Irukandji syndrome - a tale in the sting

John Hadok, Mackay Base Hospital, have documented the first death from Irukandji syndrome, in a tourist in the Whitsunday Islands of north Queensland.

The syndrome was originally attributed specifically to Carukia barnesi, a small box jellyfish, but recent research now suggests that this syndrome is caused by at least five or six small carybdeid jellyfish similar to C. barnesi and two larger jellyfish species.

Irukandji syndrome is characterised by:

• severe systemic symptoms developing 30 minutes or so after a mild jellyfish skin sting;
• severe low back pain;
• excruciating muscle cramps in all four limbs, the abdomen and chest;
• sweating, anxiety, restlessness, nausea, vomiting, headache and palpitations

and is also associated with:

• life-threatening hypertension
• pulmonary oedema
• heart dilatation

The patient died from an intracerebral haemorrhage related to severe hypertension which occurred after jellyfish envenomation. Another tourist has since died after jellyfish envenomation further north near Port Douglas, also from severe hypertension and an intracerebral haemorrhage.

Dr Fenner noted that there is currently no specific first aid treatment for carybdeid jellyfish stings, but advised that immediate vinegar dousing may prevent further envenomation from stinging cells still present on the skin.

"Most cases of envenomation by jellyfish causing Irukandji syndrome occur some distance from medical care, with helicopter or medical response often too late to treat the early pain and hypertension", Dr Fenner said.

The authors stressed venom studies on carybdeid jellyfish are urgently needed to develop preventive strategies and effective treatments for Irukandji syndrome, including an antivenom.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACT: Dr Peter Fenner (07) 4957 7800 (B/H); 0418 775 206 (A/H)

Sarah Crichton, AMA (0419) 440 076