Acute renal failure as a result of Physalia physalis sting

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.

Marine toxins and nephrotoxicity:Mechanism of injury

Marine toxins are known among several causes of toxin induced renal injury. Enzymatic mechanism by phospholipase A₂ is responsible for acute kidney injury (AKI) in sea snake envenoming without any change in cardiac output and systemic vascular resistance. Cnidarian toxins form pores in the cell membrane with Ca influx storm resulting in cell death. Among plankton toxins domoic acid, palytoxin and maitotoxin cause renal injury by ion transport into the cell through ion channels resulting in renal cell swelling and lysis. Okadaic acid, calyculin A, microcystin LR and nodularin cause AKI by serine threonine phosphatase inhibition and hyperphosphorylation with increased activity of Ca²⁺/calmodulin - dependent protein kinase II, increased cytosolic Ca²⁺, reactive oxygen species, caspase and P53. Renal injury by plankons is mostly subclinical and requires sensitive biomarker for diagnosis. In this respect repeated consumption of plankton toxin contaminated seafood is a risk of developing chronic renal disease. The subject deserves more clinical study and scientific attention.

Exploiting the nephrotoxic effects of venom from the sea anemone, Phyllodiscus semoni, to create a hemolytic uremic syndrome model in the rat

In the natural world, there are many creatures with venoms that have interesting and varied activities. Although the sea anemone, a member of the phylum Coelenterata, has venom that it uses to capture and immobilise small fishes and shrimp and for protection from predators, most sea anemones are harmless to man. However, a few species are highly toxic; some have venoms containing neurotoxins, recently suggested as potential immune-modulators for therapeutic application in immune diseases. Phyllodiscus semoni is a highly toxic sea anemone; the venom has multiple effects, including lethality, hemolysis and renal injuries. We previously reported that venom extracted from Phyllodiscus semoni induced acute glomerular endothelial injuries in rats resembling hemolytic uremic syndrome (HUS), accompanied with complement dysregulation in glomeruli and suggested that the model might be useful for analyses of pathology and development of therapeutic approaches in HUS. In this mini-review, we describe in detail the venom-induced acute renal injuries in rat and summarize how the venom of Phyllodiscus semoni could have potential as a tool for analyses of complement activation and therapeutic interventions in HUS.

Overview of tropical nephrology

Tropical nephrology covers renal diseases commonly seen in the tropics and elsewhere and specific tropical renal diseases seen mostly or only in the tropical area. Emphasis in this article is placed on the latter category, which includes renal involvement in tropical infectious diseases, natural toxin poisoning, and environmental renal problems. Pathologically, all renal structures can be affected. There is, therefore, a broad spectrum of pathologic changes, and clinical renal manifestations vary from mild urinary sediment changes to acute renal failure. Inflammatory processes plays an essential role in the pathogenesis of renal involvement in infection and toxin groups. Both models share the same inflammatory pathways through cytokines, chemokines, and mediators. Hemodynamic alterations, immune response, and direct nephrotoxicity are involved in the development of renal lesions.

Signs, Symptoms, and Management of Jellyfish Envenomation

In brief: Millions of divers, swimmers, and other ocean-goers may encounter jellyfish. If they are stung, they may need either first aid if the case is mild, or extensive treatment if they suffer anaphylaxis, cardiorespiratory problems, or long-term reactions. Some severe cases may even be fatal. The author describes the mechanisms of envenomation and tissue reaction and discusses how to recognize and treat both the immediate and late sequelae.

Jellyfish envenomation syndromes updated

Jellyfish venoms are mixtures of toxic and/or antigenic polypeptides and enzymes pathogenic to human beings. As newer therapeutic agents become available to treat the various reactions to stings caused by these animals, an accurate diagnosis of the type of reaction the patient experiences and of the offending species will be necessary. Fatal reactions may be caused either by anaphylaxis or by the action of toxins in the venom on the heart, respiratory center, or kidneys. Cutaneous eruptions after envenomation may be local, generalized, exaggerated, recurrent, delayed, persistent, or occur at sites distant from the primary sting. Fat atrophy, pigmentary changes, vasospasm, and contractures with gangrene can occur after jellyfish stings. Identification of the envenoming animal can be made by actual visualization, examination for nematocysts on skin scraping, or serologically. It may also be predicted based on knowledge of location, time, and environmental circumstances of the encounter. First-aid measures designed to prevent additional nematocyst rupture are species-specific. Anaphylaxis should be prevented by the appropriate lifesaving measures. Other syndromes, caused by the toxins of the venom or mediated by humoral or cellular immune mechanisms, should be treated specifically.

Venomous pelagic coelenterates: chemistry, toxicology, immunology and treatment of their stings

Ten years have elapsed since our last review article on the toxicology of venomous pelagic coelenterates was published (Burnett and Calton, 1977). Investigation on important medusae and the chemistry of their nematocyst venoms have been expanding. The venomous jellyfish discussed here include the Portuguese man-o'war, (Physalia physalis), the sea nettle (Chrysaora quinquecirrha), the box jellyfish (Chironex fleckeri and/or Chiropsalmus quadrigatus), the cabbage head jellyfish (Stomolophus meleagris), the lion's mane jellyfish (Cyanea capillata), the Irukandji jellyfish (Carukia barnesi), the Moreton Bay Carybdeid medusa (Morbakka), and the mauve blubber (Pelagia noctiluca).

Jellyfish envenomation syndromes

Jellyfish venoms are complex mixtures of polypeptides and enzymes pathogenic to man by means of their toxic or antigenic properties. With newer technology, more therapeutic agents will become available to treat the various envenomation syndromes caused by these animals. It will therefore be necessary to make an accurate diagnosis of the type of reaction the patient experiences, as well as to identify the offending species. Fatal reactions can be caused by hypersensitivity or induced by various toxins on the heart, respiratory center, or kidney. Cutaneous eruptions may be local or generalized, have exaggerated local edema, become recurrent, be delayed and persistent, or occur at sites distant from the primary sting. Fat atrophy, pigmentary changes, and contractures with gangrene can also appear. Identification of the responsible coelenterate can be made directly by actual visualization or indirectly by the knowledge of location, time, and environmental circumstances of the stinging. First-aid measures designed to prevent additional nematocyst rupture appear to be species-specific. Anaphylaxis should be counteracted by the lifesaving measures required. Other syndromes, either caused by toxic effects of the venom or mediated by humoral or cellular immune mechanisms, should be treated by means designed to interfere with their pathogenesis.