Irukandji Syndrome

Specimen of the Malo kingi in a clear plastic bottle

The Irukandji syndrome ( Southcott suggested the name Carukiosis in 1967 , but this did not catch on) is a poisoning of the human organism by nettle poisons of a small group of box jellyfish (Cubozoa). The poisoning is characterized by severe back , chest and abdominal pain , nausea and vomiting , headache and, in severe cases, pulmonary edema . It is usually extremely painful, but is rarely fatal. Originally it was thought that it was only triggered by stings from Carukia barnesi (Irukandji). It is now believed that up to eight other species can trigger Irukandji syndrome.

History of exploration

Even before the causer was discovered, Hugo Flecker named a number of different symptoms in 1952, which had to be the result of a reaction of the human organism to a nettle poison (this was already known from contacts with the sea wasp Chironex fleckeri ) as Irukandji syndrome. The name Irukandji is derived from an Aboriginal tribe that originally lived on the northeast coast of Queensland . The patients reported symptoms that usually come from contact with jellyfish without having seen such an animal. It was suggested that the symptoms were caused by a previously unknown species of jellyfish that is difficult to spot in open waters.

After treating several patients with the Irukandji symptom, the Australian doctor Jack Barnes set out to find the cause and in 1961 discovered a small, almost transparent jellyfish with an umbrella diameter of only two centimeters, but tentacles up to a meter long. To check whether this jellyfish was actually the cause of Irukandji syndrome, Barnes touched the tentacles of the jellyfish together with his son and a lifeguard who was present. When the expected symptoms soon arose, the jellyfish was further examined in the laboratory and later scientifically described by Ronald Vernon Southcott .

It is now assumed that the stings of at least six other species, possibly even eight or ten species, in addition to Carukia barnesi , can trigger Irukandji syndrome. They are often collectively referred to as "Irukandji species" or "Irukandji species group". This is not a systematic taxonomic group, but rather species of different genera and families of box jellyfish.

Symptoms

The stings by the Irukandji species are often hardly noticed. Affected people perceive them to be about the same intensity as a mosquito bite, if at all. In about a third, the symptoms are mild, with minor skin irritations. In about two thirds, however, the typical Irukandji syndrome develops. Symptoms can set in within minutes, but there is usually a delay (around 30 minutes on average). Those affected feel strong, often cyclical pain in the extremities, back, stomach or chest. They are accompanied by a “feeling of imminent death”, dysphoria , restlessness, sweating (diaphoresis), hypertension , nausea and vomiting . In most cases these symptoms go away quickly, but in a small number of cases pain develops that cannot be suppressed even with opioids , continues for days and requires intensified pain management. Life-threatening complications such as acute lung haemorrhage, cardiomyopathy and cardiogenic shock can develop . So far only two fatal cases have become known, with the causative species ( Carukia barnesi ) actually only being proven in one case . Both of these deaths were caused by bleeding in the brain as a result of an uncontrolled increase in blood pressure . Between 1990 and 2007, Irukandji syndrome affected 87 people in the Northern Territories (Australia) alone . The typical symptoms developed in 65%, and around half of the cases had to be hospitalized. Irukandji syndrome affects around 60 people in Australia each year. In Western Australia and North Queensland, Irukandjii poisoning is more common than Chironex fleckeri poisoning . In the Northern Territories, on the other hand, poisoning by Chironex fleckeri predominates .

treatment

So far, no antidote for poisoning by the nettle poison (s) of the Irukandji species group is known. As a first aid measure, vinegar had originally proven to be effective. In the meantime, however, treatment with vinegar is strongly discouraged, as this measure deactivates nettles that have not yet been fired, but at the same time leads to the nettles in the skin immediately releasing their remaining poison. In the meantime, zinc gluconate is being researched as a potential drug to slow down the poisonous effect until the antidote is administered and thus to give the victim valuable time. Most of the patients (70%) were injected with opioids to suppress pain, depending on the degree of pain. Magnesium sulfate was also given in some cases . About half of the patients were admitted to hospital.

Geographical distribution

Irukandji syndrome in Australia has so far been restricted to eastern and northern Australia. The known cases occurred from Fraser Island (in southern Queensland ) along the coast to the north, particularly Gove Bay to about Broome in the Australian state of Western Australia . Irukandji-like symptoms have now also been reported from Thailand, the Caribbean, and Hawaii. However, other species are certainly the triggers for Irukandji syndrome, e.g. B. Alatina mordens , Alatina moseri u. a. Species.

literature

• Hugo Flecker: Irukandji Sting to North Queensland Bathers without Production of Weals but with Severe General Symptoms . In: The Medical Journal of Australia , 2, pp. 89-91, Sydney 1952, ISSN  0025-729X
• Christopher P. Nickson, Edith B. Waugh, Susan P. Jacups, Bart J. Currie: Irukandji Syndrome Case Series From Australia's Tropical Northern Territory. In: Annals of Emergency Medicine , 54 (3), pp. 395-403, New York 2009, ISSN  0196-0644 , PMID 19409658
• M Little, P Pereira, T Carrette, J. Seymour: Jellyfish responsible for Irukandji syndrome . In: QJM , 2006 Jun, 99 (6), pp. 425-427, PMID 16687419
• PM Bailey, M Little, GA Jelinek, JA. Wilce: Jellyfish envenoming syndromes: unknown toxic mechanisms and unproven therapies . In: Med J Aust. , 2003 Jan 6,178 (1), pp. 34-37, Review, PMID 12492389

Web links

• Irukandji syndrome . The Australian Venom Compendium

Individual evidence

1. ↑ JH. Barnes: Cause and effect in Irukandji stingings. In: Med J Aust , 1964, 14, pp. 897-904, PMID 14172390
2. ↑ Jamie Seymour, Teresa Carrette: Identification of cubozoans responsible for causing Irukandji syndrome ( Memento of September 19, 2008 in the Internet Archive ). Tropical Australian Stinger Research Group, James Cook University .
3. ^ Irukandji syndrome . In: The Australian Venom Compendium (accessed June 22, 2019)
4. ↑ P Welfare, Little, M, Pereira, P, Seymour, J: An in vitro examination of the effect of vinegar on discharged nematocysts of Chironex fleckeri . In: Diving and hyperbaric medicine: the journal of the South Pacific Underwater Medicine Society . 44, No. 1, March 2014, pp. 30–4. PMID 24687483 .
5. ↑ Trace element as a jellyfish poison antidote. Spektrum.de , December 13, 2012.
6. ↑ Anna MG de Pender, Kenneth D. Winkel, Robert J. Ligthelm: Probable Case of Irukandji Syndrome in Thailand. In: Journal of Travel Medicine , 13 (4), pp. 240-243, Malden MA, ISSN  1195-1982 , doi: 10.1111 / j.1708-8305.2006.00041.x
7. ↑ CM Yoshimoto and AA Yanagihara: Cnidarian (coelenterate) envenomations in Hawaiʻi improve following heat application. In: Transactions of the Royal Society of Tropical Medicine and Hygiene , 96, pp. 300-303, New York 2002, ISSN  0035-9203

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