Jellyfish

Aka: Jellyfish, Cnidaria Sting, Cnidaria, Cnidarian Venom, Nematocyst Sting, Portuguese Man-Of-War, Sea Nettle

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II. Background

  1. Invertebrates of phylum Cnidaria
    1. Inhabit shallow coastal waters
    2. Cnidaria includes (all have stinging nematocyst, anchor the skin and degranulate)
      1. Jellyfish
      2. Portuguese Man-Of-War
      3. Anemones
      4. Hydroids (fern-like fixed marine organism)
      5. Sea anemones
      6. Coral
        1. Responsible for more human cuts than Envenomation
        2. Often causes pruritic, red wheals at wound sites
        3. Remove debris and copiously irrigate with water
  2. Jellyfish (also called Sea Nettle) Anatomy
    1. Bell: Semi-transparent umbrella-shaped
      1. Varies in diameter from inches to 7 feet
    2. Tentacles
      1. As long as 100 feet in some cases
      2. Contain stinging namatocysts
  3. Portuguese Man-Of-War
    1. Bell: Purple air float (up to 12 cm in size)
      1. Float rides above surface of water
      2. Analogous to a sail, catching the wind to move
    2. Tentacles
      1. As with Jellyfish, contain nematocysts
      2. Tentacles may be several feet in length

III. Epidemiology

  1. Cnidaria responsible for most Marine Envenomations

IV. Pathophysiology

  1. Nematocysts on tentacles responsible for stinging
  2. Nematocysts may sting even if tentacle detached

V. Symptoms (duration 2-3 days)

  1. Local burning pain
  2. Paresthesias
  3. Systemic symptoms occur in severe Envenomation
    1. Nausea or Vomiting
    2. Headache
    3. Myalgias
    4. Ataxia or Dizziness

VI. Signs

  1. Local dermatitis
    1. Local erythema and edema
    2. Linear Papules
    3. Wheals
  2. Lesions resolve within hours
    1. Some lesions may necrose and Blister
  3. Severe systemic symptoms may occur
    1. Onset 5 minutes to hours after sting
    2. Observe for symptom rebound 6-8 hours after episode

VII. Associated conditions

  1. Seabather's Eruption
    1. Pruritic dermatitis related to Cnidaria larvae

VIII. Management

  1. Avoid envenomated limb movement
  2. Rinse wounds wounds immediately with sea water (salt water, NOT fresh water)
  3. Apply 5% acetic acid or vinegar to area for 30 minutes
    1. Avoid Fresh water (will cause nematocyst discharge), Alcohol or urine
    2. Vinegar is contraindicated in Portuguese Man-Of-War stings (risk of venom release)
  4. Remove nematocysts and tentacles from skin
    1. Use credit card, shell or stick to scrape off
    2. Use gloves, or forceps
    3. Alternative method
      1. Apply shaving cream or Baking Soda slurry to area
      2. Use razor to scrape off nematocysts
    4. Do not rub or remove with towel
    5. Avoid compression
  5. After nematocysts and tentacles removal
    1. Shower in or soaking region in hot water for 20 minutes (inactivates venom)
  6. Other conservative measures
    1. Apply heat or cold to area
    2. Oral Analgesics and Antihistamines may relieve pain and Pruritus
    3. Avoid ineffective measures (meat tenderizer, ammonia, lemon)
    4. No data on Topical Corticosteroids

IX. Course

  1. Symptom recurrence may happen within first month
  2. Fatalities are rare, but may occur if Anaphylaxis
  3. Stings with highest severity (most venomous)
    1. Australian Jellyfish
    2. Box Jellyfish (Hawaii)
      1. Antivenin (antivenom) is available and recommended

X. Prevention

  1. Wet suit use reduces risk of stings

XI. References

  1. (2021) Presc Lett 28(7): 40
  2. Auerbach (2017) EM:Rap 17(10):6-7
  3. Habif (1996) Dermatology, p. 491
  4. Perkins (2004) Am Fam Physician 69(4): 885-90 [PubMed]

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Related Studies

Ontology: Cnidaria (C0009222)

Definition (MSH) A phylum of radially symmetrical invertebrates characterized by possession of stinging cells called nematocysts. It includes the classes ANTHOZOA; CUBOZOA; HYDROZOA, and SCYPHOZOA. Members carry CNIDARIAN VENOMS.
Definition (CSP) phylum of radially symmetrical invertebrates characterized by possession of stinging cells called nematocysts; includes the classes Anhozoa, Cubozoa, Hydrozoa, and Scyphozoa; members carry Cnidarian venoms.
Concepts Eukaryote (T204)
MSH D003063
SnomedCT 106900006, 112484004
English Coelenterata, Cnidarians, Coelenterate, Coelenterates, Kingdom animalia - phylum coelenterata - cnidaria (organism), Phylum Cnidaria (organism), Phylum Cnidaria, Phylum: Coelenterata, Kingdom animalia - phylum coelenterata - cnidaria, Cnidarias, Cnidarian, Coelenterate (organism), coelenterates, Cnidaria, Coelenterate, NOS
Spanish tipo Cnidaria, filo Cnidaria, tipo Cnidaria (organismo), reino animalia - tipo coelenterata - cnidaria (organismo), reino animalia - filo coelenterata - cnidaria, reino animalia - tipo coelenterata - cnidaria, tipo: Coelenterata, coelenterado, coelenterado (organismo), Cnidaria, Cnidarios
French Cnidaires, Cnidaria
Swedish Cnidaria
Czech Cnidaria
Finnish Meduusat
Russian RADIAL'NYE, KNIDARII, KISHECHNOPOLOSTNYE, COELENTERATA, КИШЕЧНОПОЛОСТНЫЕ, КНИДАРИИ, РАДИАЛЬНЫЕ
Japanese 刺胞動物, 腔腸動物, 刺胞動物門, 珊瑚, 腔腸動物門, サンゴ
Italian Cnidari, Cnidaria
Polish Jamochłony, Parzydełkowce, Cnidaria
Norwegian Cnidaria, Nesledyr, Polyppdyr
Portuguese Cnidaria, Cnidários
German Cnidaria
Dutch Cnidaria, Neteldieren
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Cnidarian Venoms (C0009223)

Definition (MSH) Venoms from jellyfish; CORALS; SEA ANEMONES; etc. They contain hemo-, cardio-, dermo- , and neuro-toxic substances and probably ENZYMES. They include palytoxin, sarcophine, and anthopleurine.
Concepts Biologically Active Substance (T123) , Hazardous or Poisonous Substance (T131)
MSH D003064
English Cnidarian Venoms, Venoms, Cnidarian, Cnidarian Venom, Venom, Cnidarian, Cnidarian Venoms [Chemical/Ingredient]
Swedish Cnidariagifter
Czech láčkovci - jedy
Finnish Meduusa-myrkyt
Russian AKTINII IADY, CHIRONEX, IADY, MORSKIKH ANEMON IADY, IADY KISHECHNOPOLOSTNYKH, KNIDARII IADY, MEDUZ IADY, CHIRONEX, ЯДЫ, АКТИНИЙ ЯДЫ, КНИДАРИЙ ЯДЫ, МЕДУЗ ЯДЫ, МОРСКИХ АНЕМОН ЯДЫ, ЯДЫ КИШЕЧНОПОЛОСТНЫХ
Japanese 腔腸動物毒液, 刺胞動物毒, クラゲ毒, イソギンチャク毒, 腔腸動物毒
Italian Veleno degli cnidari, Veleni degli cnidari
Croatian ŽARNJACI, OTROVI
French Venins de cnidaires, Venins de coelentérés
Polish Jady jamochłonów, Jady parzydełkowców
Spanish Venenos de Cnidaria, Venenos de Cnidarios
Portuguese Venenos de Cnidaria, Venenos de Cnidários
German Nesseltiergifte
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Scyphozoa (C0036475)

Definition (MSH) The class of true jellyfish, in the phylum CNIDARIA. They are mostly free-swimming marine organisms that go through five stages in their life cycle and exhibit two body forms: polyp and medusa.
Concepts Eukaryote (T204)
MSH D037401
SnomedCT 421819007
English Jellyfish, Class Scyphozoa (organism), Class Scyphozoa, Cup animals, Scyphozoa, Jellyfishs, True, Scyphozoas, True Jellyfish, True Jellyfishs, Jellyfish, True
Spanish clase Scyphozoa, clase Scyphozoa (organismo), Scyphozoa, Escifozoos, Escifomedusas, Medusa Verdadera
French Scyphozoaires, Méduses vraies, Scyphozoa
Swedish Scyphozoa
Czech Scyphozoa, medúzovci
Finnish Scyphozoa
Russian STSIFOIDNYE, MEDUZA, MEDUZA ISTINNAIA, MEDUZA ZHGUCHAIA ZAPADNOGO POBEREZH'IA, MEDUZA LUNNAIA, МЕДУЗА, МЕДУЗА ЖГУЧАЯ ЗАПАДНОГО ПОБЕРЕЖЬЯ, МЕДУЗА ИСТИННАЯ, МЕДУЗА ЛУННАЯ, СЦИФОИДНЫЕ
Japanese 鉢クラゲ綱, 鉢水母綱, 鉢虫綱, クラゲ, ハチクラゲ綱, 水母, 鉢虫類, 無縁膜クラゲ類, 真正クラゲ類, 鉢クラゲ類
Italian Meduse, Scifozoi, Scyphozoa
Portuguese Cifozoários, Scyphozoa, Cifomedusas, Medusas-Verdadeiras
Polish Scyphozoa, Meduzy
Norwegian Scyphozoa, Maneter
German Scyphozoen, Quallen, echte, Scyphozoa
Dutch Scyphozoa, Echte kwal, Kwal, oor-, Kwal, schijf-, Oorkwal, Schijfkwal
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Physalia physalis (C0324033)

Concepts Eukaryote (T204)
MSH D037402
SnomedCT 55421002
French Galère portugaise, Physalia physalis, Physalie
English Portuguese-man-of-war, Man-of-Wars, Portuguese, Portuguese Man of War, physali, Physalia, Portuguese Man-of-Wars, Physalia physali, physalis, Physalia, Man-of-War, Portuguese, portuguese man of war, portuguese man-of-war, Physalia physalis, Portuguese man of war (organism), Portuguese man of war, Portuguese Man-of-War
Czech Physalia physalis, měchýřovka portugalská
Portuguese Caravela-Portuguesa, Physalia physalis
Spanish Guerrero Portugués, fragata portuguesa, fisalia (organismo), carabela portuguesa, sifonóforo, fisalia, Physalia physalis
German Portugiesische Galeere, Physalia physalis
Italian Caravella portoghese, Physalia physalis
Norwegian Portugisisk krigsskip, Physalia physalis
Dutch Physalia physalis
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Stung by nematocyst (C0417708)

Concepts Injury or Poisoning (T037)
SnomedCT 269707006
Spanish picado por nematocisto (evento), picado por nematocisto (hallazgo), picado por nematocisto
English Stung by nematocyst, Stung by nematocyst (finding), Stung by nematocyst (event)
Derived from the NIH UMLS (Unified Medical Language System)

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