Seabather's eruption. Clinical, histologic, and immunologic features

Present and future: infectious tropical travel rashes and the impact of climate change

In this article, we discuss pertinent cutaneous findings with which patients may present after travel to tropical destinations. We address arthropod-borne infectious diseases such as cutaneous leishmaniasis, Chagas disease, cutaneous larva migrans, and myiasis. We discuss other relevant diseases with cutaneous signs such as monkey pox and severe acute respiratory syndrome coronavirus 2. We provide clinicians with information regarding the background, diagnosis, treatment, and prevention of these tropical rashes. In addition, we address the impact that climate change will have on the temporal and geographic incidence of these rashes. Viral, fungal, and vector-borne diseases have seen a geographic expansion into more northern latitudes. Among these are tick-borne Lyme disease, aquatic snail-related seabather's eruption, and atopic dermatitis. As these diseases spread, we believe that the updated information within this article is significant to the practicing physician in today's warming world.

Raising Awareness on the Clinical and Forensic Aspects of Jellyfish Stings: A Worldwide Increasing Threat

Jellyfish are ubiquitous animals registering a high and increasing number of contacts with humans in coastal areas. These encounters result in a multitude of symptoms, ranging from mild erythema to death. This work aims to review the state-of-the-art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic aspects of jellyfish stings. There are three major classes of jellyfish, causing various clinical scenarios. Most envenomations result in an erythematous lesion with morphological characteristics that may help identify the class of jellyfish responsible. In rare cases, the sting may result in delayed, persistent, or systemic symptoms. Lethal encounters have been described, but most of those cases happened in the Indo-Pacific region, where cubozoans, the deadliest jellyfish class, can be found. The diagnosis is mostly clinical but can be aided by dermoscopy, skin scrapings/sticky tape, confocal reflectance microscopy, immunological essays, among others. Treatment is currently based on preventing further envenomation, inactivating the venom, and alleviating local and systemic symptoms. However, the strategy used to achieve these effects remains under debate. Only one antivenom is currently used and covers merely one species (Chironex fleckeri). Other antivenoms have been produced experimentally but were not tested on human envenomation settings. The increased number of cases, especially due to climate changes, justifies further research in the study of clinical aspects of jellyfish envenoming.

Got the Travel Bug? A Review of Common Infections, Infestations, Bites, and Stings Among Returning Travelers

The popularity of international travel continues to increase among Americans, even though they often experience subsequent illness on return from their journey. The pathogens responsible are not necessarily endemic to the destination itself but are often the result of poor sanitary conditions or activities engaged in while away. Skin disease ranks third among all medical concerns in returning travelers. This review addresses the pathogenesis, epidemiology, clinical presentation, and treatment of the most common skin diseases in returning travelers: insect bites and bedbugs, cutaneous larva migrans, scabies, tungiasis, myiasis, leishmaniasis, viral exanthems, and marine envenomation. Primary care physicians and dermatologists should be familiar with these illnesses and a general approach to their evaluation and management.

[Jellyfish sting injuries]

BACKGROUND

Jellyfish are distributed worldwide; they cause local skin injuries upon contact which are often followed by systemic signs of envenoming.

OBJECTIVES

Which jellyfish species are of medical importance, which skin reactions and systemic symptoms occur, which first-aid measures and treatment options exist?

METHODS

Review of the medical literature and discussion of first-aid and therapeutic options.

RESULTS

Jellyfish capable of causing skin injuries occur in almost all oceans. Several jellyfish species may cause severe, potentially lethal, systemic symptoms; they include the Portuguese man-of-war (Physalia physalis) and box jellyfish (Chironex fleckeri, Carukia barnesi, Chiropsalmus quadrigatus).

CONCLUSIONS

Among the injuries and envenoming symptoms caused by marine organisms, jellyfish dermatitis should not be underestimated. Skin reactions may not only a dermatological problem, but also be accompanied by complex systemic toxic symptoms which are a challenge for internists.

Seabather's eruption: report of fourteen cases

Seabather's eruption is a papulo-pruritic dermatitis caused by the nematocysts of the larvae of the jellyfish Linuche unguiculata retained in the clothing fibers. Previously reported in Brazil, this work describes fourteen cases that occurred in the State of Santa Catarina, in southern Brazil. The new cases observed over a short period of time (the first half of January, 2012), at the height of the summer season, should alert health teams to possible epidemics on the coast of the state of Santa Catarina.

Aquatic dermatology: encounters with the denizens of the deep (and not so deep) a review. Part I: the invertebrates

Aquatic dermatoses encompass a broad spectrum of cutaneous injuries. These injuries may present through contact with invertebrate organisms such as jellyfish, sea urchins, corals, and molluscs. Each organism is equipped with a unique method of causing harm to man, therefore a myriad of presenting signs and symptoms should be recognized in order to initiate treatment. Aquatic injuries are not limited to areas of the world where these species originate. With the advent of rapid world travel and the hobby of home aquariums, dermatologists play a key role in the early diagnosis and treatment of such injuries. The method of injury, including a discussion of organism identification will be presented. Additionally, treatment of injuries caused by aquatic life will follow.

Seabather's eruption: a clinical and epidemiological study of 38 cases in Santa Catarina State, Brazil

Seabather's eruption (SBE) is an intensely itchy, papule-erythematous dermatitis that occurs predominantly in regions of the body covered by bathing costumes, after exposure to marine water. The planulae larvae of Linuche unguiculata scyphomedusae (thimble jellyfish) are the etiologic agent of the dermatitis, which is frequent in waters of Caribbean, Gulf of Mexico and Florida. The authors report 38 cases of SBE in the State of Santa Catarina (Southern region of Brazil), with emphasis on their clinical and epidemiological aspects, such as profile of victim, topography of the papules and conditions predisposing to the accident.

Infestation with larvae of the sea anemone Edwardsia lineata affects nutrition and growth of the ctenophore Mnemiopsis leidyi

The lobate ctenophore Mnemiopsis leidyi is a periodically abundant and voracious plankton predator in coastal waters along the east coast of the United States. In the 1980s it was accidentally introduced to the Black Sea where it caused a dramatic reduction in fisheries. We investigated how M. leidyi is affected by infestation with parasitic larvae of the sea anemone Edwardsia lineata. Infested M. leidyi contained 1–30 (median 7) E. lineata larvae. Within M. leidyi most larvae had their mouth in the gastrovascular system near the aboral end of the pharynx. Parasitic E. lineata ingested all food previously ingested and pre-digested by M. leidyi. Non-infested M. leidyi had higher growth rates than infested individuals, which had zero or negative growth rates. Egg production was similar for infested and non-infested M. leidyi of similar size. Simulation based on the empirical data suggests that growing, non-infested, M. leidyi are expected to have a larger life-time egg production than infested shrinking individuals. E. lineata could be at least partially responsible for the sharp decline of M. leidyi populations in fall in US coastal waters. Advantages and disadvantages of E. lineata as a potential candidate for the control of the artificially introduced M. leidyi population in the Black Sea are discussed.

Treatment of Atlantic cnidarian envenomations

Envenomation syndromes induced by Atlantic cnidaria have been tabulated and their therapy discussed. The pharmacokinetics of the venom has been emphasized. Pain occurs instantly and reaches a zenith rapidly in the surf. The nematocysts have already penetrated the dermis and disease proceeds before help can arrive. This fact plus the relative impermeability of human epidermis hampers the efficacy of topical agents. Oral analgesics, the agents of choice, are seldom offered and systemic administration of these drugs is usually not necessary. The use of hot or cold applications has not been settled. Measures to inactivate nematocysts within tentacles adherent to skin post-sting have been demonstrated in vitro, but the clinical significance of these actions has not been shown. Using an abrader (sand, crystalline papain) to counter-irritate nearby skin might provide relief. Antivenoms for Atlantic cnidaria are not available. The instances when verapamil might be employed are very rare. The reasons for the increasing case load of these injuries are discussed and the need to discover more effective therapeutic agents is emphasized.

Health effects of recreational exposure to Moreton Bay, Australia waters during a Lyngbya majuscula bloom

A survey of residents in an area subject to annual toxic cyanobacterial blooms was undertaken to examine potential health effects of cyanobacteria toxins. The survey assessed the health of marine recreational water users in Deception Bay/Bribie Island area in northern Moreton Bay, Queensland, which is exposed to blooms of the nuisance and potentially harmful cyanobacterium Lyngbya majuscula. A postal survey was mailed to 5000 residents with a response rate of 27%. High numbers of people (78%) responding to the survey reported recreational water activity in Moreton Bay. Of those having marine recreational water activity, 34% reported at least one symptom after exposure to marine waters, with skin itching the most reported (23%). Younger participants had greater water exposure and symptoms than older participants. Participants with greater exposures were more likely to have skin and eye symptoms than less exposed groups, suggesting agents in the marine environment may have contributed to these symptoms. Of those entering Moreton Bay waters 29 (2.7%) reported severe skin symptoms, 12 of whom attended a health professional. Six (0.6%) reported the classic symptoms of recreational water exposure to L. majuscula, severe skin symptoms in the inguinal region. Participants with knowledge of L. majuscula were less likely to report less skin, gastrointestinal and fever and headache symptoms. In conclusion, high numbers of participants reported symptoms after exposure to waters subject to L. majuscula blooms but only a small number appeared to be serious in nature suggesting limited exposure to toxins.

Prurido do traje de banho: relato de seis casos no Sul do Brasil

O prurido do traje de banho ou seabather’s eruption é uma dermatite intensamente pruriginosa que ocorre pelo contato com larvas plânulas do cnidário cifozoário Linuche unguiculata, especialmente sob os trajes de banhistas. As larvas disparam seus nematocistos a partir de cnidócitos ou células urticantes de defesa na pele da vítima, causando uma típica erupção pápulo-eritemato-pruriginosa. Os primeiros cinco casos descritos no Brasil foram publicados em 2001, no litoral Sudeste (Ubatuba, SP), obtendo-se associação com larvas de Linuche unguiculata, uma vez que a ocorrência e o ciclo de vida do cnidário já haviam sido estudados no Canal de São Sebastião, SP. Os autores relatam os seis casos na região Sul do Brasil (Estado de Santa Catarina), enfatizando os aspectos clínicos e a pesquisa para identificação do agente na água do mar local.

Medical illnesses and injuries encountered during surfing

Surfing is an exciting sport enjoyed in many coastal communities around the globe. Participants are prone to various conditions ranging from acute injuries to conditions borne from chronic environmental exposure. Lacerations, contusions, sprains, and fractures are the common types of acute traumatic injury. Injury from the rider's own surfboard is the prevailing mechanism of injury. Interaction with marine animals may lead to injury through envenomation. Although jellyfish stings are common, no definitive treatment strategy has been proven most effective in dealing with such stings. Exposure to jellyfish and other nematocyst-containing larvae can cause a reaction known as seabather's eruption. Stingrays and coral reefs present further hazards to the surfboard rider. Infection of wounds is often seen and should be treated with fluoroquinolones or third-generation cephalosporins to cover Vibrio species, along with Staphylococcus and Streptococcus species. Otologic sequelae of surfing include auditory exostoses, ruptured tympanic membrane, and otitis externa.

Changing paradigms in parasitic infections: common dermatological helminthic infections and cutaneous myiasis

Parasitic diseases caused by helminths, or worms, account for billions of human infections worldwide. Although most human pathogens caused by these organisms are infrequent in the United States, skin manifestations of parasitic diseases are being seen much more frequently in dermatologists' offices due to the increase in immigration and travel. Helminths are notable for their complicated lifecycles often including consecutive developmental phases, in separate hosts or in a free-living state. These parasitic organisms are usually macroscopic, multicellular organisms, and do not breed within their mammalian hosts. Notably, many helminthic diseases present with dermatologic signs and symptoms including skin nodules, cysts, migratory skin lesions, and pruritus. In this section, we discuss cutaneous myiasis as well as the four most common nematode dermatologic conditions seen in the United States.

[Cercarial dermatitis]

A POTENTIAL PUBLIC HEALTH PROBLEM: Cercarial dermatitis is caused by the infestation of the skin by cercariae of nonhuman schistosomes whose commonest hosts are aquatic birds. Human contamination can occur during swimming in fresh water infested with cercariae and notably ducks. Its geographic distribution is worldwide and is increasingly described in France during the summer months. FROM A CLINICAL POINT OF VIEW: A diffuse eruption composed of prurigenous maculopapules appears within the 24 hours following exposure. Regression is spontaneous within one day to three weeks. PREVENTION IS ADVISABLE: Treatment is symptomatic in the majority of patients. The optimal prevention, for bathers, is to swim in sufficiently deep water.

Seabather's eruption: report of five cases in southeast region of Brazil

The authors report five cases of seabather's eruption, a typical dermatitis associated predominantly to the jellyfish Linuche unguiculata (Cnidaria), that causes erythematous and pruriginous papules on areas of the skin of bathers covered by swimsuits. The rash is characteristic and the eruption is commom in the Caribbean, Florida, Mexico and Gulf States of USA. The cases are the first reported in Brazil and larvae of the jellyfish are present in the waters where the accidents happened.

One Linuche mystery solved: all 3 stages of the coronate scyphomedusa Linuche unguiculata cause seabather's eruption

BACKGROUND

Seabather's eruption (SBE) is a highly pruritic dermatosis affecting swimmers and divers in marine waters off Florida, in the Gulf of Mexico, and the Caribbean Sea. Its cause has been attributed to various organisms but recently to the larvae of the schyphomedusa, Linuche unguiculata.

OBJECTIVE

We attempted to determine whether immature and adult Linuche cause SBE.

METHODS

Episodes of SBE in the Cancun and Cozumel area of the Mexican Caribbean were evaluated during the season of high tourism (January-June). This time corresponds to the moments in the life cycle when the three swimming stages of L unguiculata-ephyrae, medusae, and larvae-can be sequentially observed. Our methods include (1) observations by divers, biologists, and students coinciding with stinging outbreaks and the onset of SBE; (2) serologic evaluation of individuals stung by L unguiculata; and (3) the demonstration of Linuche nematocysts on the affected skin.

RESULTS

All 3 swimming Linuche stages can cause SBE.

CONCLUSION

The offending stages of Linuche can be identified by the cutaneous lesion's morphology and the time of year.

Prevention of common travel ailments

An understanding of the subjects covered in this article is significant in keeping travelers healthy and comfortable. Each section covers a range of problems and suggestions for their prevention. The areas that are reviewed are: 1) fitness to fly; 2) problems in transit; 3) altitude sickness; 4) marine and swimming hazards; 5) insect precautions; 6) pre- and posttravel care; and 7) illness abroad. An effort has been made to provide practical recommendations as in many cases there is little data and no rules, thus the travel health advisor, with the patients' input, will need to determine the best course of action for each individual and itinerary.

Skin problems in the traveler

Skin lesions are common in travelers and include a mix of mundane dermatologic problems and rare diseases acquired only in remote or tropical regions. The morphology, distribution, and progression of the lesions are useful in assessing possible causes. Early in the evaluation it is important to determine whether the patient might have a process that is rapidly progressive, treatable, or transmissible. In addition to routine laboratory studies, biopsy and serologic tests are often necessary to confirm a specific diagnosis.

Cutaneous manifestations of sports participation

As interest and participation in sports and recreational activities continue to increase, so do problems of the skin associated with sports participation. Primary care physicians and dermatologists may find the diagnosis of these sometimes unusual skin lesions difficult without knowledge of their association with sporting activities. Likewise, treatment of these skin lesions may be unsatisfactory without an understanding of the unique factors that contributed to the problem. This article reviews the cutaneous manifestations of sports participation. Traumatic and environmental skin injuries, skin infections, and exacerbation of preexisting dermatoses, as well as descriptions, predisposing conditions or causative agents, diagnosis, treatment, and prevention are discussed.

Coelenterate venom research 1991-1995: clinical, chemical and immunological aspects

Important clinical, chemical, and immunological advances in coelenterate venom research have been made in recent years. Perhaps the most dramatic advance has been in the communication of research data and clinical cases between investigators in this field. Results have been processed by the International Consortium for Jellyfish Stings through their newsletter and the forthcoming publication of the Marine Stinger Book by the University of New South Wales Press.

Seabather's eruption--a case of Caribbean itch

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The antibody response in seabather's eruption

Thirty-six of 44 patients with seabather's eruption had specific IgG antibodies against Linuche unguilata (thimble jelly) medusae antigen. ELISA detected antibodies in serum stored for 10 years. The extent of the cutaneous eruption or sting severity was correlated with antibody titer. Antibodies were detected in patients acquiring the eruption in Florida, the Bahamas and Aruba, reflecting the habitat of these jellyfish. This serological assay can be useful to confirm the clinical diagnosis.