Studies

Carybdea rastoni
Japan
Ohtaki et al. 1990: 25 C. rastoni stings. Exposure of experimental subjects to C. rastoni tentacles.

Cyanea capillata
USA (Virginia, Chesapeake Bay)
Rice and Powell 1972: 35 C. capillata stings. Exposure of experimental subjects to C. capillata tentacles.

Gonionemus oshoro
Japan
Otsuru et al. 1974: 5 G. oshoro stings. Exposure of experimental subjects; additionally countless observations of stings in bathers and people gathering seagrass.

Pelagia noctiluca
Former Yugoslavia (Adriatic)
Maretic et al. 1980: description of an epidemic in the Adriatic with 250,000 jellyfish stings (estimated).

Stomolophus sp. (e.g. Stomolophus nomurai)
China
Mingliang and Shide 1990: 3,000 Stomolophus sp. stings. Identification: criteria not given.

Aurelia aurita, Chrysaora hysoscella, Rhizostoma pulmo
Italy (Adriatic)
Kokelj et al. 1990: 25 stings with each of three purified nematocyst preparations (Aurelia aurita, Chrysaora hysoscella, Rhizostoma pulmo). Exposure of experimental subjects.

Case reports

Aurelia sp.
Israel (Mediterranean)
Benmeir et al. 1990: 1 sting. Identification: attributed to A. aurita.
Burnett et al. 1988b: 1 sting. Identification: attributed to A. aurita; ELISA: Aurelia sp.

Carybdea marsupialis
Italy (Adriatic)
Kokelj et al. 1992: 1 C. marsupialis sting. Identification: self-stinging experiment.

Chrysaora sp.
Burnett et al. 1987b: 3 Chrysaora sp. stings. Identification: immunological.

Chrysaora quinquecirrha
USA (Virginia, Chesapeake Bay)
Glasser et al. 1992: corneal sting.

Cyanea annaskala
Australia
Mitchell 1962: 4 C. annaskala eye stings. Identification: mass occurrence of these jellyfish in a bay during the swimming season.

Cyanea capillata
Australia
Fenner and Fitzpatrick 1986: self-stinging experiments.

Linuche unguiculata (larvae)
USA (Florida)
Tomchik et al. 1993: observations that link "seabather's eruption" or "sea lice" to contact with the larvae of L. unguiculata.

"Morbakka" (Morbakka fenneri?, Tamoya virulenta?)
Australia
Fenner et al. 1985: 1 sting. Identification: morphological.

Pelagia noctiluca
Italy (Adriatic)
Kokelj and Burnett 1990: 1 sting. Identification: attributed to P. noctiluca.

Stomolophus meleagris
USA (North Carolina)
Burnett and Calton 1985: 1 S. meleagris sting. Identification: recognition from photographs; ELISA.

Signs & symptoms

Autopharmacological effects

In principle all jellyfish stings can cause systemic allergic reactions, including anaphylactic shock after sensitisation by previous stings (Togias et al. 1985). Sensitisation does not necessarily have to have occurred with the same species that causes the anaphylactic reaction.

Gonionemus oshoro

Nausea, vomiting, rhinitis, cough, hyperlacrimation, anaphylactic shock causing death (Otsuru et al. 1974).

 

Linuche unguiculata (larvae)

Instantaneous pain and urticarial skin symptoms after the sting are positively correlated with prior exposure (sensitisation?). Nausea, vomiting, headache, fever (particularly in children) (Tomchik et al. 1993).

 

Pelagia noctiluca
Persistent pruritus (>1 week); nausea, vomiting, syncope (Maretic et al. 1980).

Local effects

Aurelia sp.

Burning pain commencing immediately and lasting for 2 days, swelling in the region of the sting for 2 weeks (Benmeir et al. 1990). Immediate local pain, piloerection, urticaria, ulceration (Burnett et al. 1988b). Pruritus after 20 min 2/25, erythema after 48 h 4/25 (Kokelj et al. 1990).

Carybdea marsupialis
Burning pain, erythema (Kokelj et al. 1992).

Carybdea rastoni

Severe pain starting within 1 min after the sting and lasting for 10 min–8 h 25/25. Erythema with a pale centre; onset within 3–4 min after the sting, increasing over a period of 15–20 min 25/25. Disappearance of the erythema within 24 h–3 days 23/25 (Ohtaki et al. 1990) (see also "Morbidity").

 

Chrysaora hysoscella

Pruritus within 20 min 0/25, erythema after 48 h 2/25 (Kokelj et al. 1990).

 

Chrysaora sp.

Local burning pain, local erythema (Burnett et al. 1987b).

 

Chrysaora quinquecirrha

Corneal sting: severe, persistent iritis and increased intra-ocular pressure (5/5), the patients first consulted a doctor after >24 h because the symptoms occurred with some delay (normally symptoms caused by this sort of sting are self-limiting within 24–48 h) (Glasser et al. 1992).

Cyanea annaskala

Eye sting with immediate pain, photophobia, blepharospasm, conjunctival and ciliary injection and superficial to deep corneal lesions (4/4); duration of signs and symptoms 2–7 days (Mitchell 1962).

Cyanea capillata

Very mildly painful, marked erythema (Fenner and Fitzpatrick 1986). No local reaction 20/35, mild local tingling 15/35, mild erythema (a few cases from the 35) (Rice and Powell 1972).

Gonionemus oshoro
Immediate local pain, local erythema (Otsuru et al. 1974).

Linuche unguiculata (larvae)

Pain and urticarial skin symptoms and in children in particular nausea, vomiting, headache, fever 4–24 h after exposure (Tomchik et al. 1993).

"Morbakka" (Morbakka fenneri?, Tamoya virulenta?)

Local, burning pain, duration approx. 24 hours, local erythema with a pale centre, later papulovesicular skin lesions (Fenner et al. 1985).

 

Pelagia noctiluca

Immediate and sometimes sharp pain, followed by severe pruritus. Papulae with surrounding erythema. Lesions may be arranged linearly. Blistering (Maretic et al. 1980).

 

Rhizostoma pulmo

Pruritus within 20 min 4/25, erythema after 48 h 12/25 (Kokelj et al. 1990).

 

Stomolophus meleagris

Immediate burning pain, linear erythema (Burnett and Calton 1985) (see also  "Morbidity").

 

Tamoya sp.

Severe local pain, welt-like skin lesions, erythema (Williamson 1985).

Other signs & symptoms

Gonionemus oshoro

Muscular pain (Otsuru et al. 1974) (symptoms similar to those of the "Irukandji syndrome", compare Carukia barnesi).

"Morbakka" (Morbakka fenneri?, Tamoya virulenta?)

Back pain, onset approx. 30 min after the sting, duration approx. 24 h (Fenner et al. 1985) (symptoms similar to those of the "Irukandji syndrome", Fenner 1991, compare Carukia barnesi).

 

Stomolophus sp. (e.g. Stomolophus nomurai)

"Irukandji-like" syndrome with rapidly progressive pulmonary oedema (Mingliang and Shide 1990) (compare Carukia barnesi).

 

Tamoya sp.

Muscular pain (Williamson 1985) (symptoms similar to those of the "Irukandji syndrome", Fenner 1991, compare Carukia barnesi).

Morbidity

Carybdea rastoni

7–13 days after the sting linear erythema and papulovesicular skin lesions with pruritus 15/25, duration approx. 1 week, leaves mild pigmentation, histological picture that of allergic contact dermatitis (Ohtaki et al. 1990).

 

Chrysaora sp.

Recurrent skin symptoms (Burnett et al. 1987b).

 

Chrysaora quinquecirrha

Chronic unilateral glaucoma following eye sting 1/5, see above (Glasser et al. 1992).

 

Linuche unguiculata (larvae)

Recurrence of skin symptoms after 5–10 days (Tomchik et al. 1993).

 

Pelagia noctiluca
Hyperpigmentation (Kokelj and Burnett 1990, Maretic et al. 1980). Recurrent skin symptoms (Mansson et al. 1985).

Stomolophus meleagris
Recurrent skin lesion after 7 days (Burnett and Calton 1985).

Case fatality rate

Gonionemus oshoro

Fatalities have been reported and attributed to severe anaphylactic reactions after repeat exposure (Otsuru et al. 1974).

 

Stomolophus sp. (e.g. Stomolophus nomurai)
5/3,000 (Mingliang and Shide 1990).

Laboratory and physical investigations

ELISA

Within a few days after the sting, specific IgG antibodies are formed that persist for many months. The species of jellyfish that caused the sting can be identified retrospectively using antibody detection with an ELISA test. However, there are problems with specificity (Burnett et al. 1988a).

First aid

Inactivation of nematocysts remaining on the skin.

Treatment (symptomatic)

1. Pain

Cold packs (Exton et al. 1989).

Hot water (no hotter than the patient can comfortably tolerate; max. 45°C) immersion of the stung skin area for 20 minutes . If local pain is unrelieved by heat, or if hot water is not available, apply a cold pack or ice in a dry plastic bag (recommended for Non-tropical Australia).

For Australia see Australian Resuscitation Council website: Guideline 9.4.5 Envenomation - Jellyfish Stings

2. Hyperpigmentation
Pelagia noctiluca

Topical hydroquinone (1.8%) treatment: disappearance of the hyperpigmentation within 40 days (Kokelj and Burnett 1990).

 

3. Eye sting
Chrysaora quinquecirrha

Iritis: topical steroids; increased intra-ocular pressure: topical beta-blockers, carbonic anhydrase inhibitors p.o. (Glasser et al. 1992).

 

4. Systemic effects of the venom

"Irukandji-like" syndrome (see Carukia barnesi).

Treatment (specific)

Antivenom: not available.