Bluebottle Envenomation–Induced Crystalline Keratopathy

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.

Portuguese man-of-war (Physalia physalis) envenomation on the Aquitaine Coast of France: an emerging health risk

CONTEXT

The Portuguese man-o-war is a cnidaria classically found in tropical waters. It can cause serious and even life-threatening envenomation in swimmers, surfers and seafarers. Presence of the Atlantic species Physalia physalis has long been reported in European coastal waters but was always an exceptional event.

OBJECTIVE

To describe the experience of the Bordeaux Poison centre about Physalia stings since the first collective episode reported in 2008.

METHODS

Clinical retrospective description of cases series of Physalia envenomations reported to the local poison centre from 2008 to 2011 inclusive.

RESULTS

In the summer of 2008, multiple-case incident involving 40 victims were recorded on the same day on one beach in the Southern French Atlantic coast. The following year in 2009, no envenomation cases were reported in the same area, but in the next 2 years, numerous man-of-war envenomations occurred along the Aquitaine coast, that is, 154 cases in 2010 and 885 in 2011. Portuguese man-o-war stings led to severe manifestations with 15-20% of patients suffering of general symptoms that were sometimes severe enough to be considered as potentially life-threatening (8% of patients in 2011, most frequent signs: muscle pain and cramps with fasciculations, confusion and drowsiness, fainting, respiratory distress). No deaths due to Portuguese man-o-war envenomation were reported over the 4-year study period.

CONCLUSION

The results suggest that national multidisciplinary summer surveillance program in the Aquitaine coast is required in order to provide alerts to the public, to better identify patients at risk for developing severe clinical symptoms, and hopefully to improve quality of health care.