Jellyfish stings



Jellyfish stings


Christopher Sladden, Jamie Seymour and Mike Sladden


Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports


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Jellyfish are members of the phylum Cnidaria, which consists of five classes: Cubozoa (box jellyfish), Hydrozoa (Portuguese man-of-war), Schyphozoa (true jellyfish), Staurozoa (staromedusans), and Anthozoans (corals). They are found in every ocean and some fresh water, from the surface to the depths of the seas. They often consist of a bell shaped body, ranging from 1 millimeter to over 2 meters in diameter, with tentacles up to 30 meters in length. Many have complex life cycles, usually with both a sexual and an asexual stage, often with a sessile polyp stage and a motile medusal stage.


Jellyfish envenomings can occur during recreational and commercial pursuits, both in the water and when encountering living or dead animals on the shore. Jellyfish sting their prey using nematocysts, stinging structures located in specialized cells called cnidocytes. Contact with a jellyfish tentacle can trigger millions of nematocysts to pierce the skin and inject venom. Those providing care to sting victims should avoid being stung by adherent tentacles on the victim; however, the risk of the carer being envenomed is minimal.


The severity of jellyfish stings depends on the species of jellyfish involved, its age and geographic location, the location of the nematocysts involved (bell or tentacle) and factors such as patient age and general health, amount of skin involved, and number of nematocysts triggered. Understanding the complexity of jellyfish venom is still in its infancy.


Most jellyfish stings are self-limiting, causing localized pain and skin lesions. However, symptoms can range from local discomfort, to severe pain, through to cardiovascular collapse and death. Immediate management of jellyfish stings occurs at the beach with first aid and resuscitation, and then if needed in hospital. Immediate cutaneous reactions include wheals, blisters, and angioedema. Dermatologists are most likely to become involved later to manage the delayed sequelae of jellyfish stings.


In this chapter we will discuss the most important type of jellyfish stings, the different symptoms and management of these stings, as well as strategies for prevention of jellyfish stings.



Clinical features


Major box jellyfish (Chironex fleckeri)


Chironex fleckeri are only found in northern Australian waters. However, several other species of chiropdropids (or multi-tentacled box jellyfish) found throughout non-Australian tropical realms are also capable of inflicting life threatening envenomings. Stings can cause large welts, severe pain, and loss of consciousness. Victims can drown before reaching shore. Skin necrosis can occur with severe stings. Severe envenomation is rare but can cause cardiovascular collapse. Many deaths occur within minutes of envenomation, when the antivenom is often unavailable.








Management Strategy


First-line therapies

























































































Prevention of jellyfish stings
image Stinger suits worn next to the skin reduce contact with jellyfish tentacles E
image Stinger nets to provide physical barrier between jellyfish and swimmers (NB: these are only effective on jellyfish which are larger than the net mesh size) E
image Proprietary Safe Sea cream (NB: this treatment may cause the discharge of more nematocysts in some species) A
image Removing bathing suits and showering to reduce/prevent seabather’s eruption E
Immediate management of stings
image Sting victims should be removed from the water E
image Those providing care to sting victims must avoid being stung by the jellyfish E
image Immediately remove any tentacles (the dermis on fingers is usually thick enough to prevent significant envenoming to the first aider) E
image Wash sting site with sea water (not fresh water) E
image Identify type of jellyfish involved E
image Cardiopulmonary resuscitation if needed (usually only necessary for box jellyfish) E
Topical agents to provide analgesia
image Lignocaine C
image Ice C
image Hot water A
Major box jellyfish (Chironex fleckeri) stings
image Apply liberal amounts of vinegar to sting site to inactivate any undischarged nematocysts C
image Cardiac monitoring, supportive care, and cardiopulmonary resuscitation if required D
All but very minor box jellyfish stings require transport to hospital for:
image Oral and parenteral analgesia C
image Administration of intravenous antivenom D
image Administration of intravenous magnesium D
Irukandji jellyfish stings
image Apply liberal amounts of vinegar to sting C
The majority of stings require hospital admission for:
image Oral and parenteral analgesia C
image Cardiac monitoring, supportive care, and cardiopulmonary resuscitation if required D
Bluebottle and Portuguese man-of-war stings
image Application of hot water (45°C) gives rapid and significant relief C

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Aug 7, 2016 | Posted by in Dermatology | Comments Off on Jellyfish stings

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