Skin lesions in envenoming by cnidarians (Portuguese man-of-war and jellyfish): etiology and severity of accidents on the Brazilian coast

Abstract

SUMMARYThis work attempts to establish dermatological identification patterns for Brazilian cnidarian species and a probable correlation with envenoming severity. In an observational prospective study, one hundred and twenty-eight patients from the North Coast region of São Paulo State, Brazil were seen between 2002 and 2008. About 80% of these showed only local effects (erythema, edema, and pain) with small, less than 20 cm, oval or round skin marks and impressions from small tentacles. Approximately 20% of the victims had long, more than 20 cm, linear and crossed marks with frequent systemic phenomena, such as malaise, vomiting, dyspnea, and tachycardia. The former is compatible with the common hydromedusa from Southeast and Southern Brazil (Olindias sambaquiensis). The long linear marks with intense pain and systemic phenomena are compatible with envenoming by the box jellyfish Tamoya haplonema and Chiropsalmus quadrumanus and the hydrozoan Portuguese man-of-war (Physalis physalis). There was an association between skin marks and probable accident etiology. This simple observation rule can be indicative of severity, as the Cubozoa Class (box jellyfish) and Portuguese man-of-war cause the most severe accidents. In such cases, medical attention, including intensive care, is important, as the systemic manifestations can be associated with death.

Report of an outbreak of stings caused by Olindias sambaquiensis Muller, 1861 (Cnidaria: hydrozoa) in Southern Brazil

“…The observation of the lesions and marks made it clear that the hydrozoan Olindias sambaquiensis was responsible for a large number of the injuries, which accords with the clinical profile diagnosed by Haddad Jr. (2000) and Haddad Jr. et al (2010). The symptoms were also in accordance with those described by these same authors, and the use of vinegar as a first aid measure, applied in this case by the Fire Department, is recommended for Olindias sambaquiensis (MIANZAN et al, 2001).…”

“…Although there have been few papers published on this problem, some patterns have been observed for this type of sting, and the majority of cases reported in the Southeast and South regions of Brazil have been caused by Hydromedusae Olindias sambaquiensis, giving rise to injuries of moderate severity in the victims (HADDAD JR., 2000;HADDAD JR. et al, 2002, 2010. Other accidents observed have been associated, in smaller number, with the Portuguese Man o' War (Physalia physalis), two box jellyfish (Tamoya haplonema and Chiropsalmus quadrumanus) (HADDAD JR., 2000;HADDAD JR. et al, 2010) with systemic damage, and Scyphomedusae Linuche unguiculata with the condition known as seabather´s eruption (HADDAD JR., et al 2001).…”

“…Recently, careful observation of the skin marks left after contact with cnidarians has been valued as a key element in the identification of the species, which may make recognition of the agents associated with seasonal outbreaks possible (HADDAD JR. et al, 2010), thus helping to determine the first aid measures to be taken both for simple cases, such as using treatment with cold seawater and vinegar baths, and for more systemic problems, such as the hospitalization of the victims (HADDAD JR., 2000;HADDAD JR. et al, 2002, 2010.…”

“…The correlation between cutaneous lesions and the identification of the cnidarians responsible for the cases of poisoning was carried out by analysis of the images obtained, and compared with the standards presented by HADDAD JR. et al (2010). Additional information on the first aid offered to the victims was supplied by the Içara Fire Department, and from the results obtained after treatment.…”

An outbreak of Portuguese man-of-war (Physalia physalis - Linnaeus, 1758) envenoming in Southeastern Brazil

“…The venom is composed of toxic substances with necrotic, neurotoxic (pain) and cardiotoxic effects 3 . The local signs of envenomation include a few long (more than 20cm), linear erythematous and edematous plaques (imprints of the tentacles), blisters and skin necrosis 4,5 . The local symptoms include intense pain and a burning sensation.…”