- Erin N Marcus, MD, MPH, FACP
Erin N Marcus, MD, MPH, FACP
- Associate Professor of Clinical Medicine
- University of Miami Miller School of Medicine
- Geoffrey K Isbister, MD
Geoffrey K Isbister, MD
- Professor, Clinical Toxicology Research Group
- University of Newcastle, Australia
- Section Editors
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Daniel F Danzl, MD
Daniel F Danzl, MD
- Section Editor — Environmental Emergencies
- Professor of Emergency Medicine
- University of Louisville School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Jellyfish cause most marine envenomations in the United States and worldwide. There are more than 100 species of jellyfish, and the severity and treatment of their stings vary widely, depending upon the type of jellyfish, the size of the sting, and the individual patient.
This topic will discuss the clinical manifestations, diagnosis, and treatment of jellyfish stings. Recognition and treatment of marine envenomations by other animals are discussed separately. (See "Marine envenomations from corals, sea urchins, fish, or stingrays".)
Jellyfish are members of the phylum Cnidaria, as are sea anemones. Jellyfish are invertebrates that float in salt and brackish water. They have a central bell and lengthy tentacles that disconnect easily (picture 1 and picture 2). Jellyfish consume fish, crustaceans, and mollusks by injecting venomous capsules called nematocysts into their prey. The nematocysts are clustered along the jellyfish's tentacles and discharge rapidly on contact. Although Physalia sp (Portuguese man-of-war, also called bluebottle jellyfish), which are also members of the phylum Cnidaria, are not true jellyfish, they are discussed here as well.
Jellyfish nematocysts inject a mixture of proteinaceous toxins through hollow, barbed tubes into their victims' skin at an approximate force of 2 to 5 pounds per square inch . The venom enters the dermis and general circulation and can cause both skin and systemic symptoms in affected patients.
Jellyfish do not actively seek out humans. However, they can be difficult to see, and most injuries occur when humans blunder into their tentacles.
- Burnett JW, Calton GJ. Jellyfish envenomation syndromes updated. Ann Emerg Med 1987; 16:1000.
- Mills, CE. Jellyfish blooms: are populations increasing globally in response to changing ocean conditions? Hydrobiologia 2001; 451:55.
- Burnett JW. Human injuries following jellyfish stings. Md Med J 1992; 41:509.
- Vimpani G, Doudle M, Harris R. Child accident-mortality in the Northern Territory, 1978-1985. Med J Aust 1988; 148:392.
- O'Reilly GM, Isbister GK, Lawrie PM, et al. Prospective study of jellyfish stings from tropical Australia, including the major box jellyfish Chironex fleckeri. Med J Aust 2001; 175:652.
- Huynh TT, Seymour J, Pereira P, et al. Severity of Irukandji syndrome and nematocyst identification from skin scrapings. Med J Aust 2003; 178:38.
- Macrokanis CJ, Hall NL, Mein JK. Irukandji syndrome in northern Western Australia: an emerging health problem. Med J Aust 2004; 181:699.
- Fox JW. Venoms and poisons from marine organisms. In: Cecil Textbook of Medicine, 21st, Goldman. (Ed), WB Saunders, Philadelphia 2000. p.437.
- Kaufman MB. Portuguese man-of-war envenomation. Pediatr Emerg Care 1992; 8:27.
- Kain KC. Skin lesions in returned travelers. Med Clin North Am 1999; 83:1077.
- Glasser DB, Noell MJ, Burnett JW, et al. Ocular jellyfish stings. Ophthalmology 1992; 99:1414.
- Filling-Katz MR. Mononeuritis multiplex following jellyfish stings. Ann Neurol 1984; 15:213.
- Pang KA, Schwartz MS. Guillain-Barré syndrome following jellyfish stings (Pelagia noctiluca). J Neurol Neurosurg Psychiatry 1993; 56:1133.
- Salam AM, Albinali HA, Gehani AA, Al Suwaidi J. Acute myocardial infarction in a professional diver after jellyfish sting. Mayo Clin Proc 2003; 78:1557.
- Little M, Pereira P, Mulcahy R, et al. Severe cardiac failure associated with presumed jellyfish sting. Irukandji syndrome? Anaesth Intensive Care 2003; 31:642.
- BARNES JH. CAUSE AND EFFECT IN IRUKANDJI STINGINGS. Med J Aust 1964; 1:897.
- Little M, Pereira P, Carrette T, Seymour J. Jellyfish responsible for Irukandji syndrome. QJM 2006; 99:425.
- Grady JD, Burnett JW. Irukandji-like syndrome in South Florida divers. Ann Emerg Med 2003; 42:763.
- Currie BJ, Jacups SP. Prospective study of Chironex fleckeri and other box jellyfish stings in the "Top End" of Australia's Northern Territory. Med J Aust 2005; 183:631.
- Ramasamy S, Isbister GK, Seymour JE, Hodgson WC. The in vivo cardiovascular effects of box jellyfish Chironex fleckeri venom in rats: efficacy of pre-treatment with antivenom, verapamil and magnesium sulphate. Toxicon 2004; 43:685.
- Ramasamy S, Isbister GK, Seymour JE, Hodgson WC. The in vitro effects of two chirodropid (Chironex fleckeri and Chiropsalmus sp.) venoms: efficacy of box jellyfish antivenom. Toxicon 2003; 41:703.
- Bailey PM, Little M, Jelinek GA, Wilce JA. Jellyfish envenoming syndromes: unknown toxic mechanisms and unproven therapies. Med J Aust 2003; 178:34.
- Isbister, GK. Aust Prescrib 2007; 30:117.
- Bengtson K, Nichols MM, Schnadig V, Ellis MD. Sudden death in a child following jellyfish envenomation by Chiropsalmus quadrumanus. Case report and autopsy findings. JAMA 1991; 266:1404.
- Freudenthal AR, Joseph PR. Seabather's eruption. N Engl J Med 1993; 329:542.
- Loten C, Stokes B, Worsley D, et al. A randomised controlled trial of hot water (45 degrees C) immersion versus ice packs for pain relief in bluebottle stings. Med J Aust 2006; 184:329.
- Townsend. Marine bites and stings. In: Sabiston Textbook of Surgery, 16th, WB Saunders, Philadelphia 2001. p.372.
- Ward NT, Darracq MA, Tomaszewski C, Clark RF. Evidence-based treatment of jellyfish stings in North America and Hawaii. Ann Emerg Med 2012; 60:399.
- Li L, McGee RG, Isbister G, Webster AC. Interventions for the symptoms and signs resulting from jellyfish stings. Cochrane Database Syst Rev 2013; :CD009688.
- Nomura JT, Sato RL, Ahern RM, et al. A randomized paired comparison trial of cutaneous treatments for acute jellyfish (Carybdea alata) stings. Am J Emerg Med 2002; 20:624.
- Lopez, EA, Weisman, RS, Bernstein, J. A prospective study of the acute therapy of jellyfish envenomations. J Toxicol Clin Toxicol 2000; 38:513.
- Hartwick R, Callanan V, Williamson J. Disarming the box-jellyfish: nematocyst inhibition in Chironex fleckeri. Med J Aust 1980; 1:15.
- Australian Resuscitation Council. Guideline 9.4.5. Envenomation- Jellyfish stings. Available at http://www.resus.org.au/policy/guidelines/section_9/guideline-9-4-5july10.pdf (Accessed August 16, 2012).
- Thomas CS, Scott SA, Galanis DJ, Goto RS. Box jellyfish (Carybdea alata) in Waikiki. The analgesic effect of sting-aid, Adolph's meat tenderizer and fresh water on their stings: a double-blinded, randomized, placebo-controlled clinical trial. Hawaii Med J 2001; 60:205.
- Currie BJ. Marine antivenoms. J Toxicol Clin Toxicol 2003; 41:301.
- Winter KL, Isbister GK, Jacoby T, et al. An in vivo comparison of the efficacy of CSL box jellyfish antivenom with antibodies raised against nematocyst-derived Chironex fleckeri venom. Toxicol Lett 2009; 187:94.
- Corkeron MA. Magnesium infusion to treat Irukandji syndrome. Med J Aust 2003; 178:411.
- Corkeron M, Pereira P, Makrocanis C. Early experience with magnesium administration in Irukandji syndrome. Anaesth Intensive Care 2004; 32:666.
- McCullagh N, Pereira P, Cullen P, et al. Randomised trial of magnesium in the treatment of Irukandji syndrome. Emerg Med Australas 2012; 24:560.
- Little M. Failure of magnesium in treatment of Irukandji syndrome. Anaesth Intensive Care 2005; 33:541.
- Fenner PJ, Williamson JA, Burnett JW, Rifkin J. First aid treatment of jellyfish stings in Australia. Response to a newly differentiated species. Med J Aust 1993; 158:498.
- Exton DR, Fenner PJ, Williamson JA. Cold packs: effective topical analgesia in the treatment of painful stings by Physalia and other jellyfish. Med J Aust 1989; 151:625.
- Birsa LM, Verity PG, Lee RF. Evaluation of the effects of various chemicals on discharge of and pain caused by jellyfish nematocysts. Comp Biochem Physiol C Toxicol Pharmacol 2010; 151:426.
- Burnett JW, Rubinstein H, Calton GJ. First aid for jellyfish envenomation. South Med J 1983; 76:870.
- Loder JS. Letter: Treatment of jellyfish stings. JAMA 1973; 226:1228.
- Beadnell CE, Rider TA, Williamson JA, Fenner PJ. Management of a major box jellyfish (Chironex fleckeri) sting. Lessons from the first minutes and hours. Med J Aust 1992; 156:655.
- Isbister GK. Marine envenomation and poisoning. In: Medical Toxicology, 3rd ed, Dart RC (Ed), Lippincott Williams & Wilkins, Philadelphia 2004. p.1621.
- Rossetto AL, Dellatorre G, Silveira FL, Haddad Júnior V. Seabather's eruption: a clinical and epidemiological study of 38 cases in Santa Catarina State, Brazil. Rev Inst Med Trop Sao Paulo 2009; 51:169.
- Auerbach PS. Envenomations from jellyfish and related species. J Emerg Nurs 1997; 23:555.
- Gershwin, L, Dabinett, K. Comparison of eight types of protective clothing against Irukandji Jellyfish stings. J Coastal Res 2009; 25:117.
- Kimball AB, Arambula KZ, Stauffer AR, et al. Efficacy of a jellyfish sting inhibitor in preventing jellyfish stings in normal volunteers. Wilderness Environ Med 2004; 15:102.
- Boulware DR. A randomized, controlled field trial for the prevention of jellyfish stings with a topical sting inhibitor. J Travel Med 2006; 13:166.
- MARINE BIOLOGY
- CLINICAL MANIFESTATIONS
- Irukandji syndrome
- Severe stings
- Seabather's eruption
- DIFFERENTIAL DIAGNOSIS
- Recommended first aid
- - Nematocyst removal
- - Hot water immersion
- Severe stings
- - Supportive care
- - Acetic acid
- - Chironex fleckeri antivenom
- Magnesium sulfate
- - Irukandji syndrome
- Popular topical therapies
- - Cold therapy
- - Acetic acid
- - Papain meat tenderizer
- - Baking soda
- - Topical lidocaine solution
- - Other
- Delayed hypersensitivity
- Seabather's eruption
- SUMMARY AND RECOMMENDATIONS