Jellyfish sting web survey: clinical characteristics and management of Rhopilema nomadica envenomation in the Mediterranean Sea

Abstract

Jellyfish stings affect millions of people worldwide, and development of species-specific sting management protocols is imperative. In the Mediterranean Sea, protocols thus far ignored Rhopilema nomadica. Here we report the demographic and clinical characteristics of jellyfish stings in the Eastern Mediterranean Sea and propose a first aid protocol. A public survey was conducted over 14 months using an online questionnaire and a logistic generalized model was fitted to predict clinical response to commonly applied topical treatments. Four hundred eighty-one reports were collected. Local manifestations included pain, redness, swelling, lesions, and blisters. Systemic manifestations were uncommon, primarily weakness, heat sensation, and tachycardia. Most respondents (69.2%) were mildly affected, 24.1% moderately, and 6.7% severely. No long-term effects were reported. 87.3% of respondents required only field treatment. Community clinics and emergency departments were sought by 9.56% and 3.12% of respondents, respectively. Topical application of aloe vera, dimetindenum, silver sulfadiazine, and corticosteroid preparations was significantly more efficacious than vinegar. Application of urine and vinegar was more likely to be associated with no effect or worsening. Stings were mostly mild with mainly local manifestations. No long-term loss of function was reported, even in severe cases. Checking online information sources and wearing lycra or neoprene swimwear are recommended for sting avoidance and prevention. First aid recommendations include tentacle removal by rinsing with seawater and topical application of aloe vera/silver sulfadiazine/antihistamine preparations while avoiding urine or vinegar. Patients with extensive stings or systemic manifestations should be referred to emergency departments.

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https://doi.org/10.1007/s10113-023-02104-4
ORIGINAL ARTICLE
Jellyfish sting web survey: clinical characteristics andmanagement
ofRhopilema nomadica envenomation intheMediterranean Sea
DorEdelist1,2 · DrorL.Angel1· NitzaBarkan3· CarmelDanino‑Gozlan1· AnaPalanker1,4· LimorBarak3·
EmilyRobertson1· YedidiaBentur5
Received: 17 April 2023 / Accepted: 8 July 2023
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023
Abstract
Jellyfish stings affect millions of people worldwide, and development of species-specific sting management protocols is
imperative. In the Mediterranean Sea, protocols thus far ignored Rhopilema nomadica. Here we report the demographic
and clinical characteristics of jellyfish stings in the Eastern Mediterranean Sea and propose a first aid protocol. A public
survey was conducted over 14months using an online questionnaire and a logistic generalized model was fitted to pre-
dict clinical response to commonly applied topical treatments. Four hundred eighty-one reports were collected. Local
manifestations included pain, redness, swelling, lesions, and blisters. Systemic manifestations were uncommon, primarily
weakness, heat sensation, and tachycardia. Most respondents (69.2%) were mildly affected, 24.1% moderately, and 6.7%
severely. No long-term effects were reported. 87.3% of respondents required only field treatment. Community clinics
and emergency departments were sought by 9.56% and 3.12% of respondents, respectively. Topical application of aloe
vera, dimetindenum, silver sulfadiazine, and corticosteroid preparations was significantly more efficacious than vinegar.
Application of urine and vinegar was more likely to be associated with no effect or worsening. Stings were mostly mild
with mainly local manifestations. No long-term loss of function was reported, even in severe cases. Checking online
information sources and wearing lycra or neoprene swimwear are recommended for sting avoidance and prevention.
First aid recommendations include tentacle removal by rinsing with seawater and topical application of aloe vera/silver
sulfadiazine/antihistamine preparations while avoiding urine or vinegar. Patients with extensive stings or systemic mani-
festations should be referred to emergency departments.
Keywords Mediterranean Sea· Jellyfish stings· Envenomation· Sting treatment· Rhopilema nomadica· First aid protocol
Introduction
Jellyfish stings
Jellyfish stings are a common worldwide phenomenon that
can have severe effects on human health. Globally, approxi-
mately 100 species of Cnidarians impact human health,
with most stings originating from scyphozoans, cubozoans,
and hydrozoans (Cegolon etal. 2013; Montgomery etal.
2016). In the Mediterranean, mortal envenomation is rare
to non-existent (Ballesteros etal. 2021), but severe injuries
do occur. In the eastern basin, these are mainly inflicted by
Rhopilema nomadica (Oztürk etal. 2010; Bentur etal. 2017;
Glatstein etal. 2018; Galil 2018).
Communicated by Wolfgang Cramer
* Dor Edelist
blackreefs@gmail.com
1 Recanati Institute forMaritime Studies andDepartment
ofMaritime Civilizations, Charney School ofMarine
Sciences, University ofHaifa, 31905Haifa, Israel
2 Marine Resource Management Program, Ruppin Academic
Center, TelAviv-Yafo, Israel
3 Department ofStatistics, Faculty ofSocial Sciences,
University ofHaifa, 31905Haifa, Israel
4 Achva Academic College, Yinon, Israel
5 Rambam Health Care Campus, The Rappaport Faculty
ofMedicine, Technion – Israel Institute ofTechnology,
Haifa, Israel
/ Published online: 23 August 2023
Regional Environmental Change (2023) 23:114
Content courtesy of Springer Nature, terms of use apply. Rights reserved.