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Optimization and preliminary characterization of venom isolated from 3 medically important jellyfish: the box (Chironex fleckeri), Irukandji (Carukia barnesi), and blubber (Catostylus mosaicus) jellyfish.

OBJECTIVE: To optimize venom extraction and to undertake preliminary biochemical studies of venom from the box jellyfish (Chironex fleckeri), the Irukandji jellyfish (Carukia barnesi), and the blubber jellyfish (Catostylus mosaicus). METHODS: Lyophilized crude venoms from box jellyfish tentacles and whole Irukandji jellyfish were prepared in water by homogenization, sonication, and rapid freeze thawing. A second technique, consisting of grinding samples with a glass mortar and pestle and using phosphate-buffered saline, was used to prepare crude venom from isolated nematocysts of the box jellyfish, the bells of Irukandji jellyfish, and the oral lobes of blubber jellyfish. Venoms were compared by use of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and Western blot test. Toxicity of some venoms was determined by intravenous median lethal dose assay in mice. RESULTS: Different venom extraction techniques produced significantly different crude venoms for both box and Irukandji jellyfish. Irukandji and blubber venom SDS-PAGE protein profiles were established for the first time. Analysis of Western blot tests revealed that box jellyfish antivenin reacted specifically with the venom of each jellyfish. Toxicity was found in Irukandji jellyfish venom derived by use of the mortar-and-pestle method, but not in the lyophilized venom. CONCLUSIONS: Glass mortar-and-pestle grinding and use of an appropriate buffer was found to be a simple and suitable method for the preparation of venom from each jellyfish species studied. This study contributes to biochemical investigations of jellyfish venoms, particularly the venom of the Irukandji jellyfish, for which there are, to our knowledge, no published studies. It also highlights the importance of optimizing venom extraction as the first step toward understanding the complex biological effects of jellyfish venoms.

Animals↗

Efficacy of a jellyfish sting inhibitor in preventing jellyfish stings in normal volunteers.

OBJECTIVE: To evaluate the protective effects of a jellyfish sting inhibitor formulated in sunscreen lotion vs conventional sunscreen against Chrysaora fuscescens and Chiropsalmus quadrumanus jellyfish. METHODS: Twenty-four healthy subjects at 2 research sites were randomly assigned to receive the jellyfish sting inhibitor (Nidaria Technology Ltd, Jordan Valley, Israel) to one forearm and conventional sunscreen to the other arm in a blinded fashion. Subjects were stung with jellyfish tentacles on each forearm for up to 60 seconds. Erythema and pain were assessed at 15-minute intervals over a 2-hour period. RESULTS: In the C. fuscescens group, all 12 arms pretreated with conventional sunscreen demonstrated erythema, and all subjects noted subjective discomfort. In contrast, no arm pretreated with the jellyfish sting inhibitor had objective skin changes (P < .01). Two subjects noted minimal discomfort in the arm treated with the sting inhibitor (P < .01). In the C. quadrumanus group, discomfort was reported in 3 of the 12 inhibitor-treated arms compared with 10 of the 12 placebo-treated arms (P < .05). Erythema was noted on 1 arm treated with the inhibitor and 9 arms treated with the placebo (P < .01). CONCLUSIONS: The jellyfish sting inhibitor prevented sting symptoms of C. fuscescens jellyfish in 10 of 12 subjects and diminished the pain of the jellyfish sting in the remaining 2 subjects. The jellyfish sting inhibitor also inhibited the more severe sting of the C. quadrumanus jellyfish in the majority of subjects. The jellyfish sting inhibitor does not eliminate the sting from C. fuscescens or C. quadrumanus jellyfish but significantly reduces the frequency and severity of stings.

Administration, Cutaneous↗

Prospective study of jellyfish stings from tropical Australia, including the major box jellyfish Chironex fleckeri.

OBJECTIVE: To determine the immediate and delayed effects of jellyfish stings, and correlate these with microscopic identification of jellyfish nematocysts. DESIGN: Prospective study of patients presenting with jellyfish stings. PARTICIPANTS AND SETTING: 40 people presenting with jellyfish stings to the emergency department of a teaching hospital in tropical Australia between 1 August 1999 and 31 July 2000. MAIN OUTCOME MEASURES: Clinical diagnosis (sting by Chironex fleckeri, "Darwin carybdeid" or other jellyfish, or "Irukandji" syndrome); clinical severity; delayed hypersensitivity; and sticky-tape sampling and microscopic identification of nematocysts. RESULTS: Patients were aged 2-50 years, with eight aged under 15 years; 23 were male. Presentations were consistent with C. fleckeri sting in 28 cases, Darwin carybdeid sting in five, and Irukandji syndrome in four. Sticky-tape sampling was done in 39 patients and was positive for C. fleckeri nematocysts in 23 and for non-C. fleckeri nematocysts in six, with nematocysts not detected in 10 (including all four with Irukandji syndrome). All microscopically confirmed C. fleckeri stings had typical clinical presentations. None of the stings were life-threatening, and no antivenom was given. Delayed hypersensitivity reactions were seen in 11 of the 19 patients (58%) followed up after stings positive for C. fleckeri nematocysts. CONCLUSIONS: Although most jellyfish stings presenting to Royal Darwin Hospital I were caused by C. fleckeri, severe envenomation was rare. There was a strong association between clinical features and sticky-tape identification of nematocysts. Delayed hypersensitivity was common after C. fleckeri stings.

Adolescent↗

A randomized, controlled field trial for the prevention of jellyfish stings with a topical sting inhibitor.

BACKGROUND: Jellyfish stings are a common occurrence among ocean goers worldwide with an estimated 150 million envenomations annually. Fatalities and hospitalizations occur annually, particularly in the Indo-Pacific regions. A new topical jellyfish sting inhibitor based on the mucous coating of the clown fish prevents 85% of jellyfish stings in laboratory settings. The field effectiveness is unknown. The objective is to evaluate the field efficacy of the jellyfish sting inhibitor, Safe Sea. METHODS: A double-blind, randomized, placebo-controlled trial occurred at the Dry Tortugas National Park, FL, USA and Sapodilla Cayes, Belize. Participants were healthy volunteers planning to snorkel for 30 to 45 minutes. Ten minutes prior to swimming, each participant was directly observed applying a blinded sample of Safe Sea (Nidaria Technology Ltd, Jordan Valley, Israel) to one side of their body and a blinded sample of Coppertone (Schering-Plough, Kenilworth, NJ, USA) to the contralateral side as placebo control. Masked 26 g samples of both Safe Sea SPF15 and Coppertone SPF15 were provided in identical containers to achieve 2 mg/cm(2) coverage. Sides were randomly chosen by participants. The incidence of jellyfish stings was the main outcome measure. This was assessed by participant interview and examination as subjects exited the water. RESULTS: A total of 82 observed water exposures occurred. Thirteen jellyfish stings occurred during the study period for a 16% incidence. Eleven jellyfish stings occurred with placebo, two with the sting inhibitor, resulting in a relative risk reduction of 82% (95% confidence interval: 21%-96%; p= 0.02). No seabather's eruption or side effects occurred. CONCLUSIONS: Safe Sea is a topical barrier cream effective at preventing >80% jellyfish stings under real-world conditions.

Administration, Cutaneous↗

A case of jellyfish sting.

Jellyfish sting may result in a wide range of symptoms from common erythematous urticarial eruptions to the rare box-jelly induced acute respiratory failure. In Taiwan, with the increasing frequency of international travel, cases of jellyfish sting to foreigners are on the rise. We report a case of jellyfish sting with the rare presentation of painless contact dermatitis. A 38-y-o man accidentally stepped on a sea urchin with his right foot during scuba diving in a beach in Thailand. Traditional therapy with vinegar was applied on the lesion. However, when he returned to Taiwan, erythematous patches on the left thigh with linear radiations to the leg were discovered. The skin lesions had bizzare shapes and showed progressive change. No pain or numbness was noticed. Jellyfish stingwas suspected, topical medications were applied, and the patient recovered without complication. Jellyfish stings usually result in a painful erythematous eruption. In this case, though the lesion involved a large surface, there was no pain. Delayed diagnosis of jellyfish sting was due to the atypical presentation and the physician's unfamiliarity to the Thai jellyfish sting. Awareness to the wide spectrum of jellyfish sting symptoms should be promoted.

Adult↗

Is there a role for the use of pressure immobilization bandages in the treatment of jellyfish envenomation in Australia?

BACKGROUND: The aim of this paper was to review the literature relating to the use of pressure immobilization bandages in the first aid management of jellyfish sting in Australia and to attempt to make a recommendation about their use based on the current literature. METHODS: A descriptive review of all published cases of jellyfish envenomation in Australia was performed, with specific focus on the discussion of pressure immobilization bandages in the management of such cases. A Medline search was performed using the key words listed for this article. Selected articles were reviewed and further publications were identified from the published reference lists given in the selected articles. RESULTS: The published articles were grouped into three groups: in vitro evidence, case reports and editorial comment (either in journals or book). Fifteen references were identified that discussed the use of pressure immobilization bandages in the management of jellyfish envenomation. Other articles were identified that had significant management issues discussion. CONCLUSION: Most of the 'jellyfish' literature is in relation to envenomation by Chironex fleckeri. This jellyfish is usually found in tropical Australia and has resulted in the deaths of 67 people in Australia. The last death was near Cairns in 2000. Unfortunately, there are few good data on marine envenomations, with most of the literature being Chironex envenomation case reports. There are minimal data on the effect of pressure immobilization bandages on other jellyfish envenomations. There is no good evidence to support the use of pressure immobilization bandages in the management of jellyfish sting in Australia [corrected].

Animals↗

Studies on the serologic response to jellyfish envenomation.

The case histories of three patients with unusual reactions to jellyfish envenomations or increased amounts of anti-jellyfish serum antibodies are presented. These cases demonstrated the following facts: (1) Allergic reactions may play a significant pathophysiologic role in jellyfish envenomation of humans. (2) Elevated specific anti-jellyfish immunoglobulins may persist for several years. (3) Recurrence of the clinical cutaneous reaction to jellyfish stings may occur within a few weeks without additional contact with the tentacles. (4) It is apparent that serologic cross-reactivity between the sea nettle and the man-of-war occur, as do false-positive enzyme-linked immunosorbent assay (ELISA) serologic tests to either jellyfish venom.

Adult↗

Immunostimulation effect of jellyfish collagen.

Certain edible large jellyfishes belonging to the order Rhizostomeae are consumed in large quantities in China and Japan. The exumbrella part of the edible jellyfish Stomolophus nomurai was cut and soaked in dilute hydrochloric acid solution (pH 3.0) for 12 h, and heated at 121 degrees C for 20 min. The immunostimulation effects of the jellyfish extract were examined. The jellyfish extract enhanced IgM production of human hybridoma HB4C5 cells 34-fold. IgM and IgG production of human peripheral blood lymphocytes (PBL) were also accelerated, 2.8- and 1.4-fold respectively. Moreover, production of interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha by human PBL was stimulated 100- and 17-fold respectively. Collagenase treatment inactivated the immunostimulation activity of the jellyfish extract. In addition, purified collagen from bovine Achilles' tendon accelerated IgM production of hybridoma cells. These facts mean that collagen has an immunostimulation effect, and that the active substance in jellyfish extract is collagen.

Adjuvants, Immunologic↗

Eye injury after jellyfish sting in temperate Australia.

Although jellyfish stings are an uncommon medical problem in temperate Australia, significant morbidity can occur, particularly in association with infestations of large numbers of jellyfish in public swimming areas. We report a case of a jellyfish sting-related eye injury, probably caused by the "hair" jellyfish (Cyanea capillata) from southeast Australia. The patient, a 54-year-old man, was stung while swimming without goggles in a jellyfish-infested bay. He experienced severe pain in his right eye, requiring narcotic analgesia, and had decreased visual acuity associated with right-sided facial swelling. Although usually brief and self-limiting, eye injuries after jellyfish stings should be assessed and treated as early as possible to reduce the risk of longer term sequelae. Water safety campaigns should incorporate information on the prevention and early treatment of such stings.

Animals↗

Serological diagnosis of jellyfish envenomations.

1. A good correlation between the clinical and serological identification of envenomating jellyfish could be made on 30 healthy individuals and 74 patients stung by known species. 2. Six patients and one previous case were known to be false positive reactors. 3. Two of these individuals had dermatitis, one was asthmatic, three had previous significant hymenoptera envenomations and one was apparently normal. 4. Specific anti-jellyfish IgG serum concentrations would appear a few days after envenomation and persist for many months, even at high concentrations. 5. Significant numbers of patients exhibited cross reacting antibodies to other jellyfish, but no consistent pattern could be detected. 6. Significant titers were defined as those whose sera was positive after being be diluted 50-fold or greater. 7. Species specific IgM concentrations were regarded as significant only if their sera could be adsorbed against the homologous jellyfish antigen and the difference between adsorbed and non-adsorbed sera which were still positive was 50-fold. 8. Elevated persistent specific anti-jellyfish serum IgG concentrations which were still reactive if diluted 3000-fold were not protective against the cutaneous pain resulting from a natural sting.

Animals↗

Occurrence of organo-arsenicals in jellyfishes and their mucus.

Water-soluble arsenic compound fractions were extracted from seven species of jellyfishes and subjected to analysis by high-performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICP-MS) for arsenicals. A low content of arsenic was found to be the characteristic of jellyfish. Arsenobetaine (AB) was the major arsenic compound without exception in the tissues of the jellyfish species and mucus-blobs collected from some of them. Although the arsenic content in Beroe cucumis, which preys on Bolinopsis mikado, was more than 13 times that in B. mikado, the chromatograms of these two species were similar in the distribution pattern of arsenicals. The nine species of jellyfishes including two species treated in the previous paper can be classified into arsenocholine (AC)-rich and AC-poor species. Jellyfishes belonging to Semaostamae were classified as AC-rich species.

Animals↗

[Case report of jellyfish injury].

We are presenting a 47-year-old woman who was stung by jellyfish while bathing in the sea of Thailand. Immediately after the injury she developed sharp pain and urticarial erythema of the skin of the knees accompanied by muscle cramps of the entire body. After a few days a toxic contact dermatitis with edematous swelling and ulcerations developed, which did not respond to topical antibiotics or corticosteroids. Three weeks later the patient presented with a disseminated urticarial eruption, which at first responded well to topical treatment and systemic corticosteroids. Over the next few weeks, however, a relapse of the eruption and the ulcerations occurred. Raised titres of IgG and IgM antibodies against different jellyfish from the Indian and Pacific Ocean were detected in the patient's serum by the enzyme-linked immunosorbent assay. Antibodies against bees (class 1) and wasps (class 4) were found by the radioallergosorbent test. The clinical features and the immunological findings led to the diagnosis of toxic and allergic contact dermatitis to jellyfish venom. First aid and secondary treatment of jellyfish injuries are suggested.

Adrenal Cortex Hormones↗

Neutralization of toxic effects of different crude jellyfish venoms by an extract of Ipomoea pes-caprae (L.) R. Br.

An extract (IPA) of the plant Ipomoea pes-caprae (L.) R. Br., previously shown to be clinically effective toward dermatitis caused by venomous jellyfishes, was studied as to its ability to neutralize toxic activities of jellyfish venoms. Different venoms exhibited different degrees of activity. When IPA was incubated with active venoms, it inhibited the actions of all jellyfish venoms tested, with IC50 values in the range of 0.3-0.8 mgIPA/mg venom for proteolytic action, and with about 10 times lower IC50 values for the neutralization of haemolytic action. These activities of IPA support the previously reported effectiveness in the treatment of dermatitis caused by jellyfish sting.

Animals↗

Severe dyspnea due to jellyfish envenomation.

During the summer, jellyfish stings are the most common envenomation situations encountered by humans in the marine environment. The more people swim, scuba dive, or snorkel, the more necessary it is to know what should be done immediately, how life can be saved, how to prevent early and late complications, and how to facilitate convalescence in the event of jellyfish envenomation. We describe an atypical case of a 14-year-old boy with severe dyspnea due to upper airway obstruction caused by a jellyfish sting to the face and outline a practical approach to the treatment of jellyfish stings.

Adolescent↗

Cutaneous reactions caused by experimental exposure to jellyfish, Carybdea rastonii.

Dermatitis caused by contact with tentacles of jellyfish was studied on 25 volunteers. Two tentacles cut from a living jellyfish, Carybdea rastonii, were applied on each of the forearms and skin reactions were observed. All volunteers complained of severe pain, which lasted from 10 min to 8 hrs. Erythema and wheal appeared within 3 to 4 min and enlarged for 15 to 20 min. Erythema subsided within 24 hrs to 3 days in all but two individuals. Seven to 13 days after the application, linear erythema and papulo-vesicular lesions with pruritus were observed on the forearms of 15 out of 25 volunteers tested. These flare-up lesions lasted for one week leaving slight pigmentation. Histological findings from the flare-up lesions corresponded to those of allergic contact dermatitis. The lymphocyte response to the jellyfish venom in the subjects who had recurring lesions was greater than that in either the subjects with no recurring lesions or the control group, who was never exposed to jellyfish.

Adult↗

Severe cardiac failure associated with presumed jellyfish sting. Irukandji syndrome?

We present a retrospective review of twelve cases of Irukandji syndrome associated with pulmonary oedema. This is a life-threatening envenoming due to a presumed jellyfish sting throughout Northern Australia, although only one case occurred outside North Queensland. Patients presented with significant and ongoing pain, tachycardia and hypertension. Half the patients became hypotensive requiring inotropic support. Cardiac echocardiography revealed significant cardiac dysfunction. Six patients required ventilatory support. There was no death reported due to pulmonary oedema, but one patient died of intracerebral haemorrhage. We believe patients may develop a toxin associated cardiomyopathy, and jellyfish other than Carukia barnesi may be responsible. As there is confusion with nomenclature, Carukia barnesi should be known as the Barnes jellyfish, and the diagnosis of cardiotoxic marine envenoming is suggested for any patient who has been stung by a jellyfish, develops no or minimal skin markings, and develops cardiogenic pulmonary oedema associated with Irukandji syndrome.

Adolescent↗

Management of a major box jellyfish (Chironex fleckeri) sting. Lessons from the first minutes and hours.

OBJECTIVE: To report the management of a serious box jellyfish (Chironex fleckeri) envenomation from the first minutes of bystander first aid and treatment by ambulance personnel to subsequent treatment in hospital. CLINICAL FEATURES: A 14-year-old girl sustained a serious Chironex fleckeri sting. There was no loss of consciousness, but the patient suffered severe pain, myocardial irritability, acute pulmonary oedema and mild systemic hypotension, due to the direct toxic effects of the venom. Thirst was a dominant symptom. INTERVENTION AND OUTCOME: Management involved rapid bystander action and call for ambulance assistance; and early intervention with oxygen/nitrous oxide administration, compression bandaging, antivenom administration and electrocardiographic monitoring at the site by ambulance personnel. Echocardiography in hospital three hours after the sting showed a normal myocardium. In hospital management resulted in recovery. Nocturnal itching of the sting persisted for six weeks. CONCLUSIONS: (i) Vinegar dousing may irritate freshly stung skin, but as a nematocyst inhibitor vinegar remains an essential part of the first aid treatment for cubozoan jellyfish stings. (ii) Compression/immobilisation bandaging was not associated with long-term harm to the sting area. (iii) The pain of an intramuscular antivenom injection may not be felt by a chirodropid sting victim, so safe injection protocols must be strictly observed. (iv) Ambulance services in other States whereas there is a risk of box jellyfish (Chironex fleckeri or Chiropsalmus quadrigatus) stings should be similarly trained and equipped to deal with serious jellyfish envenomations.

Acetates↗

First aid treatment of jellyfish stings in Australia. Response to a newly differentiated species.

Vinegar has been shown to inhibit neomatocyst discharge in Chironex fleckeri, the deadly north Australian box-jellyfish, and application of vinegar has become accepted first aid, not only for box-jellyfish stings, but also for stings by other Australian jellyfish. However, in a newly differentiated species of Physalia in Australian waters, which causes severe envenomation, vinegar was found to cause discharge in up to 30% of neomatocysts. In treating these stings, the use of vinegar is not recommended as it may increase envenomation. Stings from the single-tentacled Physalia utriculus (the "bluebottle") are not severe, tentacles with unfired nematocysts rarely adhere to the victim's skin and vinegar dousing is not required. Vinegar treatment is therefore an unnecessary step in the first aid management of any Physalia sting but remains an essential first aid treatment for all cubozoan (box) jellyfish tested to date.

Acetates↗