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Yu E, Altschuh L. Clinical Management of North American Snake and Marine Envenomations. Emerg Med Clin North Am 2024; 42:653-666. [PMID: 38925780 DOI: 10.1016/j.emc.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Envenomations are the 23rd most common reason for calls to US poison control centers, with over 35,000 incidents reported annually. Snake bites account for over 20% of those calls, while marine envenomations are likely underreported at 3% to 4%.1 While these types of envenomations may not be encountered on a daily basis for many physicians, the different types of envenomations warrant unique management strategies based on the offending creature and symptom presentation. This text serves as a review of the epidemiology, clinical presentations, and management of endemic North American species of snakes and marine vertebrate and invertebrate envenomations.
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Affiliation(s)
- Elaine Yu
- Department of Emergency Medicine, University of California San Diego, 200 W. Arbor Drive #8676, San Diego, CA 92103, USA
| | - Lauren Altschuh
- Department of Emergency Medicine, University of California San Diego, 1501 India Street, Suite 103-147, San Diego, CA 92101, USA.
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2
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Peng X, Liu KT, Chen JB, Yan ZH, Danso B, Wang MK, Peng ZY, Xiao L. Jellyfish Stings: A Review of Skin Symptoms, Pathophysiology, and Management. Med Sci Monit 2024; 30:e944265. [PMID: 39074073 PMCID: PMC11297359 DOI: 10.12659/msm.944265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/03/2024] [Indexed: 07/31/2024] Open
Abstract
With the surge in the human coastal population and the increasing frequency of human activities along the coast, cases of marine envenomation, particularly jellyfish envenomation, have notably risen. Jellyfish stings can induce a spectrum of symptoms that vary in severity, encompassing skin injuries, acute systemic venom effects, delayed indirect sequelae, and even fatality, causing significant distress to patients. Among these manifestations, the occurrence of skin lesions following jellyfish stings is prevalent and substantial. These lesions are characterized by evident blister formation, development of bullae, subcutaneous hemorrhage, erythema, papules, wheal, ecchymosis, and ulceration or skin necrosis. Local cutaneous manifestations may persist for several weeks or even months after the initial sting. Despite aggressive treatment, many skin injuries still result in significant pigmentation or scarring after recovery. To address this issue effectively, it is imperative to conduct comprehensive evidence-based medical research, elucidate various components within jellyfish venom, and elucidate its pathogenic mechanism to develop targeted treatment programs. This article aims to review the skin symptoms, pathophysiology, and management of jellyfish stings. Such considerations can provide comprehensive guidance to medical professionals and the public and minimize the harm caused by jellyfish stings.
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Affiliation(s)
- Xiao Peng
- Faculty of Naval Medicine, Naval Medical University (Second Military Medical University), Shanghai, PR China
| | - Ke-tong Liu
- Faculty of Naval Medicine, Naval Medical University (Second Military Medical University), Shanghai, PR China
| | - Jing-bo Chen
- Faculty of Naval Medicine, Naval Medical University (Second Military Medical University), Shanghai, PR China
- Key Laboratory of Biosafety Defense (Naval Medical University), Ministry of Education, Shanghai, PR China
- Shanghai Key Laboratory of Medical Biodefense, Shanghai, PR China
| | - Zi-hao Yan
- Faculty of Naval Medicine, Naval Medical University (Second Military Medical University), Shanghai, PR China
| | - Blessing Danso
- Faculty of Naval Medicine, Naval Medical University (Second Military Medical University), Shanghai, PR China
| | - Ming-ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai, PR China
| | - Zhao-yun Peng
- Faculty of Naval Medicine, Naval Medical University (Second Military Medical University), Shanghai, PR China
- Key Laboratory of Biosafety Defense (Naval Medical University), Ministry of Education, Shanghai, PR China
- Shanghai Key Laboratory of Medical Biodefense, Shanghai, PR China
| | - Liang Xiao
- Faculty of Naval Medicine, Naval Medical University (Second Military Medical University), Shanghai, PR China
- Key Laboratory of Biosafety Defense (Naval Medical University), Ministry of Education, Shanghai, PR China
- Shanghai Key Laboratory of Medical Biodefense, Shanghai, PR China
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3
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Niżnik Ł, Jabłońska K, Orczyk M, Orzechowska M, Jasińska J, Smoliniec B, Hućko A, Kosowicz P, Klocek A, Słoma P, Roztoczyńska A, Toporowska-Kaźmierak J, Jurowski K. Hot-Water Immersion (HWI) or Ice-Pack Treatment (IPT) as First Aid for Human Envenomation by Marine Animals? Review of Literature. Toxins (Basel) 2024; 16:273. [PMID: 38922167 PMCID: PMC11209160 DOI: 10.3390/toxins16060273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
Envenomation by marine animals poses a significant health concern globally, affecting both local residents and tourists in coastal regions. The primary objective of this review is to critically evaluate the existing scientific literature to determine the most effective first-aid treatment for envenomations caused by marine animals, specifically whether hot-water immersion (HWI) or ice-pack treatment (IPT) provides the best immediate care. This comprehensive review covers a wide range of marine envenomations, from jellyfish stings to stingray injuries. While our focus is primarily on the efficacy of HWI and IPT, we also explore the role of cold-water treatment as a result of its relevance and similarity to ice-pack applications. In addition, we examine other treatments mentioned in the literature, such as medications or vinegar, and highlight their findings where applicable. To provide a clear and structured overview, we summarised the articles in separate tables. These tables categorise the type of research conducted, the marine species studied, the region of origin of the marine species, and the key findings of each study. Our analysis of the available evidence indicates a general consensus in the scientific community on the effectiveness of HWI or IPT for envenomation by marine animals. However, when treating those injuries, it is crucial to consider all factors since there is no universally superior treatment due to the diverse nature of marine habitats.
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Affiliation(s)
- Łukasz Niżnik
- Department of Regulatory and Forensic Toxicology, Institute of Medical Expertise, Łódź, ul. Aleksandrowska 67/93, 91-205 Łódź, Poland
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Karolina Jabłońska
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Michał Orczyk
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Martyna Orzechowska
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Judyta Jasińska
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Barbara Smoliniec
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Agnieszka Hućko
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Piotr Kosowicz
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Anna Klocek
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Paweł Słoma
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Aleksandra Roztoczyńska
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Joanna Toporowska-Kaźmierak
- Toxicological Science Club ‘Paracelsus’, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland (A.K.)
| | - Kamil Jurowski
- Department of Regulatory and Forensic Toxicology, Institute of Medical Expertise, Łódź, ul. Aleksandrowska 67/93, 91-205 Łódź, Poland
- Laboratory of Innovative Toxicological Research and Analyses, Institute of Medical Sciences, Medical College, Rzeszów University, Al. mjr. W. Kopisto 2a, 35-959 Rzeszow, Poland
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Li A, Yu H, Li R, Yue Y, Yu C, Liu S, Xing R, Li P. Effects of toxin metalloproteinases from jellyfish Nemopilema nomurai nematocyst on the dermal toxicity and potential treatment of jellyfish dermatitis. Int Immunopharmacol 2024; 128:111492. [PMID: 38218009 DOI: 10.1016/j.intimp.2024.111492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/15/2024]
Abstract
Jellyfish dermatitis is a common medical problem in many countries due to the jellyfish envenomation. However, there are no specific and targeted medications for their treatment. Here we investigated the possible therapeutic effects of metalloproteinase inhibitors on the dermal toxicity of Nemopilema nomurai nematocyst venom (NnNV), a giant venomous jellyfish from China, using the jellyfish dermatitis model, focusing on inflammatory effector molecules during jellyfish envenomation. Metalloproteinase may further stimulate inflammation by promoting oxidative stress in the organism and play key roles by activating MAPK and NF-κB, in the pathogenesis of jellyfish dermatitis. And the metalloproteinase inhibitors batimastat and EDTA disodium salt may treat the Jellyfish dermatitis by inhibiting the metalloproteinase activity in NnNV. These observations suggest that the metalloproteinase components of NnNV make a considerable contribution to dermal toxicity as the inflammation effect molecular, and metalloproteinase inhibitors can be regarded as novel therapeutic medicines in jellyfish envenomation. This study contributes to understanding the mechanism of jellyfish dermatitis and suggests new targets and ideas for the treatment of jellyfish envenomation.
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Affiliation(s)
- Aoyu Li
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Huahua Yu
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China.
| | - Rongfeng Li
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China
| | - Yang Yue
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China
| | - Chunlin Yu
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China
| | - Song Liu
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China
| | - Ronge Xing
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China
| | - Pengcheng Li
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao 266071, China; Laboratory for Marine Drugs and Bioproducts, Pilot National Laboratory for Marine Science and Technology (Qingdao), No. 1 Wenhai Road, Qingdao 266237, China
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Yang K, Klausner JD. Case Report: Unusual Bullous Reaction to Physalia physalis Venom after Recurrent Envenomation. Am J Trop Med Hyg 2023; 109:201-204. [PMID: 37160271 PMCID: PMC10324016 DOI: 10.4269/ajtmh.23-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/05/2023] [Indexed: 05/11/2023] Open
Abstract
Physalia physalis, often referred to colloquially as Portuguese man-of-war or bluebottle jellyfish, is a jellyfish-like organism found in tropical and subtropical areas of the Pacific, Atlantic, and Indian Oceans. Most often, envenomation by P. physalis tentacles results in painful but self-resolving epidermal stings. We report on two clinic visits of a patient who suffered from worsening reactions to recurrent P. physalis envenomation. The first clinical episode involved urticaria and severe pruritus that was worse than the pruritus the patient had experienced upon envenomation in the past. The second episode involved an unusual bullous reaction. Further study into the compounds present in P. physalis venom may help elucidate the mechanism of the present case and other abnormal reactions to envenomation. Patients and providers who care for patients at risk for recurrent stings (e.g., surfers, fishermen) should be cognizant of the potential for worsening reactions to envenomation. Further study into therapies such as oral antihistamines and Aloe vera gel may uncover additional appropriate treatments for symptomatic relief of P. physalis envenomation.
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Affiliation(s)
- Kevin Yang
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jeffrey D. Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, California
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McGee RG, Webster AC, Lewis SR, Welsford M. Interventions for the symptoms and signs resulting from jellyfish stings. Cochrane Database Syst Rev 2023; 6:CD009688. [PMID: 37272501 PMCID: PMC10240560 DOI: 10.1002/14651858.cd009688.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Jellyfish envenomation is common in many coastal regions and varies in severity depending upon the species. Stings cause a variety of symptoms and signs including pain, dermatological reactions, and, in some species, Irukandji syndrome (which may include abdominal/back/chest pain, tachycardia, hypertension, cardiac phenomena, and, rarely, death). Many treatments have been suggested for these symptoms, but their effectiveness is unclear. This is an update of a Cochrane Review last published in 2013. OBJECTIVES To determine the benefits and harms associated with the use of any intervention, in both adults and children, for the treatment of jellyfish stings, as assessed by randomised and quasi-randomised trials. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and Web of Science up to 27 October 2022. We searched clinical trials registers and the grey literature, and conducted forward-citation searching of relevant articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs of any intervention given to treat stings from any species of jellyfish stings. Interventions were compared to another active intervention, placebo, or no treatment. If co-interventions were used, we included the study only if the co-intervention was used in each group. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included nine studies (six RCTs and three quasi-RCTs) involving a total of 574 participants. We found one ongoing study. Participants were either stung accidentally, or were healthy volunteers exposed to stings in a laboratory setting. Type of jellyfish could not be confirmed in beach settings and was determined by investigators using participant and local information. We categorised interventions into comparison groups: hot versus cold applications; topical applications. A third comparison of parenteral administration included no relevant outcome data: a single study (39 participants) evaluated intravenous magnesium sulfate after stings from jellyfish that cause Irukandji syndrome (Carukia). No studies assessed a fourth comparison group of pressure immobilisation bandages. We downgraded the certainty of the evidence due to very serious risk of bias, serious and very serious imprecision, and serious inconsistency in some results. Application of heat versus application of cold Four studies involved accidental stings treated on the beach or in hospital. Jellyfish were described as bluebottles (Physalia; location: Australia), and box jellyfish that do not cause Irukandji syndrome (Hawaiian box jellyfish (Carybdea alata) and major box jellyfish (Chironex fleckeri, location: Australia)). Treatments were applied with hot packs or hot water (showers, baths, buckets, or hoses), or ice packs or cold packs. The evidence for all outcomes was of very low certainty, thus we are unsure whether heat compared to cold leads to at least a clinically significant reduction in pain within six hours of stings from Physalia (risk ratio (RR) 2.25, 95% confidence interval (CI) 1.42 to 3.56; 2 studies, 142 participants) or Carybdea alata and Chironex fleckeri (RR 1.66, 95% CI 0.56 to 4.94; 2 studies, 71 participants). We are unsure whether there is a difference in adverse events due to treatment (RR 0.50, 95% CI 0.05 to 5.19; 2 studies, 142 participants); these were minor adverse events reported for Physalia stings. We are also unsure whether either treatment leads to a clinically significant reduction in pain in the first hour (Physalia: RR 2.66, 95% CI 1.71 to 4.15; 1 study, 88 participants; Carybdea alata and Chironex fleckeri: RR 1.16, 95% CI 0.71 to 1.89; 1 study, 42 participants) or cessation of pain at the end of treatment (Physalia: RR 1.63, 95% CI 0.81 to 3.27; 1 study, 54 participants; Carybdea alata and Chironex fleckeri: RR 3.54, 95% CI 0.82 to 15.31; 1 study, 29 participants). Evidence for retreatment with the same intervention was only available for Physalia, with similar uncertain findings (RR 0.19, 95% CI 0.01 to 3.90; 1 study, 96 participants), as was the case for retreatment with the alternative hot or cold application after Physalia (RR 1.00, 95% CI 0.55 to 1.82; 1 study, 54 participants) and Chironex fleckeri stings (RR 0.48, 95% CI 0.02 to 11.17; 1 study, 42 participants). Evidence for dermatological signs (itchiness or rash) was available only at 24 hours for Physalia stings (RR 1.02, 95% CI 0.63 to 1.65; 2 studies, 98 participants). Topical applications One study (62 participants) included accidental stings from Hawaiian box jellyfish (Carybdea alata) treated on the beach with fresh water, seawater, Sting Aid (a commercial product), or Adolph's (papain) meat tenderiser. In another study, healthy volunteers (97 participants) were stung with an Indonesian sea nettle (Chrysaora chinensis from Malaysia) in a laboratory setting and treated with isopropyl alcohol, ammonia, heated water, acetic acid, or sodium bicarbonate. Two other eligible studies (Carybdea alata and Physalia stings) did not measure the outcomes of this review. The evidence for all outcomes was of very low certainty, thus we could not be certain whether or not topical applications provided at least a clinically significant reduction in pain (1 study, 62 participants with Carybdea alata stings, reported only as cessation of pain). For adverse events due to treatment, one study (Chrysaora chinensis stings) withdrew ammonia as a treatment following a first-degree burn in one participant. No studies evaluated clinically significant reduction in pain, retreatment with the same or the alternative treatment, or dermatological signs. AUTHORS' CONCLUSIONS Few studies contributed data to this review, and those that did contribute varied in types of treatment, settings, and range of jellyfish species. We are unsure of the effectiveness of any of the treatments evaluated in this review given the very low certainty of all the evidence. This updated review includes two new studies (with 139 additional participants). The findings are consistent with the previous review.
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Affiliation(s)
- Richard G McGee
- The University of Newcastle Central Coast Clinical School, Gosford Hospital, Gosford, Australia
- Department of Paediatrics, Gosford Hospital, Gosford, NSW, Australia
| | - Angela C Webster
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Sharon R Lewis
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton, Canada
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Trial Assay for Safe First-Aid Protocol for the Stinging Sea Anemone Anemonia viridis (Cnidaria: Anthozoa) and a Severe Toxic Reaction. Toxins (Basel) 2022; 14:toxins14010027. [PMID: 35051004 PMCID: PMC8780947 DOI: 10.3390/toxins14010027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023] Open
Abstract
Anemonia viridis is an abundant and widely distributed temperate sea anemone that can form dense congregations of individuals. Despite the potential severity of its sting, few detailed cases have been reported. We report a case of a severe toxic reaction following an A. viridis sting in a 35-year-old oceanographer. She developed severe pain, itching, redness, and burning sensation, which worsened one week after treatment with anti-inflammatories, antihistamines and corticosteroids. Prompted by this event, and due to the insufficient risk prevention, lack of training for marine-environment users, and lack of research into sting-specific first-aid protocols, we evaluated the cnidocyst response to five different compounds commonly recommended as rinse solutions in first-aid protocols (seawater, vinegar, ammonia, baking soda, and freshwater) by means of the Tentacle Solution Assay. Vinegar and ammonia triggered an immediate and massive cnidocyst discharge after their application and were classified as activator solutions. Baking soda and freshwater were also classified as activator solutions, although with a lower intensity of discharge. Only seawater was classified as a neutral solution and therefore recommended as a rinse solution after A. viridis sting, at least until an inhibitory solution is discovered.
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Auerbach PS, Gupta D, Van Hoesen K, Zavala A. Dermatological Progression of a Probable Box Jellyfish Sting. Wilderness Environ Med 2019; 30:310-320. [PMID: 31477508 DOI: 10.1016/j.wem.2019.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/29/2019] [Accepted: 05/17/2019] [Indexed: 01/22/2023]
Abstract
This case report describes the typical features of the dermatological progression of a patient stung by a (probable) box jellyfish. The purpose is to guide clinicians and patients to an understanding of what to expect after such a sting using the clinical narrative and unique sequential photographs of the injury. With knowledgeable consultation from experienced physicians and meticulous care, this envenomation healed without the need for skin grafting.
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Affiliation(s)
- Paul S Auerbach
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA.
| | - Deepak Gupta
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Karen Van Hoesen
- University of California San Diego School of Medicine, San Diego, CA
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9
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Molecular dissection of box jellyfish venom cytotoxicity highlights an effective venom antidote. Nat Commun 2019; 10:1655. [PMID: 31040274 PMCID: PMC6491561 DOI: 10.1038/s41467-019-09681-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 03/25/2019] [Indexed: 01/11/2023] Open
Abstract
The box jellyfish Chironex fleckeri is extremely venomous, and envenoming causes tissue necrosis, extreme pain and death within minutes after severe exposure. Despite rapid and potent venom action, basic mechanistic insight is lacking. Here we perform molecular dissection of a jellyfish venom-induced cell death pathway by screening for host components required for venom exposure-induced cell death using genome-scale lenti-CRISPR mutagenesis. We identify the peripheral membrane protein ATP2B1, a calcium transporting ATPase, as one host factor required for venom cytotoxicity. Targeting ATP2B1 prevents venom action and confers long lasting protection. Informatics analysis of host genes required for venom cytotoxicity reveal pathways not previously implicated in cell death. We also discover a venom antidote that functions up to 15 minutes after exposure and suppresses tissue necrosis and pain in mice. These results highlight the power of whole genome CRISPR screening to investigate venom mechanisms of action and to rapidly identify new medicines. Box jellyfish venom causes tissue damage, pain, and death through unknown molecular mechanisms. Here, Lau et al. perform a CRISPR screen to identify genes required for venom action and use this information to develop an antidote that blocks venom-induced pain and tissue damage in vivo.
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10
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Leone A, Lecci RM, Milisenda G, Piraino S. Mediterranean jellyfish as novel food: effects of thermal processing on antioxidant, phenolic, and protein contents. Eur Food Res Technol 2019. [DOI: 10.1007/s00217-019-03248-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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11
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Pirkle CM, Yanagihara AA. Insights in Public Health: Trapped in a Sea of Uncertainty: Limitations in Unintentional Injury Research in the Philippines and Interdisciplinary Solutions to Reduce Fatal Box Jellyfish Stings. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2019; 78:30-34. [PMID: 30697473 PMCID: PMC6333957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Catherine McLean Pirkle
- Office of Public Health Studies, Myron B. Thompson School of Social Work, University of Hawai'i at Manoa, Honolulu, HI (CMP)
| | - Angel Anne Yanagihara
- Pacific Cnidaria Research Laboratory, Pacific Biosciences Research Center, University of Hawai'i at Manoa, Honolulu, HI; Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI (AAY)
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12
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Remigante A, Costa R, Morabito R, La Spada G, Marino A, Dossena S. Impact of Scyphozoan Venoms on Human Health and Current First Aid Options for Stings. Toxins (Basel) 2018; 10:toxins10040133. [PMID: 29570625 PMCID: PMC5923299 DOI: 10.3390/toxins10040133] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 03/19/2018] [Accepted: 03/21/2018] [Indexed: 02/06/2023] Open
Abstract
Cnidaria include the most venomous animals of the world. Among Cnidaria, Scyphozoa (true jellyfish) are ubiquitous, abundant, and often come into accidental contact with humans and, therefore, represent a threat for public health and safety. The venom of Scyphozoa is a complex mixture of bioactive substances—including thermolabile enzymes such as phospholipases, metalloproteinases, and, possibly, pore-forming proteins—and is only partially characterized. Scyphozoan stings may lead to local and systemic reactions via toxic and immunological mechanisms; some of these reactions may represent a medical emergency. However, the adoption of safe and efficacious first aid measures for jellyfish stings is hampered by the diffusion of folk remedies, anecdotal reports, and lack of consensus in the scientific literature. Species-specific differences may hinder the identification of treatments that work for all stings. However, rinsing the sting site with vinegar (5% acetic acid) and the application of heat (hot pack/immersion in hot water) or lidocaine appear to be substantiated by evidence. Controlled clinical trials or reliable models of envenomation are warranted to confirm the efficacy and safety of these approaches and identify possible species-specific exceptions. Knowledge of the precise composition of Scyphozoa venom may open the way to molecule-oriented therapies in the future.
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Affiliation(s)
- Alessia Remigante
- Institute of Pharmacology and Toxicology, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria.
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, I-98166 Messina, Italy.
| | - Roberta Costa
- Institute of Pharmacology and Toxicology, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria.
| | - Rossana Morabito
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, I-98166 Messina, Italy.
| | - Giuseppa La Spada
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, I-98166 Messina, Italy.
| | - Angela Marino
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Viale F. Stagno D'Alcontres 31, I-98166 Messina, Italy.
| | - Silvia Dossena
- Institute of Pharmacology and Toxicology, Paracelsus Medical University, Strubergasse 21, A-5020 Salzburg, Austria.
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13
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Haddad V, Morandini AC, Rodrigues LE. Jellyfish Blooms Causing Mass Envenomations in Aquatic Marathonists: Report of Cases in S and SE Brazil (SW Atlantic Ocean). Wilderness Environ Med 2018; 29:142-145. [PMID: 29338991 DOI: 10.1016/j.wem.2017.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/16/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Vidal Haddad
- Botucatu School of Medicine, São Paulo State University, Brazil
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14
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Verdes A, Simpson D, Holford M. Are Fireworms Venomous? Evidence for the Convergent Evolution of Toxin Homologs in Three Species of Fireworms (Annelida, Amphinomidae). Genome Biol Evol 2018; 10:249-268. [PMID: 29293976 PMCID: PMC5778601 DOI: 10.1093/gbe/evx279] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2017] [Indexed: 12/14/2022] Open
Abstract
Amphinomids, more commonly known as fireworms, are a basal lineage of marine annelids characterized by the presence of defensive dorsal calcareous chaetae, which break off upon contact. It has long been hypothesized that amphinomids are venomous and use the chaetae to inject a toxic substance. However, studies investigating fireworm venom from a morphological or molecular perspective are scarce and no venom gland has been identified to date, nor any toxin characterized at the molecular level. To investigate this question, we analyzed the transcriptomes of three species of fireworms-Eurythoe complanata, Hermodice carunculata, and Paramphinome jeffreysii-following a venomics approach to identify putative venom compounds. Our venomics pipeline involved de novo transcriptome assembly, open reading frame, and signal sequence prediction, followed by three different homology search strategies: BLAST, HMMER sequence, and HMMER domain. Following this pipeline, we identified 34 clusters of orthologous genes, representing 13 known toxin classes that have been repeatedly recruited into animal venoms. Specifically, the three species share a similar toxin profile with C-type lectins, peptidases, metalloproteinases, spider toxins, and CAP proteins found among the most highly expressed toxin homologs. Despite their great diversity, the putative toxins identified are predominantly involved in three major biological processes: hemostasis, inflammatory response, and allergic reactions, all of which are commonly disrupted after fireworm stings. Although the putative fireworm toxins identified here need to be further validated, our results strongly suggest that fireworms are venomous animals that use a complex mixture of toxins for defense against predators.
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Affiliation(s)
- Aida Verdes
- Department of Chemistry, Hunter College Belfer Research Center, and The Graduate Center, Program in Biology, Chemistry and Biochemistry, City University of New York
- Department of Invertebrate Zoology, Sackler Institute for Comparative Genomics, American Museum of Natural History, New York, New York
- Departamento de Biología (Zoología), Facultad de Ciencias, Universidad Autónoma de Madrid, Spain
| | - Danny Simpson
- Department of Population Health, New York University School of Medicine
| | - Mandë Holford
- Department of Chemistry, Hunter College Belfer Research Center, and The Graduate Center, Program in Biology, Chemistry and Biochemistry, City University of New York
- Department of Invertebrate Zoology, Sackler Institute for Comparative Genomics, American Museum of Natural History, New York, New York
- Department of Biochemistry, Weill Cornell Medical College, Cornell University
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15
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Cnidarian Jellyfish: Ecological Aspects, Nematocyst Isolation, and Treatment Methods of Sting. Results Probl Cell Differ 2018; 65:477-513. [PMID: 30083932 DOI: 10.1007/978-3-319-92486-1_21] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cnidarians play an important role in ecosystem functioning, in the competition among species, and for possible utilization of several active compounds against cardiovascular, nervous, endocrine, immune, infective, and inflammatory disorders or having antitumoral properties, which have been extracted from these organisms. Nevertheless, notwithstanding these promising features, the main reason for which cnidarians are known is due to their venomousness as they have a serious impact on public health as well as in economy being able to affect some human activities. For this reason a preeminent subject of the research about cnidarians is the organization of proper systems and methods of care and treatment of stinging. This chapter aims to present the data about the morphological, ecological, toxicological, epidemiological, and therapeutic aspects regarding cnidarians with the purpose to summarize the existing knowledge and to stimulate future perspectives in the research on these organisms.
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Little M. Hot water immersion
v
icepacks for treating pain of
Chironex fleckeri
stings: a randomised controlled trial. Med J Aust 2017; 207:362. [DOI: 10.5694/mja17.00398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/13/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Mark Little
- James Cook University, Cairns, QLD
- Cairns Hospital, Cairns, QLD
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Doyle TK, Headlam JL, Wilcox CL, MacLoughlin E, Yanagihara AA. Evaluation of Cyanea capillata Sting Management Protocols Using Ex Vivo and In Vitro Envenomation Models. Toxins (Basel) 2017; 9:E215. [PMID: 28686221 PMCID: PMC5535162 DOI: 10.3390/toxins9070215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/27/2017] [Accepted: 07/03/2017] [Indexed: 01/19/2023] Open
Abstract
Lion's mane jellyfish (Cyanea capillata) stings cause severe pain and can lead to dangerous systemic effects, including Irukandji-like syndrome. As is the case for most cnidarian stings, recommended medical protocols in response to such stings lack rigorous scientific support. In this study, we sought to evaluate potential first aid care protocols using previously described envenomation models that allow for direct measurements of venom activity. We found that seawater rinsing, the most commonly recommended method of tentacle removal for this species, induced significant increases in venom delivery, while rinsing with vinegar or Sting No More® Spray did not. Post-sting temperature treatments affected sting severity, with 40 min of hot-pack treatment reducing lysis of sheep's blood (in agar plates), a direct representation of venom load, by over 90%. Ice pack treatment had no effect on sting severity. These results indicate that sting management protocols for Cyanea need to be revised immediately to discontinue rinsing with seawater and include the use of heat treatment.
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Affiliation(s)
- Thomas K Doyle
- Discipline of Zoology, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway H91 W5P7, Ireland.
| | - Jasmine L Headlam
- Discipline of Zoology, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway H91 W5P7, Ireland.
| | - Christie L Wilcox
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI 96813, USA.
| | - Eoin MacLoughlin
- Discipline of Zoology, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway H91 W5P7, Ireland.
| | - Angel A Yanagihara
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI 96813, USA.
- Békésy Laboratory of Neurobiology, Pacific Biosciences Research Center, School of Ocean and Earth Science and Technology, University of Hawaii at Mānoa, Honolulu, HI 96822, USA.
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18
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Wilcox CL, Headlam JL, Doyle TK, Yanagihara AA. Assessing the Efficacy of First-Aid Measures in Physalia sp. Envenomation, Using Solution- and Blood Agarose-Based Models. Toxins (Basel) 2017; 9:E149. [PMID: 28445412 PMCID: PMC5450697 DOI: 10.3390/toxins9050149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 01/22/2023] Open
Abstract
Stings from the hydrozoan species in the genus Physalia cause intense, immediate skin pain and elicit serious systemic effects. There has been much scientific debate about the most appropriate first aid for these stings, particularly with regard to whether vinegar use is appropriate (most current recommendations recommend against vinegar). We found that only a small percentage (≤1.0%) of tentacle cnidae discharge during a sting event using an ex vivo tissue model which elicits spontaneous stinging from live cnidarian tentacles. We then tested a variety of rinse solutions on both Atlantic and Pacific Physalia species to determine if they elicit cnidae discharge, further investigating any that did not cause immediate significant discharge to determine if they are able to inhibit cnidae discharge in response to chemical and physical stimuli. We found commercially available vinegars, as well as the recently developed Sting No More® Spray, were the most effective rinse solutions, as they irreversibly inhibited cnidae discharge. However, even slight dilution of vinegar reduced its protective effects. Alcohols and folk remedies, such as urine, baking soda and shaving cream, caused varying amounts of immediate cnidae discharge and failed to inhibit further discharge, and thus likely worsen stings.
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Affiliation(s)
- Christie L Wilcox
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA.
| | - Jasmine L Headlam
- Discipline of Zoology, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway H91 W5P7, Ireland.
| | - Thomas K Doyle
- Discipline of Zoology, School of Natural Sciences, Ryan Institute, National University of Ireland Galway, Galway H91 W5P7, Ireland.
| | - Angel A Yanagihara
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA.
- Békésy Laboratory of Neurobiology, Pacific Biosciences Research Center, University of Hawaii at Manoa, Honolulu, HI 96822, USA.
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19
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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:E105. [PMID: 28294982 PMCID: PMC5371860 DOI: 10.3390/toxins9030105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 01/22/2023] Open
Abstract
Cnidarian envenomations are the leading cause of severe and lethal human sting injuries from marine life. The total amount of venom discharged into sting-site tissues, sometimes referred to as "venom load", has been previously shown to correlate with tentacle contact length and sequelae severity. Since <1% of cnidae discharge upon initial tentacle contact, effective and safe removal of adherent tentacles is of paramount importance in the management of life-threatening cubozoan stings. We evaluated whether common rinse solutions or scraping increased venom load as measured in a direct functional assay of venom activity (hemolysis). Scraping significantly increased hemolysis by increasing cnidae discharge. For Alatina alata, increases did not occur if the tentacles were first doused with vinegar or if heat was applied. However, in Chironex fleckeri, vinegar dousing and heat treatment were less effective, and the best outcomes occurred with the use of venom-inhibiting technologies (Sting No More® products). Seawater rinsing, considered a "no-harm" alternative, significantly increased venom load. The application of ice severely exacerbated A. alata stings, but had a less pronounced effect on C. fleckeri stings, while heat application markedly reduced hemolysis for both species. Our results do not support scraping or seawater rinsing to remove adherent tentacles.
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Affiliation(s)
- Angel Anne Yanagihara
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI 96822, USA.
- Békésy Laboratory of Neurobiology, Pacific Biosciences Research Center, University of Hawaii at Mānoa, Honolulu, HI 96822, USA.
| | - Christie L Wilcox
- Department of Tropical Medicine, Medical Microbiology and Pharmacology, John A. Burns School of Medicine, University of Hawaii at Mānoa, Honolulu, HI 96822, USA.
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20
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Crude venom from nematocysts of Pelagia noctiluca (Cnidaria: Scyphozoa) elicits a sodium conductance in the plasma membrane of mammalian cells. Sci Rep 2017; 7:41065. [PMID: 28112211 PMCID: PMC5253680 DOI: 10.1038/srep41065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/14/2016] [Indexed: 01/25/2023] Open
Abstract
Cnidarians may negatively impact human activities and public health but concomitantly their venom represents a rich source of bioactive substances. Pelagia noctiluca is the most venomous and abundant jellyfish of the Mediterranean Sea and possesses a venom with hemolytic and cytolytic activity for which the mechanism is largely unknown. Here we show that exposure of mammalian cells to crude venom from the nematocysts of P. noctiluca profoundly alters the ion conductance of the plasma membrane, therefore affecting homeostatic functions such as the regulation and maintenance of cellular volume. Venom-treated cells exhibited a large, inwardly rectifying current mainly due to permeation of Na+ and Cl−, sensitive to amiloride and completely abrogated following harsh thermal treatment of crude venom extract. Curiously, the plasma membrane conductance of Ca2+ and K+ was not affected. Current-inducing activity was also observed following delivery of venom to the cytosolic side of the plasma membrane, consistent with a pore-forming mechanism. Venom-induced NaCl influx followed by water and consequent cell swelling most likely underlie the hemolytic and cytolytic activity of P. noctiluca venom. The present study underscores unique properties of P. noctiluca venom and provides essential information for a possible use of its active compounds and treatment of envenomation.
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21
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Little M, Fitzpatrick R, Seymour J. Successful use of heat as first aid for tropical Australian jellyfish stings. Toxicon 2016; 122:142-144. [PMID: 27720978 DOI: 10.1016/j.toxicon.2016.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/29/2016] [Accepted: 10/04/2016] [Indexed: 11/28/2022]
Abstract
Currently the Australian Resuscitation Council (ARC) recommends dousing with vinegar followed by ice as first aid for jellyfish stings in tropical Australia, with limited evidence to support this recommendation (Li et al., 2013). We report our successful experience in using hot water immersion as first aid in treating two people stung by venomous tropical Australian jellyfish, one by Chironex fleckeri and one by Carukia barnesi.
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Affiliation(s)
- Mark Little
- FACEM MPH &TM DTM & H Department of Emergency Medicine, Cairns Hospital, Cairns, Australia; Queensland Tropical Health Alliance School of Public Health and Tropical Medicine, James Cook University, Australia.
| | - Richard Fitzpatrick
- Queensland Tropical Health Alliance, James Cook University, Cairns Campus, Mcgregor Road, 4878, Cairns, Australia
| | - Jamie Seymour
- Queensland Tropical Health Alliance, School of Public Health and Tropical Medicine, Centre for Biodiscovery & Molecular Development of Therapeutics, Queensland Emergency Medical Research Foundation, Faculty of Medicine, Health & Molecular Sciences, James Cook University, Cairns Campus, Mcgregor Road, 4878, Cairns, Australia
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