Irukandji syndrome is a condition that results from
envenomation by certain
box jellyfish
Box jellyfish (class Cubozoa) are cnidaria
Cnidaria () is a phylum under kingdom Animalia containing over 11,000 species of aquatic animals found both in Fresh water, freshwater and Marine habitats, marine environments, predominantly the latt ...
.
In rare instances the sting may result in
cardiac arrest
Cardiac arrest is when the heart suddenly and unexpectedly stops beating. It is a medical emergency that, without immediate medical intervention, will result in sudden cardiac death within minutes. Cardiopulmonary resuscitation (CPR) and possib ...
and death. The most common jellyfish involved is the ''
Carukia barnesi'', a species of
Irukandji jellyfish
The Irukandji jellyfish ( ) are any of several similar, extremely venomous species of rare jellyfish. With a very small adult size of about a cubic centimetre (1 cm3), they are both the smallest and one of the most venomous jellyfish in th ...
.
[ Those stung may experience severe or even excruciating pain.
The syndrome was given its name in 1952 by Hugo Flecker, after the ]Aboriginal
Aborigine, aborigine or aboriginal may refer to:
*Aborigines (mythology), in Roman mythology
* Indigenous peoples, general term for ethnic groups who are the earliest known inhabitants of an area
*One of several groups of indigenous peoples, see ...
Irukandji people who live in Palm Cove, north of Cairns, Queensland
)
, nickname = Sunshine State
, image_map = Queensland in Australia.svg
, map_caption = Location of Queensland in Australia
, subdivision_type = Country
, subdivision_name = Australia
, established_title = Before federation
, established_ ...
, Australia, where stings are common.
Signs and symptoms
Most stings occur during the summer wet season in October–May in North Queensland, with different seasonal patterns elsewhere. Because the jellyfish are very small, the venom is only injected through the tips of the nematocysts (the cnidocysts) rather than the entire lengths; as a result the sting may barely be noticed at first. It has been described as feeling like little more than a mosquito
Mosquitoes (or mosquitos) are members of a group of almost 3,600 species of small flies within the family Culicidae (from the Latin ''culex'' meaning "gnat"). The word "mosquito" (formed by ''mosca'' and diminutive ''-ito'') is Spanish for "lit ...
bite. The symptoms, however, gradually become apparent and then more and more intense in the subsequent 5 to 120 minutes (30 minutes on average). Irukandji syndrome includes an array of systemic symptoms, including severe headache
Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.
Headaches can occur as a resul ...
, backache, muscle pains, chest and abdominal pain
Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues.
Common causes of pain in the abdomen include gastroenteritis and irritable bowel syndrome. About 15% of people have a m ...
, nausea
Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...
and vomiting
Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.
Vomiting can be the result of ailments like food poisoning, gastroenteri ...
, sweating
Perspiration, also known as sweating, is the production of fluids secreted by the sweat glands in the skin of mammals.
Two types of sweat glands can be found in humans: eccrine glands and apocrine glands. The eccrine sweat glands are distri ...
, anxiety
Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil
Turmoil may refer to:
* ''Turmoil'' (1984 video game), a 1984 video game released by Bug-Byte
* ''Turmoil'' (2016 video game), a 2016 indie oil tycoon video ...
, hypertension, tachycardia
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal ( ...
, and pulmonary edema
Pulmonary edema, also known as pulmonary congestion, is excessive liquid accumulation in the tissue and air spaces (usually alveoli) of the lungs. It leads to impaired gas exchange and may cause hypoxemia and respiratory failure. It is du ...
. Symptoms generally improve in four to 30 hours, but may take up to two weeks to resolve completely.[
]
Toxicity
When properly treated, a single sting is almost never fatal; however, two people in Australia are believed to have died from Irukandji stings, which has greatly increased public awareness of Irukandji syndrome. It is unknown how many other deaths from Irukandji syndrome have been wrongly attributed to other causes.[
]
Pathophysiology
The exact mechanism of action of the venom is unknown, but catecholamine
A catecholamine (; abbreviated CA) is a monoamine neurotransmitter, an organic compound that has a catechol ( benzene with two hydroxyl side groups next to each other) and a side-chain amine.
Catechol can be either a free molecule or a ...
excess may be an underlying mechanism in severe cases. Animal studies appear to confirm a relationship between envenoming and an increase in circulating noradrenaline and adrenaline
Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...
.
Treatment
Similar to other box jellyfish
Box jellyfish (class Cubozoa) are cnidaria
Cnidaria () is a phylum under kingdom Animalia containing over 11,000 species of aquatic animals found both in Fresh water, freshwater and Marine habitats, marine environments, predominantly the latt ...
stings, first aid consists of flushing the area with vinegar
Vinegar is an aqueous solution of acetic acid and trace compounds that may include flavorings. Vinegar typically contains 5–8% acetic acid by volume. Usually, the acetic acid is produced by a double fermentation, converting simple sugars to ...
to neutralize the tentacle stinging apparatus. As no antivenom
Antivenom, also known as antivenin, venom antiserum, and antivenom immunoglobulin, is a specific treatment for envenomation. It is composed of antibodies and used to treat certain venomous bites and stings. Antivenoms are recommended only if ...
is available, treatment is largely supportive, with analgesia
Pain management is an aspect of medicine and health care involving relief of pain (pain relief, analgesia, pain control) in various dimensions, from acute and simple to chronic and challenging. Most physicians and other health professionals ...
being the mainstay of management. Nitroglycerin
Nitroglycerin (NG), (alternative spelling of nitroglycerine) also known as trinitroglycerin (TNG), nitro, glyceryl trinitrate (GTN), or 1,2,3-trinitroxypropane, is a dense, colorless, oily, explosive liquid most commonly produced by nitrating g ...
, a common drug used for cardiac conditions, is utilised by medical personnel to minimise the risk of pulmonary edema and to reduce hypertension. Antihistamines may be of benefit for pain relief, but most cases require intravenous opioid
Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioi ...
analgesia. Fentanyl
Fentanyl, also spelled fentanil, is a very potent synthetic opioid used as a pain medication. Together with other drugs, fentanyl is used for anesthesia. It is also used illicitly as a recreational drug, sometimes mixed with heroin, cocaine ...
or morphine
Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies ('' Papaver somniferum''). It is mainly used as a pain medication, and is also commonly used recreationally, or to make other illicit opioids. Ther ...
are usually chosen. Pethidine
Pethidine, also known as meperidine and sold under the brand name Demerol among others, is a synthetic opioid pain medication of the phenylpiperidine class. Synthesized in 1938 as a potential anticholinergic agent by the German chemist Otto Ei ...
(meperidine, brand name Demerol in the US) should be avoided, as large doses are often required for pain relief and in this situation significant adverse effects from the pethidine metabolite
In biochemistry, a metabolite is an intermediate or end product of metabolism.
The term is usually used for small molecules. Metabolites have various functions, including fuel, structure, signaling, stimulatory and inhibitory effects on enzymes, ...
norpethidine may occur.
Magnesium sulfate
Magnesium sulfate or magnesium sulphate (in English-speaking countries other than the US) is a chemical compound, a salt with the formula , consisting of magnesium cations (20.19% by mass) and sulfate anions . It is a white crystalline solid, ...
(Epsom Salts
Magnesium sulfate or magnesium sulphate (in English-speaking countries other than the US) is a chemical compound, a salt with the formula , consisting of magnesium cations (20.19% by mass) and sulfate anions . It is a white crystalline solid, ...
) has been proposed as a treatment for Irukandji syndrome after being apparently successfully used in one case. Early evidence suggested a benefit; however, according to a later report, a series of three patients failed to show any improvement with magnesium; the author emphasized the experimental status of this treatment. Some preliminary laboratory experiments using the venom extracted from ''Malo maxima'' (the 'Broome Irukandji') on rat cardiovascular tissue ''in vitro'' has suggested that magnesium does in fact block many of the actions of this venom.
Epidemiology
Reports of Irukandji syndrome have come from Australia, the United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 U.S. state, states, a Washington, D.C., federal district, five ma ...
(Hawaii
Hawaii ( ; haw, Hawaii or ) is a state in the Western United States, located in the Pacific Ocean about from the U.S. mainland. It is the only U.S. state outside North America, the only state that is an archipelago, and the only ...
and Florida
Florida is a state located in the Southeastern region of the United States. Florida is bordered to the west by the Gulf of Mexico, to the northwest by Alabama, to the north by Georgia, to the east by the Bahamas and Atlantic Ocean, a ...
), the French Antilles
The French West Indies or French Antilles (french: Antilles françaises, ; gcf, label=Antillean Creole, Antiy fwansez) are the parts of France located in the Antilles islands of the Caribbean:
* The two overseas departments of:
** Guadeloupe ...
, Bonaire
Bonaire (; , ; pap, Boneiru, , almost pronounced ) is a Dutch island in the Leeward Antilles in the Caribbean Sea. Its capital is the port of Kralendijk, on the west (leeward) coast of the island. Aruba, Bonaire and Curaçao form the ABC ...
, the Caribbean, Timor Leste
East Timor (), also known as Timor-Leste (), officially the Democratic Republic of Timor-Leste, is an island country in Southeast Asia. It comprises the eastern half of the island of Timor, the exclave of Oecusse on the island's north-weste ...
and Papua New Guinea
Papua New Guinea (abbreviated PNG; , ; tpi, Papua Niugini; ho, Papua Niu Gini), officially the Independent State of Papua New Guinea ( tpi, Independen Stet bilong Papua Niugini; ho, Independen Stet bilong Papua Niu Gini), is a country i ...
.[ Cubozoan species other than ''Carukia barnesi'' are presumed to be responsible for envenomations outside Australia.][
]
History
In 1964 Jack Barnes
Jack Barnes (born 1940) is an American Communist and the National Secretary of the Socialist Workers Party. Barnes was elected the party's national secretary in 1972, replacing the retiring Farrell Dobbs. He joined the SWP in the early 1960s ...
confirmed the cause of the syndrome was a sting from a small box jellyfish
Box jellyfish (class Cubozoa) are cnidaria
Cnidaria () is a phylum under kingdom Animalia containing over 11,000 species of aquatic animals found both in Fresh water, freshwater and Marine habitats, marine environments, predominantly the latt ...
: the Irukandji jellyfish
The Irukandji jellyfish ( ) are any of several similar, extremely venomous species of rare jellyfish. With a very small adult size of about a cubic centimetre (1 cm3), they are both the smallest and one of the most venomous jellyfish in th ...
, which can fire venom-filled stingers out of its body and into passing victims. To prove that the jellyfish was the cause of the syndrome, he captured one and deliberately stung himself, his 9-year-old son and a local lifeguard, then observed the resulting symptoms. Other cubozoans possibly can cause Irukandji syndrome; those positively identified include'' Carukia barnesi'', Alatina mordens, '' Alatina alata'', ''Malo maxima
''Malo maxima'' is a small, and extremely dangerous Irukandji Jellyfish that is known to cause Irukandji Syndrome. It is one of the four species of ''Malo'', along with ''Malo bella'', ''Malo filipina'', and ''Malo kingi''. The ''Malo maxima'' was ...
'', '' Malo kingi'', ''Carybdea xaymacana'', ''Keesingia gigas
''Keesingia gigas'', the "giant" (Greek ''gigas'') ''Keesingia'', is one of two new species of Irukandji jellyfish, the only one of the genus ''Keesingia'' in the Alatinid family.
Found off the north-west coast of Western Australia, the species ...
'', an as-yet unnamed "fire jelly", and another unnamed species.
Culture and society
A 2005 Discovery Channel
Discovery Channel (known as The Discovery Channel from 1985 to 1995, and often referred to as simply Discovery) is an American cable channel owned by Warner Bros. Discovery, a publicly traded company run by CEO David Zaslav. , Discovery Chan ...
program, ''Killer Jellyfish'', portrayed the severity of the pain from an Irukandji jellyfish sting when two Australian researchers ( Jamie Seymour and Teresa Carrette) were stung. Another program aired on the Discovery Channel, ''Stings, Fangs and Spines'', featured a 20-minute spot on Irukandji syndrome. In the segment, a young Australian woman was stung and developed a severe case.
A 2007 fictional '' Sea Patrol'' episode ( S1, E4) involves two crew members of HMAS ''Hammersley'' being stung by an Irukandji jellyfish.
On the television program ''Super Animal'', a woman compared her experience with Irukandji syndrome to the pain of childbirth
Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births glo ...
.
Steve Backshall reports with accounts from victims of Irukandji stings on his ITV wildlife series ''Fierce'' in 2016.
References
{{DEFAULTSORT:Irukandji syndrome
Parasitic infestations, stings, and bites of the skin
Toxic effects of venomous animals
Syndromes
Invertebrate attacks