Prospective study of Chironex fleckeri and other box jellyfish stings in the "Top End" of Australia's Northern Territory

Bart Currie, Susan Jacups

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objective: To describe the epidemiology and clinical features of box jellyfish envenoming in the Top End of the Northern Territory and, in particular, confirmed stings from the major Australian box jellyfish, Chironex fleckeri. Design: Prospective collection of clinical data and skin scrapings or sticky-tape tests for nematocyst identification from patients presenting to Royal Darwin Hospital and remote coastal community health clinics in the Northern Territory, spanning 10950km of coastline; analysis of tidal, weather and seasonal data. Patients: All patients with jellyfish sting details recorded between 1 April 1991 and 30 May 2004. Main outcome measures: Demographic and clinical features, use of C. fleckeri antivenom, and associations between weather, seasonal and tidal factors and confirmed C. fleckeri stings. Results: Of 606 jellyfish stings documented, 225 were confirmed to have been caused by C. fleckeri. 37% of C. fleckeri stings were in children, 92% occurred during the "stinger season" (1 October to 1 June), 83% occurred in water 1 m or less deep, and 17% occured while victims were entering the water. Stings were least common on outgoing tides (P < 0.001) and commonest between 15:00 and 18:00 (P < 0.001) and on days with wind speed less than that month's average (P < 0.001). Nearly all victims experienced immediate pain, but this could often be controlled with ice; only 30% required parenteral narcotics and 8% required hospital admission. Cardiorespiratory arrest occurred within several minutes of the sting in the one fatal case, involving a 3-year-old girl with only 1.2 m of visible tentacle contact. C. fleckeri antivenom was given to another 21 patients, none of whom had life-threatening features at the time they were given antivenom. Conclusions: Most C. fleckeri stings are not life-threatening; patients who die usually have cardiopulmonary arrest within minutes of the sting. The potential benefit of antivenom and magnesium under these circumstances remains to be shown, but a protocol with their rapid use is recommended if cardiopulmonary arrest has occurred. Unfortunately, this is unrealistic for many rural coastal locations, and the priority remains prevention of stings by keeping people, especially children, out of the sea during the stinger season.
    Original languageEnglish
    Pages (from-to)631-636
    Number of pages6
    JournalMedical Journal of Australia
    Volume183
    Issue number11-12
    Publication statusPublished - 2005

    Fingerprint

    Cubozoa
    Northern Territory
    Bites and Stings
    Prospective Studies
    Antivenins
    Weather
    Heart Arrest
    Nematocyst
    Water
    Narcotics
    Ice
    Oceans and Seas
    Magnesium

    Cite this

    @article{c2fc675bc5574bf09ed21586fa102d19,
    title = "Prospective study of Chironex fleckeri and other box jellyfish stings in the {"}Top End{"} of Australia's Northern Territory",
    abstract = "Objective: To describe the epidemiology and clinical features of box jellyfish envenoming in the Top End of the Northern Territory and, in particular, confirmed stings from the major Australian box jellyfish, Chironex fleckeri. Design: Prospective collection of clinical data and skin scrapings or sticky-tape tests for nematocyst identification from patients presenting to Royal Darwin Hospital and remote coastal community health clinics in the Northern Territory, spanning 10950km of coastline; analysis of tidal, weather and seasonal data. Patients: All patients with jellyfish sting details recorded between 1 April 1991 and 30 May 2004. Main outcome measures: Demographic and clinical features, use of C. fleckeri antivenom, and associations between weather, seasonal and tidal factors and confirmed C. fleckeri stings. Results: Of 606 jellyfish stings documented, 225 were confirmed to have been caused by C. fleckeri. 37{\%} of C. fleckeri stings were in children, 92{\%} occurred during the {"}stinger season{"} (1 October to 1 June), 83{\%} occurred in water 1 m or less deep, and 17{\%} occured while victims were entering the water. Stings were least common on outgoing tides (P < 0.001) and commonest between 15:00 and 18:00 (P < 0.001) and on days with wind speed less than that month's average (P < 0.001). Nearly all victims experienced immediate pain, but this could often be controlled with ice; only 30{\%} required parenteral narcotics and 8{\%} required hospital admission. Cardiorespiratory arrest occurred within several minutes of the sting in the one fatal case, involving a 3-year-old girl with only 1.2 m of visible tentacle contact. C. fleckeri antivenom was given to another 21 patients, none of whom had life-threatening features at the time they were given antivenom. Conclusions: Most C. fleckeri stings are not life-threatening; patients who die usually have cardiopulmonary arrest within minutes of the sting. The potential benefit of antivenom and magnesium under these circumstances remains to be shown, but a protocol with their rapid use is recommended if cardiopulmonary arrest has occurred. Unfortunately, this is unrealistic for many rural coastal locations, and the priority remains prevention of stings by keeping people, especially children, out of the sea during the stinger season.",
    keywords = "analgesic agent, ice, magnesium, narcotic agent, snake venom antiserum, vinegar, adolescent, adult, aged, article, Australia, cardiopulmonary insufficiency, child, clinical feature, clinical protocol, clinical study, community care, controlled study, demography, envenomation, fatality, female, health care facility, hospital admission, human, jellyfish, major clinical study, male, medical record, pain, prospective study, seashore, seasonal variation, skin examination, snake, victim, weather, Acetic Acid, Adolescent, Adult, Age Distribution, Aged, Analgesia, Animals, Antivenins, Bites and Stings, Child, Child, Preschool, Cnidarian Venoms, Cryotherapy, Cubozoa, Female, Heart Arrest, Hospitalization, Humans, Infusions, Parenteral, Irritants, Male, Middle Aged, Narcotics, Pain, Prospective Studies, Seasons, Time Factors",
    author = "Bart Currie and Susan Jacups",
    year = "2005",
    language = "English",
    volume = "183",
    pages = "631--636",
    journal = "Medical Journal of Australia",
    issn = "0025-729X",
    publisher = "Australasian Medical Publishing Company",
    number = "11-12",

    }

    Prospective study of Chironex fleckeri and other box jellyfish stings in the "Top End" of Australia's Northern Territory. / Currie, Bart; Jacups, Susan.

    In: Medical Journal of Australia, Vol. 183, No. 11-12, 2005, p. 631-636.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Prospective study of Chironex fleckeri and other box jellyfish stings in the "Top End" of Australia's Northern Territory

    AU - Currie, Bart

    AU - Jacups, Susan

    PY - 2005

    Y1 - 2005

    N2 - Objective: To describe the epidemiology and clinical features of box jellyfish envenoming in the Top End of the Northern Territory and, in particular, confirmed stings from the major Australian box jellyfish, Chironex fleckeri. Design: Prospective collection of clinical data and skin scrapings or sticky-tape tests for nematocyst identification from patients presenting to Royal Darwin Hospital and remote coastal community health clinics in the Northern Territory, spanning 10950km of coastline; analysis of tidal, weather and seasonal data. Patients: All patients with jellyfish sting details recorded between 1 April 1991 and 30 May 2004. Main outcome measures: Demographic and clinical features, use of C. fleckeri antivenom, and associations between weather, seasonal and tidal factors and confirmed C. fleckeri stings. Results: Of 606 jellyfish stings documented, 225 were confirmed to have been caused by C. fleckeri. 37% of C. fleckeri stings were in children, 92% occurred during the "stinger season" (1 October to 1 June), 83% occurred in water 1 m or less deep, and 17% occured while victims were entering the water. Stings were least common on outgoing tides (P < 0.001) and commonest between 15:00 and 18:00 (P < 0.001) and on days with wind speed less than that month's average (P < 0.001). Nearly all victims experienced immediate pain, but this could often be controlled with ice; only 30% required parenteral narcotics and 8% required hospital admission. Cardiorespiratory arrest occurred within several minutes of the sting in the one fatal case, involving a 3-year-old girl with only 1.2 m of visible tentacle contact. C. fleckeri antivenom was given to another 21 patients, none of whom had life-threatening features at the time they were given antivenom. Conclusions: Most C. fleckeri stings are not life-threatening; patients who die usually have cardiopulmonary arrest within minutes of the sting. The potential benefit of antivenom and magnesium under these circumstances remains to be shown, but a protocol with their rapid use is recommended if cardiopulmonary arrest has occurred. Unfortunately, this is unrealistic for many rural coastal locations, and the priority remains prevention of stings by keeping people, especially children, out of the sea during the stinger season.

    AB - Objective: To describe the epidemiology and clinical features of box jellyfish envenoming in the Top End of the Northern Territory and, in particular, confirmed stings from the major Australian box jellyfish, Chironex fleckeri. Design: Prospective collection of clinical data and skin scrapings or sticky-tape tests for nematocyst identification from patients presenting to Royal Darwin Hospital and remote coastal community health clinics in the Northern Territory, spanning 10950km of coastline; analysis of tidal, weather and seasonal data. Patients: All patients with jellyfish sting details recorded between 1 April 1991 and 30 May 2004. Main outcome measures: Demographic and clinical features, use of C. fleckeri antivenom, and associations between weather, seasonal and tidal factors and confirmed C. fleckeri stings. Results: Of 606 jellyfish stings documented, 225 were confirmed to have been caused by C. fleckeri. 37% of C. fleckeri stings were in children, 92% occurred during the "stinger season" (1 October to 1 June), 83% occurred in water 1 m or less deep, and 17% occured while victims were entering the water. Stings were least common on outgoing tides (P < 0.001) and commonest between 15:00 and 18:00 (P < 0.001) and on days with wind speed less than that month's average (P < 0.001). Nearly all victims experienced immediate pain, but this could often be controlled with ice; only 30% required parenteral narcotics and 8% required hospital admission. Cardiorespiratory arrest occurred within several minutes of the sting in the one fatal case, involving a 3-year-old girl with only 1.2 m of visible tentacle contact. C. fleckeri antivenom was given to another 21 patients, none of whom had life-threatening features at the time they were given antivenom. Conclusions: Most C. fleckeri stings are not life-threatening; patients who die usually have cardiopulmonary arrest within minutes of the sting. The potential benefit of antivenom and magnesium under these circumstances remains to be shown, but a protocol with their rapid use is recommended if cardiopulmonary arrest has occurred. Unfortunately, this is unrealistic for many rural coastal locations, and the priority remains prevention of stings by keeping people, especially children, out of the sea during the stinger season.

    KW - analgesic agent

    KW - ice

    KW - magnesium

    KW - narcotic agent

    KW - snake venom antiserum

    KW - vinegar

    KW - adolescent

    KW - adult

    KW - aged

    KW - article

    KW - Australia

    KW - cardiopulmonary insufficiency

    KW - child

    KW - clinical feature

    KW - clinical protocol

    KW - clinical study

    KW - community care

    KW - controlled study

    KW - demography

    KW - envenomation

    KW - fatality

    KW - female

    KW - health care facility

    KW - hospital admission

    KW - human

    KW - jellyfish

    KW - major clinical study

    KW - male

    KW - medical record

    KW - pain

    KW - prospective study

    KW - seashore

    KW - seasonal variation

    KW - skin examination

    KW - snake

    KW - victim

    KW - weather

    KW - Acetic Acid

    KW - Adolescent

    KW - Adult

    KW - Age Distribution

    KW - Aged

    KW - Analgesia

    KW - Animals

    KW - Antivenins

    KW - Bites and Stings

    KW - Child

    KW - Child, Preschool

    KW - Cnidarian Venoms

    KW - Cryotherapy

    KW - Cubozoa

    KW - Female

    KW - Heart Arrest

    KW - Hospitalization

    KW - Humans

    KW - Infusions, Parenteral

    KW - Irritants

    KW - Male

    KW - Middle Aged

    KW - Narcotics

    KW - Pain

    KW - Prospective Studies

    KW - Seasons

    KW - Time Factors

    M3 - Article

    VL - 183

    SP - 631

    EP - 636

    JO - Medical Journal of Australia

    JF - Medical Journal of Australia

    SN - 0025-729X

    IS - 11-12

    ER -