Irukandji syndrome case series from Australia's Tropical Northern Territory.
OBJECTIVE
We describe Irukandji syndrome (a painful hypercatecholaminergic condition caused by jellyfish envenoming) in Australia's Northern Territory.


METHODS
We collected prospectively a standardized data set on patients presenting to health facilities in the Northern Territory. Additional cases were identified retrospectively. Data collected included demographic, geographic, seasonal, and environmental features, as well as sting details, clinical manifestations, investigations, management, and outcomes.


RESULTS
From 1990 to 2007, Irukandji syndrome affected 87 people. Age ranged from 1 to 51 years (64% male victims; 41% children [63% indigenous]). Activities associated with stings included snorkeling or scuba diving (35%) and swimming (29%). Stings commonly occurred in water greater than 2 m deep (63%), with fine weather (73%) and still or light breeze (70%). Seasonal variation was bimodal; peaks in May and October corresponded to prevailing offshore winds in the Darwin and Gove areas, respectively. Pain was severe (65%), with rapid onset (<30 minutes in 79%). Sting lesions (visible in 63%) were mild, and nematocysts (detected in 7 cases) had variable morphology. Systemic features were common, including hypertension and ECG abnormalities. Severe complications included troponin-level increases (2 cases) and cardiomyopathy with ventricular tachycardia (1 case), but no fatalities. Management included vinegar as first aid (66%), parenteral opioids (70%) (range 2 to 82.5 mg morphine equivalents in adults), and magnesium sulfate (3 cases). Hospital admission (49%) and aeromedical retrieval (16%) were commonplace.


CONCLUSIONS
Irukandji syndrome in the Northern Territory was clinically consistent with previous studies but had distinct seasonal, geographic, and environmental features. Indigenous children in remote coastal communities are at risk, and there is room for improvement in prevention and management.
Nickson
Christopher P
CP
Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Waugh
Edith B
EB
Jacups
Susan P
SP
Currie
Bart J
BJ
D019342:Acetic Acid / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000777:Anesthetics / Q000627:therapeutic use; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D001733:Bites and Stings / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D009202:Cardiomyopathies / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D003064:Cnidarian Venoms / Q000037:antagonists & inhibitors; D005260:Female; D005392:First Aid; D006760:Hospitalization; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000628:therapy; D007202:Indicators and Reagents / Q000627:therapeutic use; D007223:Infant; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D015876:Northern Territory / Q000453:epidemiology; D010146:Pain / Q000175:diagnosis / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement; D011042:Poisons / Q000627:therapeutic use; D011446:Prospective Studies; D012189:Retrospective Studies; D037401:Scyphozoa; D012621:Seasons; D013550:Swimming / Q000293:injuries*; D013577:Syndrome; D016896:Treatment Outcome; D055815:Young Adult
D000701:Analgesics, Opioid; D000777:Anesthetics; D000997:Antivenins; D003064:Cnidarian Venoms; D007202:Indicators and Reagents; D011042:Poisons; D008278:Magnesium Sulfate; D019342:Acetic Acid