Abstract
Cnidarian envenomations are the leading cause of severe and lethal human sting injuries from marine life. The total amount of venom discharged into sting-site tissues, sometimes referred to as “venom load”, has been previously shown to correlate with tentacle contact length and sequelae severity. Since <1% of cnidae discharge upon initial tentacle contact, effective and safe removal of adherent tentacles is of paramount importance in the management of life-threatening cubozoan stings. We evaluated whether common rinse solutions or scraping increased venom load as measured in a direct functional assay of venom activity (hemolysis). Scraping significantly increased hemolysis by increasing cnidae discharge. For Alatina alata, increases did not occur if the tentacles were first doused with vinegar or if heat was applied. However, in Chironex fleckeri, vinegar dousing and heat treatment were less effective, and the best outcomes occurred with the use of venom-inhibiting technologies (Sting No More® products). Seawater rinsing, considered a “no-harm” alternative, significantly increased venom load. The application of ice severely exacerbated A. alata stings, but had a less pronounced effect on C. fleckeri stings, while heat application markedly reduced hemolysis for both species. Our results do not support scraping or seawater rinsing to remove adherent tentacles.
Highlights
Box jellyfish stings are an increasing public health problem, causing more deaths annually than shark attacks worldwide [1,2,3,4]
As the number of cnidae discharging in a cubozoan sting site represents a small fraction of the packed cnidae along the tentacle surface [16], first-aid steps taken immediately after a sting— when tentacles and shed cnidae may be still adherent—can have dramatic effects on venom load and clinical outcomes
We found that common recommendations—including rinsing the area with seawater, scraping away tentacles, and the application of ice packs—can severely exacerbate venom-induced hemolysis, a metric of sting sequelae
Summary
Box jellyfish stings are an increasing public health problem, causing more deaths annually than shark attacks worldwide [1,2,3,4]. Envenomations can range in severity from mild sting-site pain to loss of life within minutes [4,5,6,7]. Sting severity varies based on several factors, the most important of which are the species involved and the dose of venom delivered [8,9]. Studies have shown that the outcomes vary based on first-aid and clinical-care measures [10,11,12,13]. Since only
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