A Probable Case of Irukandji Syndrome in Thailand

Harbour Hospital, Rotterdam, South Holland, Netherlands
Journal of Travel Medicine (Impact Factor: 1.58). 07/2006; 13(4):240-3. DOI: 10.1111/j.1708-8305.2006.00041.x
Source: PubMed


The Irukandji syndrome is a jellyfish envenomation caused by Carukia barnesi or related jellyfish. In literature, the distribution of "Irukandji-like" syndromes is restricted to Australia. We report a case of probable Irukandji syndrome in Thailand. With this report, we hope to promote awareness to aid sting prevention and stimulate research.

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Available from: Kenneth Daniel Winkel
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    • "Irukandji syndrome reported from Broome (Macrokanis et al., 2004) 2005 New species of carybdeids identified: Malo maxima, Carukia shinju, Alatina mordens and Gerongia rifkinae (Gershwin, 2005a; Gershwin 2005b; Gershwin & Alderslade, 2005 ) 2005 Pharmacological analysis of Carukia barnesi venom extracts confirming release of catecholamines (Winkel et al., 2005; Ramasamay et al., 2005) and modulation of neural sodium channel (Winkel et al., 2005). 2006 Irukandji syndrome recognised in South East Asia (de Pender et al., 2006) 2007 Identification of another species of carybdeid: Malo kingi (Gershwin, 2007) 2008 Re-classification of genus of carybdeid: Morbakka fenneri (Gershwin, 2008). Catecholamine release by Alatina nr mordens (Winter et al., 2008). "
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    ABSTRACT: The Australian carybdeid jellyfish associated with Irukandji syndrome is Carukia barnesi, (Barnes' jellyfish). Other Australian carybdeid jellyfish that may be associated with the syndrome include Carukia shinju, Carybdea xaymacana, Malo maxima, Malo kingi, Alatina mordens, Gerongia rifkinae, and Morbakka fenneri ("Morbakka"). These small jellyfish are difficult to capture and identify. They are located offshore of the coasts of Australian states including Queensland, The Northern Territory, Western Australia and South Australia. The syndromic illness, resulting from a characteristic relatively minor sting, develops after about 30 minutes and consists of severe muscle pains especially of the lower back, muscle cramps, vomiting, sweating, agitation, vasoconstriction, prostration, hypertension and in cases of severe envenomation, acute heart failure. The mechanisms of actions of their toxins are obscure but they appear to include modulation of neuronal sodium channels leading to massive release of endogenous catecholamines (C. barnesi, A. mordens and M. maxima) and thereby to possible stress-induced cardiomyopathy. In addition, pore formation may occur in myocardial cellular membranes (C. xaymacana). In human cases of severe envenomation, systemic hypertension and myocardial dysfunction are associated with membrane leakage of troponin. Clinical management includes parenteral analgesia, antihypertensive therapy, oxygen and mechanical ventilation. No effective first-aid is known. Large knowledge gaps exist in biology of the jellyfish, their distribution, their toxins and mode of actions and in treatment of the Irukandji syndrome.
    Full-text · Article · Feb 2012 · Toxicon
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    • "The deaths in 2002 of two tourists in Far North Queensland, Australia, highlighted the potential risk and severity of this syndrome (Fenner and Hadok, 2002; Huynh et al., 2003). It is now appreciated to occur elsewhere in the Indo-Pacific and the Caribbean (de Pender et al., 2006; Grady and Burnett, 2003; Pommier et al., 2005; Yoshimoto and Yanagihara, 2002). Only a single species – Carukia barnesi – has been definitively confirmed as a cause of Irukandji syndrome, however many different species have been linked to it (Barnes, 1964; Burnett et al., 1996; Fenner et al., 1985; Gershwin, 2005, 2007; Little et al., 2001, 2006; Little and Seymour, 2003; O'Reilly et al., 2001; Southcott, 1967; Tibballs et al., 2001). "
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    ABSTRACT: The in vitro cardiac and vascular pharmacology of Malo maxima, a newly described jellyfish suspected of causing Irukandji syndrome in the Broome region of Western Australia, was investigated in rat tissues. In left atria, M. maxima crude venom extract (CVE; 1-100μg/mL) caused concentration-dependent inotropic responses which were unaffected by atropine (1μM), but significantly attenuated by tetrodotoxin (TTX; 0.1μM), propranolol (1μM), Mg(2+) (6mM) or calcitonin gene-related peptide antagonist (CGRP(8-37); 1μM). CVE caused no change in right atrial rate until 100μg/mL, which elicited bradycardia. This was unaffected by atropine, TTX, propranolol or CGRP(8-37). In the presence of Mg(2+), CVE 30-100μg/mL caused tachycardia. In small mesenteric arteries CVE caused concentration-dependent contractions (pEC(50) 1.03±0.07μg/mL) that were unaffected by prazosin (0.3μM), ω-conotoxin GVIA (0.1μM) or Mg(2+) (6mM). There was a 2-fold increase in sensitivity in the presence of CGRP(8-37) (3μM). TTX (0.1μM), box jellyfish Chironex fleckeri antivenom (92.6U/mL) and benextramine (3μM) decreased sensitivity by 2.6, 1.9 and 2.1-fold, respectively. CVE-induced maximum contractions were attenuated by C. fleckeri antivenom (-22%) or benextramine (-49%). M. maxima CVE appears to activate the sympathetic, but not parasympathetic, nervous system and to stimulate sensory nerve CGRP release in left atria and resistance arteries. These effects are consistent with the catecholamine excess thought to cause Irukandji syndrome, with additional actions of CGRP release.
    Full-text · Article · Mar 2011 · Toxicology Letters
    • "While incidence of stings in North Queensland and the Northern Territory has been documented in the literature for many years, cases in other areas of the world have only been published since 2003 (Grady and Burnett, 2003; Macrokanis et al., 2004; de Pender et al., 2006). Consequently, the knowledge of Irukandji syndrome is still developing and effective treatment is under development. "
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    ABSTRACT: This manuscript presents both demographic and descriptive data related to a distressing clinical condition known as Irukandji syndrome. Chart audit and observation data were collected to explore trends in patient characteristics and to review the current practices surrounding the management of the syndrome by advanced practice ED nurses. Irukandji syndrome, a known health emergency in northern Australia, causes severe symptoms such as muscle pains, nausea and vomiting, headache and chest pain causing clinical challenges for emergency nurses. Little is written about this condition from a nursing perspective. A mixed methods case study approach. Data were collected by observation and chart audit from 186 patients diagnosed with Irukandji syndrome between 2001-2007. Of the 186 patients, 44.1% were local residents and 58.6% were men. Median age of the patients was 27 years (range 16-77). There was a time trend with a greater number of stings occurring out at the Great Barrier Reef than at mainland beaches (p < 0.001). Important results were found regarding waiting times for pain management and intuitive rather than documented assessment practices of advanced practice nursing staff. Irukandji syndrome causes severe emotional distress and acute pain, however, people continue to swim in marine sting environments and fail to make use of available protective clothing such as body suits. Local residents continue to be stung regardless of the educational information available suggesting a review of the current public education campaign is required. Nurses failed to document assessment processes limiting adequately the ability to assess trends in the patient's condition effectively and treat symptoms efficiently. It is, therefore, timely to review the critical role that assessment plays in clinical care.
    No preview · Article · Jan 2010 · Journal of Clinical Nursing
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