Nickson, Christopher P; Waugh, Edith; Jacups, Susan; Currie, Bart

Author(s)

Nickson, Christopher P

Waugh, Edith

Jacups, Susan

Currie, Bart

Publication Date

2009-09-01

Abstract

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

Citation

Ann Emerg Med . 2009 Sep;54(3):395-403. doi: 10.1016/j.annemergmed.2009.03.022. Epub 2009 May 5.

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/19409658/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/5741

MESH subject

Acetic Acid

Adolescent

Adult

Analgesics, Opioid

Anesthetics

Animals

Antivenins

Bites and Stings

Cardiomyopathies

Child

Child, Preschool

Cnidarian Venoms

Female

First Aid

Hospitalization

Humans

Hypertension

Indicators and Reagents

Infant

Magnesium Sulfate

Male

Middle Aged

Northern Territory

Pain

Pain Management

Pain Measurement

Poisons

Prospective Studies

Retrospective Studies

Seasons

Swimming

Syndrome

Treatment Outcome

Young Adult

Scyphozoa

Title

Irukandji syndrome case series from Australia's Tropical Northern Territory.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Nickson, Christopher P Waugh, Edith Jacups, Susan Currie, Bart
Publication Date	2009-09-01
Abstract	We describe Irukandji syndrome (a painful hypercatecholaminergic condition caused by jellyfish envenoming) in Australia's Northern Territory. 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. 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. 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.
Citation	Ann Emerg Med . 2009 Sep;54(3):395-403. doi: 10.1016/j.annemergmed.2009.03.022. Epub 2009 May 5.
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/19409658/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/5741
MESH subject	Acetic Acid Adolescent Adult Analgesics, Opioid Anesthetics Animals Antivenins Bites and Stings Cardiomyopathies Child Child, Preschool Cnidarian Venoms Female First Aid Hospitalization Humans Hypertension Indicators and Reagents Infant Magnesium Sulfate Male Middle Aged Northern Territory Pain Pain Management Pain Measurement Poisons Prospective Studies Retrospective Studies Seasons Swimming Syndrome Treatment Outcome Young Adult Scyphozoa
Title	Irukandji syndrome case series from Australia's Tropical Northern Territory.
Type of document	Journal Article
Entity Type	Publication

Irukandji syndrome case series from Australia's Tropical Northern Territory.

Files: