemically off. I know it will pass just surprised by the delayed reaction and hope this will settle over the next day or so. Edith

Comments