Raising Awareness on the Clinical and Forensic Aspects of Jellyfish Stings: A Worldwide Increasing Threat

Abstract

Jellyfish are ubiquitous animals registering a high and increasing number of contacts with humans in coastal areas. These encounters result in a multitude of symptoms, ranging from mild erythema to death. This work aims to review the state-of-the-art regarding pathophysiology, diagnosis, treatment, and relevant clinical and forensic aspects of jellyfish stings. There are three major classes of jellyfish, causing various clinical scenarios. Most envenomations result in an erythematous lesion with morphological characteristics that may help identify the class of jellyfish responsible. In rare cases, the sting may result in delayed, persistent, or systemic symptoms. Lethal encounters have been described, but most of those cases happened in the Indo-Pacific region, where cubozoans, the deadliest jellyfish class, can be found. The diagnosis is mostly clinical but can be aided by dermoscopy, skin scrapings/sticky tape, confocal reflectance microscopy, immunological essays, among others. Treatment is currently based on preventing further envenomation, inactivating the venom, and alleviating local and systemic symptoms. However, the strategy used to achieve these effects remains under debate. Only one antivenom is currently used and covers merely one species (Chironex fleckeri). Other antivenoms have been produced experimentally but were not tested on human envenomation settings. The increased number of cases, especially due to climate changes, justifies further research in the study of clinical aspects of jellyfish envenoming.

Bioactivity Profiling and Untargeted Metabolomics of Microbiota Associated with Mesopelagic Jellyfish Periphylla Periphylla

“…They are typical consumers of zooplankton using their tentacles, oral arms and stingers to capture their prey [ 11 ]. Some jellyfish produce toxins in nematocyst organelles which are cardiotoxic, cytotoxic, neurotoxic, hemolytic and dermonecrotic and, hence, remain a public health concern with regards to recreational activities, fishery and tourism [ 12 , 13 ]. The outer layer of the jellyfish is sheathed in mucus mainly composed of proteins, lipids and sugars [ 14 ], making the jellyfish an attractive niche for microbial colonization.…”

Reflectance Confocal Microscopy of Skin after the Sting of the Jellyfish <i>Pelagia noctiluca</i>

“…Among the jellyfishes in Mediterranean Sea, the Schypozoan mauve stinger, Pelagia noctiluca (Forsskål, 1775) is the most involved species in the cases of sting of medical importance because of its widespread distribution, ecological role, and accidental interactions with humans [5][6][7][8][9]. This species is characterized by a pink, mauve, or light brown color and an umbrella of 3-12 cm in diameter, with sixteen marginal lobes, eight marginal sense organs, and eight marginal tentacles [5][6][7][8][9][10]. In this species, the cnidocysts are present in the tentacles, in the oral arms, and in the upper surface of the bell [5].…”

“…The P. noctiluca venom shows mainly hemolytic and cytolytic activities; specifically, venom-induced NaCl influx followed by water and consequent cell swelling most likely underlie the hemolytic and cytolytic activity of this venom [8]. However, P. noctiluca sting is often mild (differently from the more dangerous one caused by various Cubozoa and Hydrozoa species), inducing usually only local symptoms [6][7][8][9]. In the last years, several scientific proofs highlight how noninvasive diagnostic methods, such as dermoscopy and reflectance confocal microscopy (RCM), can play a role in the diagnosis of animal stings and bites and the relative management [6].…”

Inhibition of Nematocyst Discharge from Pelagia noctiluca (Cnidaria: Scyphozoa)—Prevention Measures against Jellyfish Stings

“…Due to their toxicity, jellyfish stings have a negative impact on human health [9,10]. It is estimated that 150 million people worldwide are exposed to jellyfish annually [11], and encounters with some cubozoan species in tropical and subtropical waters can result in serious health problems (e.g., cardiopulmonary arrest) [12,13]. However, the jellyfish that inhabit the Mediterranean Sea are considered non-life-threatening species [14][15][16].…”

“…Inhibitory substances can be incorporated as prophylaxis in sunscreens to prevent stings [11,32,33], and in first-aid products to avoid further cnidocyst discharge [23,28,30]. Although jellyfish stings are common, the scientific community remains in disagreement about the effectiveness of most substances and products [9,13,28,30,31]. The discrepancies and confusion are due to limited data for making evidence-based recommendations and the lack of a regulated and agreed framework among researchers [28,34,35].…”