Nematocysts: Difference between revisions
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*Jellyfish; [[box jellyfish|box jellyfish]] is most deadly | *Jellyfish; [[box jellyfish|box jellyfish]] is most deadly | ||
*Most toxic: Australia and other Indo-Pacific waters | *Most toxic: Australia and other Indo-Pacific waters | ||
<gallery mode="packed"> | |||
File:Avispa marina cropped.png|[[Box jellyfish]] | |||
File:Lithothamnion sp..jpg|Coral reef | |||
File:Portuguese Man-O-War (Physalia physalis).jpg|Portuguese Man-O-War {Physalia physalis) | |||
File:Actiniaria.jpg|A selection of various sea anemones | |||
</gallery> | |||
===Mechanism=== | ===Mechanism=== | ||
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==Clinical Features== | ==Clinical Features== | ||
[[File:PMC3760923 abd-88-0496-g04.png|thumb|Skin lesion after contact with the cubomedusa Chiropsalmus quadrumanus jellyfish]] | |||
*Isolated stinging, pain | *Isolated stinging, pain | ||
*Severe | *Severe | ||
| Line 35: | Line 44: | ||
==Management== | ==Management== | ||
*Remove tentacles and nematocysts | *Remove tentacles and nematocysts | ||
*Hot salt water immersion (inactivates heat labile toxins) | *Hot salt water immersion (inactivates heat labile toxins), submerging the area in 45 ℃ water for 20 minutes has been shown to provide significant pain relief<ref>#Isbister GK, Currie BJ. Hot water immersion v icepacks for treating pain of Chironex fleckeri stings: a randomised controlled trial. Med J Aust. 2017 Oct 16;207(8):362. PubMed PMID: 29020913.</ref> | ||
*Consider topical [[lidocaine]] | *Consider topical [[lidocaine]] | ||
*Consider oral or parenteral [[analgesia]] for severe pain | *Consider oral or parenteral [[analgesia]] for severe pain | ||
*Acetic Acid may inhibit or trigger nematocyst discharge and thereby increase or decrease pain depending on species (can use fruit juice or other flavored sodas if vinegar not available) | *Acetic Acid may inhibit or trigger nematocyst discharge and thereby increase or decrease pain depending on species (can use fruit juice or other flavored sodas if vinegar not available) | ||
**It does inhibit nematocyst discharge in the Box Jellyfish species <ref>Yanagihara AA, Wilcox CL. Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations. Toxins (Basel). 2017;9(3):105. Published 2017 Mar 15. doi:10.3390/toxins9030105</ref> | |||
*'''Symptomatic treatment for Irukandji syndrome''' | *'''Symptomatic treatment for Irukandji syndrome''' | ||
*'''Antivenom is available for severe [[box jellyfish]] sting''' | *'''Antivenom is available for severe [[box jellyfish]] sting''' | ||
Revision as of 15:30, 4 January 2021
Background
- Jellyfish; box jellyfish is most deadly
- Most toxic: Australia and other Indo-Pacific waters
Coral reef
Portuguese Man-O-War {Physalia physalis)
A selection of various sea anemones
.jpg)
Mechanism
- Physical contact or osmotic gradient causes discharge of nematocysts
- A spring loaded venom delivery system
- Once opened, a nematocyst releases all of its contained venom
Clinical Features
- Isolated stinging, pain
- Severe
Irukandji syndrome
- Myalgias, back, chest pain,
- Abdominal pain
- Nausea and vomiting
- Diaphoresis
- Hypertension
- Tachycardia
- Myocardial injury
- Pulmonary edema
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Evaluation
- Generally a clinical diagnosis
Management
- Remove tentacles and nematocysts
- Hot salt water immersion (inactivates heat labile toxins), submerging the area in 45 ℃ water for 20 minutes has been shown to provide significant pain relief[1]
- Consider topical lidocaine
- Consider oral or parenteral analgesia for severe pain
- Acetic Acid may inhibit or trigger nematocyst discharge and thereby increase or decrease pain depending on species (can use fruit juice or other flavored sodas if vinegar not available)
- It does inhibit nematocyst discharge in the Box Jellyfish species [2]
- Symptomatic treatment for Irukandji syndrome
- Antivenom is available for severe box jellyfish sting
Avoid
- Urine, ethanol, ammonia
- Fresh or tap water (causes nematocyst discharge via the osmotic gradient)
Disposition
See Also
References
- Ward NT, Darracq MA, Tomaszewski C, et al. Evidence based treatment of jellyfish stings in North America and Hawaii. Ann Emerg Med. 2012;60(4):339-414.
- Cegolon L, Heymann WC, Lange JH, et al. Jellyfish stings and their management: a review. Mar Drugs. 2013;11(2): 523-50
- ↑ #Isbister GK, Currie BJ. Hot water immersion v icepacks for treating pain of Chironex fleckeri stings: a randomised controlled trial. Med J Aust. 2017 Oct 16;207(8):362. PubMed PMID: 29020913.
- ↑ Yanagihara AA, Wilcox CL. Cubozoan Sting-Site Seawater Rinse, Scraping, and Ice Can Increase Venom Load: Upending Current First Aid Recommendations. Toxins (Basel). 2017;9(3):105. Published 2017 Mar 15. doi:10.3390/toxins9030105