Dermatologia comparativa: lesão de ataque por caravela portuguesa (Physalia physalis)

Abstract

Abstract:It is reported the case of a 21-year-old female bather with a skin lesion, heart-shaped ,characteristic of attack by jellyfish. Keywords: Cnidaria; Cnidarian venoms; Heart; Hydrozoa Resumo: Demonstra-se lesão dermatológica, em caprichoso formato de coração, característica de ataque por caravela-portuguesa, em banhista do sexo feminino, 21 anos. Palavras-chave: Cnidários; Coração; Hidrozoários; Venenos de cnidários 2 The phylum Cnidaria is composed of aquatic animals with radial structure that present tentacles around the oral cavity. There are, in each tentacle, inumerous oval bodies nameded nematocysts, capable of injecting venom by a stinging filament that is triggered when the cell is touched. 3 The jellyfish is responsible for the the greatest and most serious number of accidents of this type in Brazil, specially in the summmer. 4 The attack by Physalia physalis can lead to toxic damages (erythema, edema, necrosis, direct action to the myocardium, nervous tissue, hepatic and renal) and allergic damages (early and late), including anaphylaxis, urticaria and granuloma formation.3 Pain begins immediately after exposure. Delayed reactions can present increased levels of IgG, responses mediated by T cells and cross reaction with all types of jellyfish venom. 2In case of an accident it is essential to ask how it happened, the elapsed time, description of the jellyfish and local and systemic symptoms. The seriousness depends on many factors such as : number of nematocysts discharged, health and age of the patient, weight, affected body area, impairment of the extremities (50% more severe), location and tickness of the affected skin (near the head and chest, absorption of the poison is faster). Medical literature reports two deaths caused by this type of jellyfish.

Jellyfish Stings: A Practical Approach

“…In general, reactions to jellyfish stings vary from the usual nonsystemic, localized skin reactions to the rare systemic life-threatening ones, depending on the species of the envenoming organism, the duration and extent of exposure, the number of nematocysts discharged, affected body area, location and thickness of affected skin, health, weight, age, and reaction of the host to envenomation, and the initial treatment administered. 10,11…”

“…Systemic reactions may occur in addition to the above reactions, particularly due to envenomation with certain species of jellyfish. These reactions may be due to direct action of the venom on the heart, liver, kidney, and nervous system 10 or to severe allergic reactions (early and late), although angioedema and anaphylaxis due to jellyfish stings are considered rare. 17 Irukandji syndrome is a serious systemic reaction caused mainly by a Carukia barnesi sting.…”

“…38 Shortly after the sting, intravenous (or in field, intramuscular) administration of antivenom available for severe Australian box jellyfish ( Chironex fleckeri ) stings may also be required (Table 2). 7 ,10,26,38 There are significant concerns, however, regarding the efficacy of the antivenom in reversing the neurotoxic and myotoxic effects of the venom. 6 Magnesium sulfate, which has been reported to improve the effectiveness of the antivenom, may be added for victims of Chironex fleckeri with severe cardiovascular effects who did not respond to advanced life support (Table 2).…”

A Survey of Jellyfish Sting Knowledge among Naval Personnel in Northeast China

“…Victims who are stung by jellyfish should go ashore immediately and clean the wound with seawater. Fresh water must be avoided, as the osmotic pressure is low, thus causing nematocysts to burst and release toxins [ 24 ]. The next step is to remove the tentacles and nematocysts that remain in the skin.…”

Trastuzumab-Associated Flagellate Erythema: Report in a Woman with Metastatic Breast Cancer and Review of Antineoplastic Therapy-Induced Flagellate Dermatoses

“…The individual flagellate dermatoses may be referred to as flagellate erythema or flagellate dermatitis or both (Table 1 ) [ 1 , 4 – 42 ]. Flagellate erythema has a unique clinical presentation.…”