Fatal envenomation by
            <i>Chironex fleckeri</i>
            , the north Australian box jellyfish: the continuing search for lethal mechanisms

Lumley, J. S. P.; Williamson, John; Fenner, Peter J.; Burnett, Joseph W.; Colquhoun, David

doi:10.5694/j.1326-5377.1988.tb99466.x

Cited by 66 publications

(46 citation statements)

References 16 publications

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“…Envenomation results in painful violaceous skin lesions, and occasionally in death attributed to cardiovascular collapse [7], [8], often within minutes following a sting. The toxic components of cnidarian venoms show direct effects on muscle and nerve tissue [9], [10].…”

Section: Introductionmentioning

confidence: 99%

“…The Commonwealth Serum Laboratory antivenom (CSL Limited, Parkville, Australia) is of limited value [2], [8], [14]. Because calcium entry into cardiac myocytes has been observed after experimental application of C. fleckeri venom, calcium channel blockade has been proposed as treatment for such stings.…”

Section: Introductionmentioning

confidence: 99%

“…Detailed clinical data on individuals stung by Chironex are sparse, but available information suggests that a hypertensive phase is followed by hypotension and cardiovascular collapse [7], [8]. Current therapy is limited to supporting hemodynamics and treating symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Cubozoan Venom-Induced Cardiovascular Collapse Is Caused by Hyperkalemia and Prevented by Zinc Gluconate in Mice

Yanagihara

Shohet

2012

PLoS ONE

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Chironex fleckeri (Australian box jellyfish) stings can cause acute cardiovascular collapse and death. We developed methods to recover venom with high specific activity, and evaluated the effects of both total venom and constituent porins at doses equivalent to lethal envenomation. Marked potassium release occurred within 5 min and hemolysis within 20 min in human red blood cells (RBC) exposed to venom or purified venom porin. Electron microscopy revealed abundant ∼12-nm transmembrane pores in RBC exposed to purified venom porins. C57BL/6 mice injected with venom showed rapid decline in ejection fraction with progression to electromechanical dissociation and electrocardiographic findings consistent with acute hyperkalemia. Recognizing that porin assembly can be inhibited by zinc, we found that zinc gluconate inhibited potassium efflux from RBC exposed to total venom or purified porin, and prolonged survival time in mice following venom injection. These findings suggest that hyperkalemia is the critical event following Chironex fleckeri envenomation and that rapid administration of zinc could be life saving in human sting victims.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cubozoan Venom-Induced Cardiovascular Collapse Is Caused by Hyperkalemia and Prevented by Zinc Gluconate in Mice

Yanagihara

Shohet

2012

PLoS ONE

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“…Symptoms of major C. fleckeri stings include excruciating pain, rapid acute cutaneous inflammation, dermonecrosis, permanent scarring, hypertension, hypotension, shock, dyspnoea, impaired consciousness, cardiac dysfunction and pulmonary oedema (reviewed in [6]). The onset of symptoms is extremely rapid [7] and in severe cases, death from pulmonary and/or cardiac failure can occur within minutes [8]. At least 70 deaths due to C. fleckeri envenoming have occurred in Australia and numerous deaths from related species have been reported in the Philippines, Maldives islands, Japan, Papua New Guinea, South India, Java, Malaysia and Gulf of Thailand [9].…”

Section: Introductionmentioning

confidence: 99%

Venom Proteome of the Box Jellyfish Chironex fleckeri

et al. 2012

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The nematocyst is a complex intracellular structure unique to Cnidaria. When triggered to discharge, the nematocyst explosively releases a long spiny, tubule that delivers an often highly venomous mixture of components. The box jellyfish, Chironex fleckeri, produces exceptionally potent and rapid-acting venom and its stings to humans cause severe localized and systemic effects that are potentially life-threatening. In an effort to identify toxins that could be responsible for the serious health effects caused by C. fleckeri and related species, we used a proteomic approach to profile the protein components of C. fleckeri venom. Collectively, 61 proteins were identified, including toxins and proteins important for nematocyte development and nematocyst formation (nematogenesis). The most abundant toxins identified were isoforms of a taxonomically restricted family of potent cnidarian proteins. These toxins are associated with cytolytic, nociceptive, inflammatory, dermonecrotic and lethal properties and expansion of this important protein family goes some way to explaining the destructive and potentially fatal effects of C. fleckeri venom. Venom proteins and their post-translational modifications (PTMs) were further characterized using toxin-specific antibodies and phosphoprotein/glycoprotein-specific stains. Results indicated that glycosylation is a common PTM of the toxin family while a lack of cross-reactivity by toxin-specific antibodies infers there is significant divergence in structure and possibly function among family members. This study provides insight into the depth and diversity of protein toxins produced by harmful box jellyfish and represents the first description of a cubozoan jellyfish venom proteome.

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“…There are 4 pedalia, each with up to 15 tentacles 3 m in length (Hartwick, 1987). A 4-year-old boy died within 10 min of a sting from 4 m of tentacle and other deaths have occurred within 3 min (Lumley et al, 1988).…”

Section: Chironex Fleckeri (Family Chirodropidae)mentioning

confidence: 99%

Cubozoan jellyfish envenomation syndromes and their medical treatment in northern Australia

Fenner¹

1991

Hydrobiologia

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Fatal envenomation by Chironex fleckeri , the north Australian box jellyfish: the continuing search for lethal mechanisms

Cited by 66 publications

References 16 publications

Cubozoan Venom-Induced Cardiovascular Collapse Is Caused by Hyperkalemia and Prevented by Zinc Gluconate in Mice

Cubozoan Venom-Induced Cardiovascular Collapse Is Caused by Hyperkalemia and Prevented by Zinc Gluconate in Mice

Venom Proteome of the Box Jellyfish Chironex fleckeri

Cubozoan jellyfish envenomation syndromes and their medical treatment in northern Australia

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