Severity of Irukandji syndrome and nematocyst identification from skin scrapings.
OBJECTIVE
(1) To identify the causative jellyfish species by examining skin scrapings in patients presenting to Cairns Base Hospital with marine stings, and (2) to describe clinical outcomes of those with Irukandji syndrome and those in whom nematocysts were identified from skin scrapings.


METHODS
(1) A retrospective case series of 128 patients, identified from Cairns Base Hospital emergency department records with discharge diagnoses of marine stings between 1 July 2001 and 30 June 2002. (2) A prospective study of skin scrapings from 50 patients presenting with marine stings from the same period.


METHODS
Number of patients with Irukandji syndrome, their opioid requirements and cardiac findings (where available); identification of causative species from nematocysts isolated from skin scrapings.


RESULTS
116 patients retrospectively identified with marine stings had Irukandji syndrome. Of 50 patients who had skin scrapings, 39 had nematocysts consistent with Carukia barnesi. Symptoms experienced ranged from local pain alone to severe Irukandji syndrome with elevated troponin I levels, changes on electrocardiogram, cardiac dysfunction on echocardiography, and high opioid dose requirements. One patient had an unidentified cnidome on his skin scraping. He developed severe Irukandji syndrome and subsequently died from its complications.


CONCLUSIONS
This is the first published report of Carukia barnesi being successfully identified from skin scrapings. Most patients with identifiable cnidomes experiencing Irukandji syndrome were stung by Carukia barnesi, which we show causes a wide range of illness, including cardiac dysfunction. Our finding of a cnidome not consistent with Carukia barnesi in the setting of Irukandji syndrome makes it possible that other species of jellyfish may also cause this syndrome.
Huynh
Truc T
TT
Emergency Department, Cairns Base Hospital, Cairns, Queensland 4870, Australia.
Seymour
Jamie
J
Pereira
Peter
P
Mulcahy
Richard
R
Cullen
Paul
P
Carrette
Teresa
T
Little
Mark
M
D000328:Adult; D000818:Animals; D001733:Bites and Stings / Q000150:complications*; D003064:Cnidarian Venoms; D037462:Cubozoa; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology; D013577:Syndrome
D003064:Cnidarian Venoms