Managing Irukandji Syndrome

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Managing Irukandji Syndrome is important for many emergency departments, particularly in North Queensland. The recent discovery of irukandji jellyfish off Fraser Island, and with four people hospitalised in the past weeks as a result of irukandji stings, serve as a timely reminder of the danger presented by these and other marine stingers, and a warning to EDs outside of traditional stinger areas that they may become more prevalent. Despite the low incidence, the condition is associated with possible life-threatening cardiovascular complications that make it difficult to manage. Although considered life-threatening, there have only been two confirmed Irukandji Syndrome fatalities, both occurring in 2002, however dozens of people are hospitalised from Irukandji Syndrome every year. 

Around ten jellyfish are known to produce the range of symptoms collectively known as Irukandji Syndrome. These jellyfish are the smallest known box jellyfish, usually no more than 1 cubic centimetre in volume and with only four small tentacles often too small to be seen. 

Although tiny they punch above their weight. A minor sting is generally followed within 5 to 30 minutes by severe generalised pain or cramps, nausea and vomiting, breathing difficulties, localised or general sweating, restlessness, anxiety, headache, waves of spasms in the back and stomach, dizziness, and a terrible sense of dread. Irukandji Syndrome affects people differently and some patients may develop heart failure, pulmonary oedema and hypertensive stroke. 

Stinging by jellyfish is caused by the simultaneous discharge of thousands of microscopic stinging capsules called nematocysts located on the tentacles of the jellyfish. Nematocysts contain coiled tubules loaded with venom, which are discharged into the patient’s skin like darts upon contact.

James Cook University Associate Professor Jamie Seymour, who is also a specialist in irukandji with the Australian Institute of Tropical Health and Medicine in Cairns, and who describes the pain of a sting as "10 out of 10", said the irukandji’s move south down the east coast of Australia has been corresponding with a 1- to 2-degree temperature rise in the water off the southern Queensland coast, and the animals have moved predictably with that. He believes that it’s only a matter of time before they get from southern end of Fraser Island to the Sunshine Coast. It's timely then for emergency departments and clinicians working outside of areas more widely associated with stingers to become more informed about the dangers and treatment options.

Further Reading

Journal Articles on CKN

Australian Resuscitation Council Guideline 9.4.5

DynaMed Plus Topic: Marine envenomation

Queensland Ambulance Service Factsheet

Surf Life Saving Queensland resources on www.marinestingers.com

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