Severe Cardiac Failure Associated with Presumed Jellyfish Sting. Irukandji Syndrome?

Abstract

We present a retrospective review of twelve cases of Irukandji syndrome associated with pulmonary oedema. This is a life-threatening envenoming due to a presumed jellyfish sting throughout Northern Australia, although only one case occurred outside North Queensland. Patients presented with significant and ongoing pain, tachycardia and hypertension. Half the patients became hypotensive requiring inotropic support. Cardiac echocardiography revealed significant cardiac dysfunction. Six patients required ventilatory support. There was no death reported due to pulmonary oedema, but one patient died of intracerebral haemorrhage. We believe patients may develop a toxin associated cardiomyopathy, and jellyfish other than Carukia barnesi may be responsible. As there is confusion with nomenclature, Carukia barnesi should be known as the Barnes jellyfish, and the diagnosis of cardiotoxic marine envenoming is suggested for any patient who has been stung by a jellyfish, develops no or minimal skin markings, and develops cardiogenic pulmonary oedema associated with Irukandji syndrome.

Jellyfish Stings: A Practical Approach

“…The ILSF reported, however, that the hands of the rescuer should be washed as soon as Table 2. Antivenom for the box jellyfish Chironex fleckeri 12,24,25 Indications Antivenom should be administered as soon as first aid is applied. It should be given to a victim of suspected Chironex fleckeri stinging in the following circumstances:…”

Intracerebral hemorrhage and death after envenoming by the jellyfishCarukia barnesi

“…8 Heart failure can occur. 9 The pain is frequently severe and in one series of 116 patients a mean dose of 31 mg morphine was required to control the pain. 10 The associated tachycardia, hypertension, diaphoresis, and cardiac failure have led many clinicians to draw parallels with hyperadrenergic states, and furthermore many have speculated a pathophysiological catecholamine mechanism for the symptomatology.…”

Case review: A 28-year-old Korean man with Irukandji syndrome

“…The initial skin envenomation is followed by a characteristic time delay (20-30 min) before the onset of severe systemic symptoms which can last from hours to days. Together these comprise what is referred to as Irukandji syndrome for which there is currently no known antivenom (Fenner and Carney, 1999;Little et al, 2003;Taylor et al, 2002;Little et al, 2001). Local signs and symptoms of Irukandji syndrome include minor erythema, sweating and piloerection.…”

“…These include severe backache, muscle pains, chest and abdominal pain, nausea and vomiting, headache, sweating and (rarely) pulmonary oedema (Little and Mulcahy, 2005;Fenner et al, 1988Fenner et al, , 1986). There has also been evidence of severe cardiac dysfunction resulting in longer hospitalisation for some patients (Little et al, 2003(Little et al, , 2001. The symptomatology is outlined in Table 2.…”

“…Two deaths from Irukandji syndrome occurred in 2001-2002 in North Queensland. Both men died from intracerebral haemorrhages shortly after developing symptoms of the syndrome and these were the first reported deaths caused by the Irukandji syndrome (CRC Reef Research Centre, 2005;Macrokanis et al, 2004;Little et al, 2003).…”