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Jellyfish sting in Adult
Other Resources UpToDate PubMed

Jellyfish sting in Adult

Contributors: Robert Norris MD, Joanne Feldman MD, MS
Other Resources UpToDate PubMed

Synopsis

The most common envenomations encountered in aquatic environments by humans are by members of the phylum Cnidaria. This phylum includes jellyfish, Portuguese man-of-war, sea anemones, and corals. The common element to all of these groups is the presence of nematocysts or stinging capsules that contain various toxins. Injuries caused by these organisms range from mild irritations to painful, serious injuries with tissue necrosis—sometimes fatal.

Jellyfish and Portuguese man-of-war (Physalia physalis) injuries initially present with sharp burning pain followed rapidly by development of erythematous welts in whip-like patterns on the body. These subside within hours, but resolve to hyperpigmentation in minor cases or bullae and necrosis in severe cases. Systemic symptoms may accompany severe P. physalis injuries and include nausea, abdominal cramps, irritability, chest tightness, and dyspnea.

Stings by Chironex fleckeri, known as box jellyfish or sea wasp (an enormous jellyfish found in tropical Australian waters), are typically severe. The lesions have a characteristic frosted appearance to them due to a dermatonecrotic toxin. Commonly, exposure is fatal due to hemolytic and cardiotoxic toxins. See also Hawaiian box jellyfish sting and lion's mane jellyfish sting.

Sea anemone dermatitis is caused by exposure to one of several species and usually results in conditions similar to allergic contact dermatitis, but differs in that the symptoms occur within minutes of contact.

Exposures to coral may be quite mild and result only in irritation and pruritus. Stings from fire corals, which are not true corals, are painful initially and result in papular and pustular eruptions that can progress to tissue necrosis.

Codes

ICD10CM:
T63.621A – Toxic effect of contact with other jellyfish, accidental, initial encounter

SNOMEDCT:
274920002 – Jellyfish sting

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Coral injury
  • Fire coral sting
  • Sponge dermatitis
  • Sea cucumber skin irritation
  • Sea anemone sting
  • Phytophotodermatitis is not as immediately painful and occurs only on sun-exposed skin.
  • Allergic contact dermatitis is more pruritic and less painful.
  • Abrasion
  • Laceration

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated:10/04/2017
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Jellyfish sting in Adult
A medical illustration showing key findings of Jellyfish sting (Box Jellyfish Sting) : Vomiting, Tachycardia, Diaphoresis, BP increased
Clinical image of Jellyfish sting - imageId=292160. Click to open in gallery.  caption: 'Edematous, erythematous papules and plaques in linear arrays at the antecubital fossa following a lion's mane jellyfish sting.'
Edematous, erythematous papules and plaques in linear arrays at the antecubital fossa following a lion's mane jellyfish sting.
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