Irukandji syndrome: a superb review article
May 5, 2012, 12:15 pm
Australian carybdeid jellyfish causing “Irukandji syndrome”. Tibballs J et al. Toxicon 2012 May;59:617-625.
“Irukandji syndrome” can be caused by the sting of a number of jellyfish, predominantly Carukia barnesi. This tiny (20 mm) cnidarian is found in the waters off northern Australia. Its sting initially seems minor, but is followed within 30 minutes to an hour with severe manifestations of catecholamine storm: hypertension, tachycardia, EKG changes, and occasionally cardiomyopathy (Takutsubo).
This superb review article comprehensively presents the current state of knowledge about Irukandji syndrome.
The authors note that the venom of C. barnesi modulates sodium channels, releasing endogenous catecholamines and also possibly causing poration of myocardial cell membranes. After the initial mild local sting symptoms, systemic effects begin with severe muscle pain (especially of the lower back) with abdominal cramps, vomiting, diaphoresis, and hypertension. Troponin may be elevated. Priapism can occur.
Treatment includes parenteral analgesia and other supportive measures. Although unproven, application of vinegar or hot water over the affected area seems to inactivate unfired C. barnesi nematocysts. For hypertension, phentolamine and nitrates have been used. (Sublingual nitroglycerin can be given in the pre-hospital phase.) Intravenous magnesium sulfate may provide pain relief and decrease hypertension and other hyperadrenergic manifestations.
In severe cases, cardiogenic pulmonary edema can manifest 6-18 hours after the original injury. Management includes oxygen, diuretics, vasodilators, inotropes, and CPAP or intubation and ventilation.
This article is essential for anyone with an interest in the topic. For medical personnel in Australia who may have to deal with these injuries, it is a must-read. But as the following video from National Geographic points out, Irukandji syndrome can occur almost anywhere:
Thanks to Chris Nickson of Life in the Fast Lane to drawing my attention to this article. Speaking of LITFL, Mike Cadogan has an excellent review of Irukandji syndrome on that site, with great illustrations.