Jellyfish Stings and Their Management: A Review
Abstract
:1. Introduction
2. Methods
3. Main Stinging Pelagic Cnidaria (Figure 1 Illustrates the Taxonomy of Cnidarians)
3.1. Physalia Species
- (1)
- Physalia physalis (the Portuguese Man O’ War): This worldwide species has a boat-like pneumatophore 2–25 cm long, with multi-tentacles measuring from 10 m up to 30 m [1]; yet, it is not a true jellyfish. This species is responsible for a large number of stings, with some being fatal.
- (2)
3.2. Cubozoans Species
3.2.1. Chironex fleckeri
3.2.2. Chiropsalmus quadrigatus
3.2.3. Chiropsalmus quadrumanus
3.2.4. Carukia barnesi and Other Australian Carybdeids
3.2.5. Carybdea rastoni
3.2.6. Carybdea alata
3.2.7. Morbakka
3.3. Pelagiidae Species
3.3.1. Pelagia noctiluca
3.3.2. Chrysaora quinquecirrha
3.4. Cyaneidae Species
Cyanea capillata
3.5. Pelagic Cnidaria: Distribution, Envenomation and Treatment
Species and Size | Geographic Distribution | Local Symptoms | Systemic Symptoms; (Deadly = D) |
---|---|---|---|
P. physalis Float: 2–30 cm high Tentacles: 10–30 m | worldwide, more common in tropical waters [1,2,7,16] | acute pain, wheals ≥7 cm, skin necrosis after 24 h (++/+++) [1,2,16] | muscular spasms, abdominal pain, arrhythmias, headache, D [1,2,16] |
P. utriculus Float: 2–10 cm high Single tentacle: 2–5 m | Tropical Indo-Pacific ocean, Australia, South-Atlantic [1,2] | local pain, wheals (+/++) [1,2] | very rare or none [1,2] |
C. fleckeri Bell: (20 × 30) cm Tentacles: 2–3 m | Indo-Pacific region and Australia [1,2] | pain, massive wheals, vesicles for 10 days, scarring (+++) [1,2,31] | severe hypotension, cardiac failure/arrest, arrhythmias, pulmonary hypertension, D [1,31] |
C. quadrigatus Bell: (10 × 8) cm Tentacles: 5–30 cm | Australia, Indo-Pacific region [1,2] | pain, wheals, swelling for 24 h (++/+++) | asystole, bradycardia, hypotension, pulmonary hypertension/oedema, D [1,59,75] |
C. quadrumanus Bell: (14 × 10) cm Tentacles: 3–4 m | North West Atlantic, Caribbean and Brazil [6,82] | pain, wheals (for 24 h); scarring and dyschromia for 2 months (++/+++) [2,82] | hypotension, acute cardiac failure, pulmonary hypertension/oedema, D [2,82] |
C. barnesi Bell: (2.5 × 2) cm Tentacles: 5–35 cm | Australia [1,2] | oval erythema 5 × 7 cm with surrounding papules (+/++) [1,2,83] | Irukandji syndrome (back pain, severe hypertension, agitation, muscle cramps, headache, nausea/vomiting, sweating), D [1,2,83] |
Morbakka Bell: (11 × 5) cm Tentacles: 10 cm | Australia [1,2] | 10 mm wide wheals, intense pain, itching, vesicles, skin necrosis (++/+++) [1,2,83] | Irukandji syndrome (muscle spasms, back pain, anxiety, respiratory distress, hypotension, sweating) [1,2,83] |
C. rastoni Bell: (5 × 2) cm Tentacles: 5–30 cm | Australia [1,2] | delayed and moderate pain, wheals (3–12 mm width), swelling, blisters (rare), pigmentary changes for 2 weeks after sting (++) [1] | No [1] |
C. alata Bell: (9 × 5) cm Tentacles: 30–40 cm | tropical and sub-tropical Pacific waters, Hawaii [2,75,87] | pain, wheals, blisters, dyschromia for 2 weeks (++/+++) [2,51,75,87] | mild Irukandji syndrome, possible allergic reactions [52,83,87] |
Tamoya haplonema Bell: (10 × 5) cm Tentacles: 3 cm | Atlantic ocean (tropical/sub-tropical waters) [2,7,75] | burning pain (for about 2 h), wheals, blisters/scarring (++) [2,7,75] | muscle cramps, nausea, vomiting, restless, sweating, headache [2,7,75] |
P. noctiluca Bell: (10 × 3) cm Tentacles: 10 m | worldwide, tropical and cold waters (common in Mediterranean, North Atlantic, North Pacific) [1,2] | instant severe pain, wheals, possible hyperpigmentation (++/+++) [1,2,106] | (rare) allergic reaction and respiratory distress [1,2,105] |
C. quinquecirrha Bell Φ: 6 cm Tentacles: 50 cm | Australia, Atlantic, Pacific, Indian ocean [1,2] | intense pain, wheals/rash for days (+/++) [1,51] | (rare) allergic reaction and respiratory distress, D [1,51] |
C. capillata Bell Φ: ≥1 m Tentacles: 30–50 cm | worldwide; more common in North Sea, North Atlantic, Arctic Sea, North Pacific [1,2,17] | Pain, wheals, erythema may persist for days (++/+++) [1,2,17] | (possible) muscle cramps, sweating, nausea, allergic reaction [1,2,17] |
Chirodropids | Carybdeids | |||||
---|---|---|---|---|---|---|
C. fleckeri | C. quadrumanus | C. alata | C. barnesi | C. rastoni | Morbakka | |
Sea water rinsing | A,B(4) [1,2] | B(4) [51], F(2) [51] | A,B(1,4) [1,2,103,104] | A(4) [1,2] | A(4) [1,2] | |
Hot water/packs | A,B(4) [26], E(4) [70,71], F(4) [70] | A(1,3) [23,52,83,87,103] | A(4) [83] | |||
Tentacle removal | B(4) [1,2] | B(4) [1,2] | B(4) [1,2,87] | B(4) [1,2] | B(4) [1,2] | |
Topical Vinegar | A,B(1,4) [1,51,69] | A,B(4) [7], C(4) [51] | C(4) [87], F(4) [103] | B(4) [2] | B(4) [99] | B(4) [105] |
Ice packs | A(1) [64] | D(2) [51] | C(4) [87], F(4) [103] | |||
Fresh water | C(4) [11,12] | F(2) [51] | A(1) [104], C(4) [12] | |||
BaCl2 | ||||||
MgCl2 | ||||||
NaOH | B(4) [105] | |||||
NaCl | ||||||
NaClO | ||||||
Choline-Cl | ||||||
MgCl2 solution | ||||||
Urea | C(4) [53] | C(4) [51] | ||||
Stingose § | A,B(1,4) [69] | A(1) [104], F(4) [103] | B(4) [99] | B(4) [105] | ||
Acetone | ||||||
Bromelain 10% | C(4) [51], F(2) [51] | |||||
Papain | A(1) [104] | |||||
Baking soda slurry † | B(4) [99] | B(4) [105] | ||||
Methylated spirits | C(4) [53] | C(4) [99] | C(4) [105] | |||
Ammonia | C(4) [51], D(2) [51] | |||||
Ethanol | A,E(4) [11], C(4) [53] | C(4) [51], D(2) [51] | C(4) [99] | |||
Topic lidocaine | A(2) [51], B(4) [51] | |||||
Opiates i.v. | A(4) [1,31] | A(4) [1,31] | A(4) [83] | |||
MgSO4 ♥ i.v. | E(4) [74] | A,E(4) [100] | ||||
Reserpine i.v. | ||||||
Phentolamine i.v. | E(4) [83] | |||||
Glyceryl trinitrate ♣ | E(4) [88] | |||||
Antihistamine i.v. | ||||||
Anti-venom | A,E(1) [59,78] | E(4) [59,78] * | F(4) [59] | F(4) [59] | F(4) [59] | F(4) [59] |
PIB | C(4) [114], E(4) [115] | C(4) [81] *, E(4) [114] |
Physalia | Scyphozoans | |||
---|---|---|---|---|
P. physalis | C. quinquecirrha | P. noctiluca | C. capillata | |
Sea water rinsing | A(1) [1,2], B(4) [51] | B(4) [46,48], F(2) [51] | A(4) [109,110] | A(4) [109] |
Hot water/packs | A(1,4) [43-45], F(4) [55] | F(4) [55] | ||
Tentacle removal | B(4) [1,2] | B(4) [1,2,106] | B(4) [1,2,110] | B(4) [110] |
Topical Vinegar | A(1,4) [46,47], B(4) [46,48,55], C(4) [7,49] | C(4) [46], D(4,2) [51] | C(4) [109] | C(4) [106] |
Ice packs | A(1,4) [43-45] | F(4) [46,48] | A(4) [45] | |
Fresh water | B(4) [49] | F(2) [51] | ||
BaCl2 | B(4) [110] | B(4) [110] | ||
MgCl2 | B(4) [110] | B(4) [110] | ||
NaOH | C(4) [46] | |||
NaCl | C(4) [110] | |||
NaClO | C(4) [46] | C(4) [46] | ||
Choline-Cl | C(4) [110] | |||
MgCl2 solution | B(4) [110] | C(4) [46] | ||
Urea | F(4) [51] | |||
Stingose § | A(1) [47], B(4) [46] | B(4) [46] | ||
Acetone | C(4) [46] | C(4) [46] | ||
Bromelain 10% | A(1) [47], C(4) [51] | C(4) [46], F(2) [51] | ||
Papain | A(1,4) [54], F(4) [55] | A(4) [46], B(4) [46] | ||
Baking soda slurry † | B(1) [47],C(4) [46] | B(4) [46,109] | B(4) [46] | A(4) [42,110] |
Methylated spirits | C(4) [49], D(1) [47] | B(4) [109] | A,B(4) [109] | |
Ammonia | C(4) [46,51] | C(4) [51], D(4,2) [51] | ||
Ethanol | C(4) [51] | C(4) [51], D(2) [51] | C(4) [109] | |
Topic lidocaine | A,B(4) [51] | A(4,2) [51], B(4) [51] | ||
Opiates i.v. | A(4) [31] | |||
MgSO4 ♥ i.v. | ||||
Reserpine i.v. | E(4) [56] | |||
Phentolamine i.v. | ||||
Glyceryl trinitrate ♣ | ||||
Antihistamine i.v. | E(4) [57] | E(4) [108] | E(4) [108] | E(4) [108] |
Anti-venom | F(4) [78] | F(4) [78] | ||
PIB |
4. Discussion
- Alleviating the local effects of venom (pain and tissue damage);
- Preventing further discharge of nematocysts;
- Controlling systemic reactions, including shock.
5. Conclusions
Conflict of Interest
References
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Cegolon, L.; Heymann, W.C.; Lange, J.H.; Mastrangelo, G. Jellyfish Stings and Their Management: A Review. Mar. Drugs 2013, 11, 523-550. https://doi.org/10.3390/md11020523
Cegolon L, Heymann WC, Lange JH, Mastrangelo G. Jellyfish Stings and Their Management: A Review. Marine Drugs. 2013; 11(2):523-550. https://doi.org/10.3390/md11020523
Chicago/Turabian StyleCegolon, Luca, William C. Heymann, John H. Lange, and Giuseppe Mastrangelo. 2013. "Jellyfish Stings and Their Management: A Review" Marine Drugs 11, no. 2: 523-550. https://doi.org/10.3390/md11020523