Irukandji syndrome
Encyclopedia
Irukandji syndrome is a condition that is induced by venom
ization through the sting of Carukia barnesi
, a species of Irukandji jellyfish
, and other cubozoans. The condition is rarely fatal, but if immediate medical action is not taken, within only 20 minutes the victim could go into cardiac arrest
and die. The syndrome was given its name in 1952 by Hugo Flecker, after the Aboriginal
Irukandji people who live in Palm Cove, north of Cairns, Australia
where stings are common.
: the Irukandji jellyfish
. In order to prove that the jellyfish was the cause of the syndrome, he captured one and deliberately stung himself, his son, and a local lifeguard, and observed the symptoms. It is suspected that other cubozoans can cause Irukandji syndrome, but only seven jellyfish are positively identified (Carukia barnesi
, Alatina cf. mordens, Carybdea alata
, Malo maximus, Malo kingi
, Carybdea xaymacana, an as-yet unnamed "fire jelly", and another unnamed species).
excess may be an underlying mechanism in severe Irukandji syndrome. Animal studies appear to confirm a relationship between envenoming and an increase in circulating noradrenaline and adrenaline.
bite. The symptoms, however, gradually become apparent and then more and more intense in the following 5 to 120 minutes (30 minutes on average). Irukandji syndrome includes an array of systemic symptoms including severe headache
, backache, muscle pains, chest and abdominal pain
, nausea
and vomiting
, sweating
, anxiety
, hypertension
, tachycardia
and pulmonary edema
. One unusual symptom associated with Irukandji syndrome is a feeling of "impending doom". Patients have been reported as being so certain that they are going to die that they beg their doctors to kill them to get it over with. Symptoms generally abate in 4 to 30 hours, but may take up to two weeks to resolve completely.
, first aid consists of flushing the area with vinegar
to neutralize the tentacle stinging apparatus. There is no antivenom; treatment is largely supportive, with analgesia being the mainstay of management. Antihistamines
may be of benefit for pain relief, but most cases require intravenous opioid
analgesia. Fentanyl or morphine
are usually chosen. Pethidine
(aka meperidine in U.S. (Demerol)) should be avoided, as large doses are often required for pain relief and in this situation significant adverse effects from the pethidine metabolite norpethidine may occur.
Magnesium sulfate
has been proposed as a treatment for Irukandji syndrome after being apparently successfully used in one case. Early evidence suggested a benefit; however, according to a later report a series of 3 patients failed to show any improvement with magnesium; the author reiterated the experimental status of this treatment.
, Hawaii
, Florida
, French West Indies
, Bonaire, the Caribbean
, Timor Leste and Papua New Guinea
. It is presumed that cubozoan species other than Carukia barnesi are responsible for envenomations outside Australia.
sting is apparent in the 2005 Discovery Channel
documentary Killer Jellyfish about Carukia barnesi
, when two Australian researchers (Jamie Seymour
and Teresa Carrette) are stung. Even under the "maximum dose of morphine," Teresa remarked that she "wished she could rip her skin off," and is later seen writhing uncontrollably from the pain while lying on her hospital bed. In one scene, Teresa's feet are shown contorting and digging into the bed, and she is wiggling her toes and kicking her feet around. When the camera moves back, Teresa is seen rubbing her face, her body is contorting in agony, and her legs are rapidly sliding and kicking around on the bed. Jamie, at his worst, is also seen writhing in pain, curled up in a ball and barely able to speak. Jamie said he wished that he was stung by Chironex fleckeri
instead since "the pain goes away in 20 minutes or you die."
Another recent program that aired on the Discovery Channel entitled Stings, Fangs and Spines featured a 20-minute spot on Irukandji syndrome. In the segment, a young Australian woman was stung and developed a severe case of Irukandji syndrome. In a testament to the severity of pain involved, a re-enactment (featuring the actual victim portraying herself) shows her screaming and violently thrashing around on the hospital bed in an almost convulsive state, for the bulk of the segment. She later commented that this unbearable pain lasted for hours, and added that "I didn't think it was possible for anyone to endure that level of pain without turning into a vegetable."
On the television program Super Animal, a woman compared her pain from childbirth
to her experience with Irukandji syndrome: "It's like when you're in labor, having a baby, and you've reached the peak of a contraction—that absolute peak—and you feel like you just can't do it anymore. That's the minimum that [Irukandji] pain is at, and it just builds from there."
Venom
Venom is the general term referring to any variety of toxins used by certain types of animals that inject it into their victims by the means of a bite or a sting...
ization through the sting of Carukia barnesi
Carukia barnesi
Carukia barnesi is a small and extremely venomous jellyfish found near Australia. Stings can result in Irukandji syndrome, and thus this species is commonly known as Irukandji jellyfish, although this name does not distinguish it from other Irukandji jellyfish such as Malo kingi.A mature C....
, a species of Irukandji jellyfish
Irukandji jellyfish
Irukandji jellyfish are tiny and extremely venomous jellyfish that inhabit marine waters of Australia and which are able to fire their stingers into their victim, causing symptoms collectively known as Irukandji syndrome. Its size is roughly no larger than a cubic centimetre...
, and other cubozoans. The condition is rarely fatal, but if immediate medical action is not taken, within only 20 minutes the victim could go into cardiac arrest
Cardiac arrest
Cardiac arrest, is the cessation of normal circulation of the blood due to failure of the heart to contract effectively...
and die. The syndrome was given its name in 1952 by Hugo Flecker, after the Aboriginal
Indigenous Australians
Indigenous Australians are the original inhabitants of the Australian continent and nearby islands. The Aboriginal Indigenous Australians migrated from the Indian continent around 75,000 to 100,000 years ago....
Irukandji people who live in Palm Cove, north of Cairns, Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
where stings are common.
Early experience
In 1964, Jack Barnes confirmed that the cause of the syndrome was a sting from a small box jellyfishBox jellyfish
Box jellyfish are cnidarian invertebrates distinguished by their cube-shaped medusae. Box jellyfish are known for the extremely potent venom produced by some species: Chironex fleckeri, Carukia barnesi and Malo kingi are among the most venomous creatures in the world...
: the Irukandji jellyfish
Irukandji jellyfish
Irukandji jellyfish are tiny and extremely venomous jellyfish that inhabit marine waters of Australia and which are able to fire their stingers into their victim, causing symptoms collectively known as Irukandji syndrome. Its size is roughly no larger than a cubic centimetre...
. In order to prove that the jellyfish was the cause of the syndrome, he captured one and deliberately stung himself, his son, and a local lifeguard, and observed the symptoms. It is suspected that other cubozoans can cause Irukandji syndrome, but only seven jellyfish are positively identified (Carukia barnesi
Carukia barnesi
Carukia barnesi is a small and extremely venomous jellyfish found near Australia. Stings can result in Irukandji syndrome, and thus this species is commonly known as Irukandji jellyfish, although this name does not distinguish it from other Irukandji jellyfish such as Malo kingi.A mature C....
, Alatina cf. mordens, Carybdea alata
Carybdea alata
Carybdea alata is an Australian species of box jellyfish, often referred to as a sea wasp. It is also found in the Arabian Sea along the beaches of Pakistan....
, Malo maximus, Malo kingi
Malo kingi
Malo kingi is an Irukandji jellyfish named after victim Robert King, a tourist from the United States who died from its sting. It was first described to science in 2007, and is one of two species in genus Malo. It has some of the world's most potent venom, even though it is no bigger than a human...
, Carybdea xaymacana, an as-yet unnamed "fire jelly", and another unnamed species).
Toxicity
When properly treated a single sting is normally not fatal; however, two people in Australia are believed to have died from Irukandji stings, which has greatly increased public awareness of Irukandji syndrome. It is unknown how many other deaths from Irukandji syndrome have been wrongly attributed to other causes. The exact mechanism of action of Irukandji venom is unknown. It has been suggested that catecholamineCatecholamine
Catecholamines are molecules that have a catechol nucleus consisting of benzene with two hydroxyl side groups and a side-chain amine. They include dopamine, as well as the "fight-or-flight" hormones adrenaline and noradrenaline released by the adrenal medulla of the adrenal glands in response to...
excess may be an underlying mechanism in severe Irukandji syndrome. Animal studies appear to confirm a relationship between envenoming and an increase in circulating noradrenaline and adrenaline.
Symptoms
Most stings occur during the summer wet season in October-May in North Queensland, with different seasonal patterns elsewhere. Because the Jellyfish is very small, and the venom is only injected through the tips of the nematocysts (the cnidocysts) rather than the entire lengths, the sting may barely be noticed at first. It has been described as feeling like little more than a mosquitoMosquito
Mosquitoes are members of a family of nematocerid flies: the Culicidae . The word Mosquito is from the Spanish and Portuguese for little fly...
bite. The symptoms, however, gradually become apparent and then more and more intense in the following 5 to 120 minutes (30 minutes on average). Irukandji syndrome includes an array of systemic symptoms including severe headache
Headache
A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
, backache, muscle pains, chest and abdominal pain
Abdominal pain
Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...
, nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
and vomiting
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
, sweating
Sweating
Perspiration is the production of a fluid consisting primarily of water as well as various dissolved solids , that is excreted by the sweat glands in the skin of mammals...
, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
, hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, tachycardia
Tachycardia
Tachycardia comes from the Greek words tachys and kardia . Tachycardia typically refers to a heart rate that exceeds the normal range for a resting heart rate...
and pulmonary edema
Pulmonary edema
Pulmonary edema , or oedema , is fluid accumulation in the air spaces and parenchyma of the lungs. It leads to impaired gas exchange and may cause respiratory failure...
. One unusual symptom associated with Irukandji syndrome is a feeling of "impending doom". Patients have been reported as being so certain that they are going to die that they beg their doctors to kill them to get it over with. Symptoms generally abate in 4 to 30 hours, but may take up to two weeks to resolve completely.
Treatment
Similarly to other box jellyfishBox jellyfish
Box jellyfish are cnidarian invertebrates distinguished by their cube-shaped medusae. Box jellyfish are known for the extremely potent venom produced by some species: Chironex fleckeri, Carukia barnesi and Malo kingi are among the most venomous creatures in the world...
, first aid consists of flushing the area with vinegar
Vinegar
Vinegar is a liquid substance consisting mainly of acetic acid and water, the acetic acid being produced through the fermentation of ethanol by acetic acid bacteria. Commercial vinegar is produced either by fast or slow fermentation processes. Slow methods generally are used with traditional...
to neutralize the tentacle stinging apparatus. There is no antivenom; treatment is largely supportive, with analgesia being the mainstay of management. Antihistamines
Histamine antagonist
A histamine antagonist, commonly referred to as antihistamine, is a pharmaceutical drug that inhibits action of histamine by blocking it from attaching to histamine receptors.- Clinical effects :...
may be of benefit for pain relief, but most cases require intravenous opioid
Opioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...
analgesia. Fentanyl or morphine
Morphine
Morphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
are usually chosen. Pethidine
Pethidine
Pethidine or meperidine Pethidine (INN) or meperidine (USAN) Pethidine (INN) or meperidine (USAN) (commonly referred to as Demerol but also referred to as: isonipecaine; lidol; pethanol; piridosal; Algil; Alodan; Centralgin; Dispadol; Dolantin; Mialgin (in Indonesia); Petidin Dolargan (in Poland);...
(aka meperidine in U.S. (Demerol)) should be avoided, as large doses are often required for pain relief and in this situation significant adverse effects from the pethidine metabolite norpethidine may occur.
Magnesium sulfate
Magnesium sulfate
Magnesium sulfate is a chemical compound containing magnesium, sulfur and oxygen, with the formula MgSO4. It is often encountered as the heptahydrate epsomite , commonly called Epsom salt, from the town of Epsom in Surrey, England, where the salt was distilled from the springs that arise where the...
has been proposed as a treatment for Irukandji syndrome after being apparently successfully used in one case. Early evidence suggested a benefit; however, according to a later report a series of 3 patients failed to show any improvement with magnesium; the author reiterated the experimental status of this treatment.
Geographic distribution
Reports of Irukandji syndrome have come from AustraliaAustralia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
, Hawaii
Hawaii
Hawaii is the newest of the 50 U.S. states , and is the only U.S. state made up entirely of islands. It is the northernmost island group in Polynesia, occupying most of an archipelago in the central Pacific Ocean, southwest of the continental United States, southeast of Japan, and northeast of...
, Florida
Florida
Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...
, French West Indies
French West Indies
The term French West Indies or French Antilles refers to the seven territories currently under French sovereignty in the Antilles islands of the Caribbean: the two overseas departments of Guadeloupe and Martinique, the two overseas collectivities of Saint Martin and Saint Barthélemy, plus...
, Bonaire, the Caribbean
Caribbean
The Caribbean is a crescent-shaped group of islands more than 2,000 miles long separating the Gulf of Mexico and the Caribbean Sea, to the west and south, from the Atlantic Ocean, to the east and north...
, Timor Leste and Papua New Guinea
Papua New Guinea
Papua New Guinea , officially the Independent State of Papua New Guinea, is a country in Oceania, occupying the eastern half of the island of New Guinea and numerous offshore islands...
. It is presumed that cubozoan species other than Carukia barnesi are responsible for envenomations outside Australia.
Media demonstrations
The severity of the pain from an Irukandji jellyfishIrukandji jellyfish
Irukandji jellyfish are tiny and extremely venomous jellyfish that inhabit marine waters of Australia and which are able to fire their stingers into their victim, causing symptoms collectively known as Irukandji syndrome. Its size is roughly no larger than a cubic centimetre...
sting is apparent in the 2005 Discovery Channel
Discovery Channel
Discovery Channel is an American satellite and cable specialty channel , founded by John Hendricks and distributed by Discovery Communications. It is a publicly traded company run by CEO David Zaslav...
documentary Killer Jellyfish about Carukia barnesi
Carukia barnesi
Carukia barnesi is a small and extremely venomous jellyfish found near Australia. Stings can result in Irukandji syndrome, and thus this species is commonly known as Irukandji jellyfish, although this name does not distinguish it from other Irukandji jellyfish such as Malo kingi.A mature C....
, when two Australian researchers (Jamie Seymour
Jamie Seymour
Jamie Seymour is an Australian venom biologist. He is currently a professor at James Cook University in Cairns, Northern Queensland, Australia. As shown in the 2005 Discovery Channel documentary Killer Jellyfish, Jamie was stung by an Irukandji jellyfish and was hospitalised...
and Teresa Carrette) are stung. Even under the "maximum dose of morphine," Teresa remarked that she "wished she could rip her skin off," and is later seen writhing uncontrollably from the pain while lying on her hospital bed. In one scene, Teresa's feet are shown contorting and digging into the bed, and she is wiggling her toes and kicking her feet around. When the camera moves back, Teresa is seen rubbing her face, her body is contorting in agony, and her legs are rapidly sliding and kicking around on the bed. Jamie, at his worst, is also seen writhing in pain, curled up in a ball and barely able to speak. Jamie said he wished that he was stung by Chironex fleckeri
Chironex fleckeri
Chironex fleckeri, commonly known as sea wasp, is a species of Box jellyfish found in coastal waters from northern Australia and New Guinea north to the Philippines and Vietnam. It has been described as "the most lethal jellyfish in the world", with at least 63 known deaths from 1884 to...
instead since "the pain goes away in 20 minutes or you die."
Another recent program that aired on the Discovery Channel entitled Stings, Fangs and Spines featured a 20-minute spot on Irukandji syndrome. In the segment, a young Australian woman was stung and developed a severe case of Irukandji syndrome. In a testament to the severity of pain involved, a re-enactment (featuring the actual victim portraying herself) shows her screaming and violently thrashing around on the hospital bed in an almost convulsive state, for the bulk of the segment. She later commented that this unbearable pain lasted for hours, and added that "I didn't think it was possible for anyone to endure that level of pain without turning into a vegetable."
On the television program Super Animal, a woman compared her pain from childbirth
Childbirth
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
to her experience with Irukandji syndrome: "It's like when you're in labor, having a baby, and you've reached the peak of a contraction—that absolute peak—and you feel like you just can't do it anymore. That's the minimum that [Irukandji] pain is at, and it just builds from there."
External links
- Irukandji Syndrome
- Report of successful treatment of Irukandji Syndrome
- Australian Venom Research Unit
- Life in the Fast Lane - Irukandji Syndrome
- Life in the Fast Lane - Toxicology Conundrum #008
- Life in the Fast Lane - Toxicology Conundrum #009
- Life in the Fast Lane - Jack Barnes and the Irukandji Enigma