First envenomation report of the Cnidarian Physalia physalis in Indonesia.

Despite the high number of victims every year, Physalia physalis's envenomations in Indonesia are scientifically unsounded. This annual event occurred mainly in Java's southern beaches and the Eastern Bali Islands, which are the most tourist destinations. The lack of scientific reports can lead to unaware and uneducated beachgoers resulting in a high number of victims, which in turn may ruin the economic sectors. Thus, this study aimed to report P. physalis's envenomation and its treatments in the southern beaches of the Special Region of Yogyakarta Province. It was based on the 15 beach lifeguards' and the primary health care units' reports in 2019-2020. The envenomation cases varied among beaches and years, whereas the highest number of cases were reported in the most popular beach (Parangtritis beach). The partial beach closing due to the pandemic COVID-19 caused the number of cases in 2020 was slightly lower than that in 2019. The envenomations' general symptoms were oedema and local pain that were treated with 5% food vinegar and hot water, if available. The severe cases (dyspnoea, nausea, vomiting, and cephalgia) were only reported twice in 2019. They were hospitalised in primary health care units; however, many people still practise the traditional non-scientific treatments, particularly in a chaotic situation.

Fatal jellyfish envenoming-Pediatric and geographic vulnerabilities.

Lethal jellyfish envenoming is a very rare event. Two illustrative cases of fatalities following envenomation from the multi-tentacled box jellyfish, Chironex fleckeri, are reported that involved a six-year-old boy and a three-year-old girl, both of whom had been playing in shallow beach waters in remote Northern Territory communities (Australia). A recommended approach to autopsy in suspected cases is described, which should include examination of the clothing and skin surfaces for the fine tentacles of Chironex fleckeri. In addition, the combined length and maximum width of tentacle marks should be measured/calculated and collection of unfixed tentacles with adhesive tape onto a glass slide should be undertaken to check for nematocysts. Such rare cases show that children are at higher risk of a lethal outcome, particularly if they are resident in remote coastal tropical communities.

Irukandji-like syndrome caused by single-tentacle box jellyfish found in Thailand, 2007-2019.

BACKGROUND: Irukandji syndrome definition is still widely misunderstood. Irukandji-like syndrome is more unclear than Irukandji syndrome. This study aimed to describe Irukandji-like syndrome in cases involving stinging by single-tentacle box jellyfish species in Thailand. MATERIALS AND METHODS: Surveillance system and networks of toxic jellyfish incidents were established to enable case detection. In the period 2007 to 2019, all cases of stinging by single-tentacle box jellyfish resulting in collapse, hospital attendance or death were investigated. RESULTS: The majority of the 19 Irukandji-like syndrome cases were male (68.2%), median age 35.0 years (range 6.0-60.0), and Thai nationality (52.3%). Clinical manifestations of Irukandji-like syndrome were categorised as severe wound pain with immediate systemic reaction (66.7%), moderate wound pain with gradual systemic reaction (16.7%), and moderate wound pain with the immediate systemic reaction after a physical/chemical trigger (16.7%). The pain occurring when being stung differed from the pain occurring during the systemic reaction. The five most common symptoms were pain (100.0%), high blood pressure (100.0%), palpitations (86.7%), respiratory distress (52.6%), and near collapse/collapse (31.6%). The pain occurs when being stung was excruciating or burning pain at the wounds, felt like an electric shock, and rapidly expanded to heart pain. While the pain occurring during the systemic reaction was back pain, muscle pain, joint pain, abdominal pain, and body aches. The marks from the tentacles appeared similar in appearance to the caterpillar tracks of tanks. In 6 cases the species could be identified and all of them involving the Morbakka spp. CONCLUSIONS: This was the largest study of Irukandji-like syndrome cases involving stings by single-tentacle box jellyfish in Thailand and the different clinical manifestations might be caused by different species of single-tentacle box jellyfish.

Paralytic shellfish poisoning and palytoxin poisoning in dogs.

BACKGROUND: Fatal cases of exposure to paralytic shellfish toxins and palytoxins have occurred in companion animals but are poorly described. METHODS: We describe one case of paralytic shellfish poisoning (PSP) and three cases of palytoxin poisoning in dogs. RESULTS: Mild PSP occurred following ingestion of crab while walking on a beach. Analysis confirmed the presence of paralytic shellfish toxins, particularly decarbamoyl saxitoxin, in clinical samples and marine organisms. This case occurred shortly after an outbreak of PSP in dogs on the eastern coast of England. Palytoxin poisoning occurred in a dog after it chewed coral removed from an aquarium. Signs included collapse, hypothermia, bloody diarrhoea and respiratory distress. The dog was euthanised due to rapid deterioration and poor prognosis. Palytoxin was not detected in a premortem blood sample. Two other dogs in a separate incident developed only mild signs (fever and respiratory distress) after suspected exposure to aerosolised palytoxin and recovered within a few hours. CONCLUSION: Cases of PSP are episodic and not common in dogs. Cases of palytoxin exposure are reportedly increasing in humans, and there is presumably also an increased risk to pets. There is no specific treatment for PSP or palytoxin poisoning.

Inhalation poisoning with palytoxin from aquarium coral: case description and safety advice.

Palythoa spp. corals and some other marine organisms contain one of the most poisonous substances ever known - palytoxin (PTX). Due to their modest life requirements and ease of breeding, these corals are popular in home aquariums. Here we refer to a case of PTX poisoning of a middle-aged woman who inhaled poisonous vapours while brushing the corals from live rock and compare it with the available literature. As the case revealed that the symptoms of PTX poisoning are not specific and neither is treatment, our aim was to give a brief tabulated review of the symptoms that may indicate such poisoning. Cases of palytoxin poisoning have been reported worldwide, and severe ones (mostly due to ingestion of contaminated sea food) can end in death. As it appears, most (if not all) poisonings result from unawareness of the risk and reckless handling by aquarists. This is one of the first articles which provides some practical advice about the use of personal protection equipment, including gloves, masks, eyewear, and other clothing during any coral manipulation to minimise the risk. We also draw attention to the lack of marketing/trading regulations for dangerous coral species and/or regulations or instructions dealing with their removal and health protection.

Toxic corneal reaction due to exposure to palytoxin. / Toxicidad corneal por exposición a palitoxina.

A case is presented of corneal toxicity after exposure to palytoxin. A 42 year-old man came with symptoms of pain and blurred vision in his right eye. He reported that a zoanthid coral from a saltwater aquarium had squirted into his eye. Slit-lamp examination showed a prominent central ring infiltrate of 4×6mm without epithelial defect and satellite sub-epithelial micro-infiltrates. After 2 months of topical treatment with steroids, the stromal ring infiltrate was resolved, but a stromal thinning and residual fibrosis remained. Palytoxin is a potent vasoconstrictor that damages the ionic gradient of the cells, causing cell death. It is crucial to remove the toxin and start an aggressive topical therapy as soon as possible. In addition, considering the potential ocular and systemic adverse effects that this toxin can produce, it would be advisable to inform people of its existence and regulate the distribution of this type of corals.

Fatal Pulmonary Edema in a Child After Jellyfish Stings in Korea.

Jellyfish have been increasing at a global scale in recent years. These blooms not only have deleterious effects on marine ecosystems, they also increase the risk of jellyfish stings and accompanying envenomation. Here, we report a fatal case of pulmonary edema caused by jellyfish envenomation in a child in Korea. The patient died 4 h after envenomation despite cardiopulmonary resuscitation. Nemopilema nomurai was the suspected species of jellyfish encountered by the patient, although we are unable to confirm this. With this case report, we aim to inform on the serious issue of toxicity associated with jellyfish species that bloom mainly along Korean, east Chinese, and Japanese shores and to discuss appropriate first aid methods in case of jellyfish stings.

Millepora species (Fire Coral) Sting: A Case Report and Review of Recommended Management.

Fire corals (Millepora spp) are the second most common reef-forming organisms and are frequently found in tropical and subtropical waters. Fire corals are not true corals but rather hydrozoans more closely related to jellyfish and sea nettles. Rigidly affixed to the reef and with a branching structure, each fire coral is a colony of numerous individual hydrozoans forming a collective symbiotic organism. It is common for divers to accidentally make contact with fire corals. Fire coral contact is characterized by the immediate onset of burning pain caused by venom discharge from numerous tiny nematocysts located externally on the creature. Treatment consists of saltwater irrigation of the wound, nematocyst removal, and supportive care of the associated symptoms of pain, dermatitis, and pruritus. Rarely, fire coral can cause systemic toxicity. We present a case report of a 30-y-old recreational diver who experienced a fire coral sting of her left anterior thigh and review the recommended prevention and management of fire coral stings.

Retrospective study of jellyfish envenomation in emergency wards in Guadeloupe between 2010 and 2016: When to diagnose Irukandji syndrome?

BACKGROUND: In Guadeloupe (French West Indies), many marine envenomation cases by jellyfish are observed. Some of them might induce an Irukandji syndrome (IS). The aim of this study was to analyse the clinical features of IS from the envenomation cases in the two public hospitals in Guadeloupe, and to compare them to non-IS stings. METHODS: All jellyfish envenomation cases between the 1st of January 2010 and the 1st of September 2016, from the emergencies data-base, have been extracted. The primary endpoint was the existence of an IS defined by a jellyfish sting followed by one of the symptoms among: severe lumbosacral, thoracic or abdominal pain, muscle cramps of the four limbs, profuse sweating, anxiety, restlessness, nausea, or vomiting. RESULTS: Two hundred and eleven envenomation cases have been extracted, 45.0% of them happened between the 22nd and the 26th day of the lunar phase during a period from June to September. Ninety five patients had an IS. Three of them had Quincke's edema and one a cardiopulmonary failure. Other clinical signs have been associated with IS compared to other sting cases, including hypertension (51.6% vs 18.1%, p < 0.001), tremor (32.6% vs 14.7%, p = 0.0014), paresthesia (20.0% vs. 10.3%, p = 0.049), dyspnea (13.7% vs 3.4%, p = 0.006), and the pain evaluation by the visual analogue pain scale (7.5 ± 2.6 and 6.0 ± 2.6, p = 0.001). CONCLUSION: Jellyfish envenomation is frequently associated with IS in Guadeloupean emergency wards. The IS cases were probably due to the species Alatina alata, and their periodicity can be determined according to the cycle of the moon. If patients showed symptoms slightly less severe than those in Australian studies, a case of cardiac decompensation, the first out of the Pacific, was observed. Based on our results, new definition of IS and severe IS are proposed.

Rhabdomyolysis during envenomation by Physalia sp envenomation in New Caldonia.

We report the first case of rhabdomyolysis following envenomation by a Physalia sp in New Caledonia. Systemic envenomation by this marine hydrozoan is well known, including myalgia as a commonly reported clinical feature. Nonetheless, a related increase in muscle enzymes, featuring rhabdomyolysis, has not previously been described. In this case report, we describe a patient with rhabdomyolysis and acute renal failure. Rhabdomyolysis should be checked in case of systemic physalia envenomation.

Human envenomations caused by Portuguese man-of-war (Physalia physalis) in urban beaches of São Luis City, Maranhão State, Northeast Coast of Brazil.

INTRODUCTION:: The clinical and epidemiological aspects associated with Portuguese man-of-war envenomation were investigated and characterized. METHODS:: Data from recorded envenomation events between 2005 and 2013 were provided by the GBMar (Group of Firemen Maritime of Maranhão State) and SEMUSC (Municipal Secretary of Security with Citizenship). RESULTS:: Most victims were children, and clinical manifestations included intense pain, edema, erythema, and rare systemic manifestations. CONCLUSIONS:: The envenomation events were predictable and based on patterns involving multiple factors (environmental and/or human behavior); however, the initially applied measures did not match the current recommendations of the Health Ministry of Brazil.

Human envenomations caused by Portuguese man-of-war (Physalia physalis) in urban beaches of São Luis City, Maranhão State, Northeast Coast of Brazil

ABSTRACT INTRODUCTION: The clinical and epidemiological aspects associated with Portuguese man-of-war envenomation were investigated and characterized. METHODS: Data from recorded envenomation events between 2005 and 2013 were provided by the GBMar (Group of Firemen Maritime of Maranhão State) and SEMUSC (Municipal Secretary of Security with Citizenship). RESULTS: Most victims were children, and clinical manifestations included intense pain, edema, erythema, and rare systemic manifestations. CONCLUSIONS: The envenomation events were predictable and based on patterns involving multiple factors (environmental and/or human behavior); however, the initially applied measures did not match the current recommendations of the Health Ministry of Brazil.

The clinical manifestations, outcome and identification of jellyfish stings in Jaffna, Sri Lanka.

We carried out a descriptive study over one year on 62 fishermen stung by jellyfish while fishing. Most were aged under 60 years. The timing of the sting was mostly between midnight and 4am (32%). Clinical symptoms were mainly localised pain and burning (80%), itching (67%) and shortness of breath (42%). Almost all patients received antihistamines (97%) and steroids (87%). None of them needed intensive care; they needed only 1-2 days in hospital. Jellyfish identified in fishing nets were Catostylus mosaicus, Cynea capillata and moon jellyfish.

Determination of Palytoxins in Soft Coral and Seawater from a Home Aquarium. Comparison between Palythoa- and Ostreopsis-Related Inhalatory Poisonings.

Anecdotal reports exist of aquarium hobbyists that experienced severe respiratory distress and/or skin injury following cleaning operation of home aquaria containing Palythoa sp. soft corals. Hundreds of cases of respiratory illness and/or dermatitis have been recorded in proximity to the sea concomitantly with algal blooms of Ostreopsis spp. in the Mediterranean area. Both Palythoa spp. and Ostreopsis spp. contain congeners of palytoxin, a highly potent toxin whose inhalation hazard is however unknown. In this study, we demonstrate the presence of high levels of palytoxins (palytoxin and hydroxypalytoxin) in both soft coral and seawater from a home marine aquarium involved in the poisoning of a whole family. Due to the high toxin levels found in seawater, a procedure for a rapid and efficient determination of palytoxin in seawater was setup. A comparison of symptoms of Palythoa- and Ostreopsis-related inhalatory poisonings showed many similarities including fever, respiratory distress, nausea, and flu-like symptoms. From the chemical and symptomatological data reported herein it is reasonable to hold palytoxins responsible for respiratory disorders following inhalation. Although the exact mechanism through which palytoxin congeners exert their inhalatory toxicity is still unknown, this represents a step toward demonstrating that palytoxin congeners exert toxic effects through inhalation both in natural environments and in the surroundings of private and public aquaria.

Fenómeno de Koebner en un liquen escleroso tras una picadura de medusa: una morfología excepcional / Koebner Phenomenon in a Patient With Lichen Sclerosus Following a Jellyfish Sting: An Exceptional Morphology

No disponible