title: Severe Dermatonecrotic Toxin and Wound Complications Associated With Box Jellyfish Stings 2008-2013.
abstract: BACKGROUND
  The Toxic Jellyfish Network and its surveillance system were set up in 2008 and in 2009, respectively. Case investigations detected 3 cases with severe cutaneous injuries described in this article.
  
  
  METHODS
  There were 57 probable cases of box jellyfish stings between 2008 and 2013. Three of these injuries resulted in dermal necrosis, and 2 were associated with severe wound complications. A Thai man aged 21 years sustained wounds on his left knee and thigh. He received oral antibiotics and daily wet dressings; he did not receive steroids. He subsequently developed blisters, swelling of the lower left leg, neuritis, and severe itching in the later stages. Nevertheless, his wounds did not become infected and there was no keloid scarring. An American woman aged 25 years sustained stings on her right hand and arm. She received antibiotic ointment and a tape that was placed directly on the wound without any gauze or padding underneath. She developed a wound infection 2 weeks postinjury. Surgical debridement was required twice to remove necrotic tissue; keloid scars persisted on evaluation at 4 months. An American woman aged 33 years received stings on her left upper thigh. Initial treatment was provided by local residents, who crushed morning glory leaves to extract the juice and then applied the juice (mixed with water) to her wounds. She received intravenous steroids, oral antihistamines, oral analgesics, and antibiotic cream at the hospital. Despite this aggressive treatment, the wounds became gangrenous and surgical debridement was required to remove necrotic tissue.
  
  
  CONCLUSIONS
  Clinicians need to be knowledgeable regarding the potentially serious wounds that can develop following jellyfish stings. Additional research is needed to identify best management approaches.
authors.affiliation: Lakkana Thaikruea, MD, PhD, Community Medicine Department, Medicine Faculty, Chiang Mai University, Chiang Mai, Thailand. Potjaman Siriariyaporn, MD, DrPh, Epidemiology Bureau, Disease Control Department, Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Lakkana
authors.initials: L
authors.lastname: Thaikruea
authors.forename: Potjaman
authors.initials: P
authors.lastname: Siriariyaporn
mesh_terms: D000328:Adult; D000818:Animals; D001733:Bites and Stings / Q000150:complications* / Q000628:therapy; D037462:Cubozoa; D005260:Female; D006801:Humans; D008297:Male; D055815:Young Adult