The Anaphylaxis Blues Jellyfish strikes back
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+ The Anaphylaxis Blues Jellyfish strikes back Dr Daniel Khamoudes Toxicology Service Prince Of Wales Hospital
description
The Anaphylaxis Blues Jellyfish strikes back. Dr Daniel Khamoudes Toxicology Service Prince Of Wales Hospital. Outline. Case History Facts. Case. 38M Otherwise well Hx of anaphylaxis to bee stings Blue Bottle Sting at Maroubra 1730 First aid with water to remove - PowerPoint PPT Presentation
Transcript of The Anaphylaxis Blues Jellyfish strikes back
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The Anaphylaxis BluesJellyfish strikes back
Dr Daniel KhamoudesToxicology Service
Prince Of Wales Hospital
+Outline
Case History Facts
+Case
38M Otherwise well Hx of anaphylaxis to bee stings Blue Bottle Sting at Maroubra 1730
First aid with water to remove
Presented POW ED 1800 with pain Primary sting L lateral ankle Pain locally and L groin 8/10
+Case
In ambulance bay, hot water submersion 1830 sudden onset tongue angioedema
Moved to resus Nil respiratory or haemodynamic compromise Adrenaline 0.5mg IM at 1855
Rapid resolution within 5 minutes Hydrocortisone 200mg IV Ranitidine 50mg IV Fexofenadine 180mg po Fentanyl 150mcg, in 50mcg aliquots
+Case
Return of angioedema 2000 Nil respiratory or haemodynamic compromise Second dose Adrenaline 0.5mg IM 2010 Resolution of symptoms over 10 minutes
Further boluses of Fentanyl as groin pain an issue Creatine kinase and UEC NAD HDU admission for observation re angioedema Nil further episodes Pain settled overnight
+History
Discovered 19031
Richet and Portier Dogs vs Jellyfish toxin Second exposure lower dose lethal 1913 Nobel Prize
Origin Greek –ana (against) –phylaxis (protection) Originally aphylaxis (publicist)
1. Wikipedia
+Mechanism
Nematoblasts->Nematocysts Spring loaded syring Discharge within 700ns of contact 18m/s 5.4x106g Pressure 7.7GPa Local and systemic injury
+Mechanism
+Mechanism
Toxin2
Local and systemic
Tubule Collagens, glycoproteins and polysaccharides Innate and adaptive cellular and humoral responses
2. J Tibballs, A Yanagihara, H Turner, K Winkel. Immunological and Toxinological Responses to Jellyfish Stings. Inflammation & Allergy - Drug Targets, 2011, 10, 438-446.
+Mechanism
+Physalia Utriculus
Physalia physalis vs Physalia utriculus Float and Tail Nematocysts remain active
+Local effects
Immediate pain and erythema Progressive pain to draining lymph nodes Long term scarring unlikely but occurs
+Local Effects
+Systemic Effects
Venom Pore forming in plasma membrane, Ca influx/swelling/lysis2,3
Neuro/cardio toxicity2,4
Potential deaths with Physalia physalis 5,6
Immune Response – immediate and delayed Hypersensitivity reaction
Previous exposure Cross reactivity
3. Edwards, L.P.; Whitter, E.; Hessinger, D.A. Apparent membrane pore-formation by Portuguese Man-of-war (Physalia physalis). Toxicon, 2002, 40(9), 1299-1305.4. Burnett, J.W. Treatment of Atlantic cnidarian envenomations. Toxicon, 2009, 54(8), 1201-1205.5.5. Tibballs, J. Australian venomous jellyfish, envenomation syndromes, toxins and therapy. Toxicon, 2006, 48(7), 830-859. 6. L Cegolon, W Heymann, G Mastrangelo. Jellyfish Stings and Their Management: A Review. Marine Drugs, Feb 2013. 11(2):523-550
+Treatment
Supportive Analgesia Consider regional
Hot water submersion3
Anaphylaxis APP ALS IgG production noted8
7. C Loten, B Stokes, D Worsley, J Seymour, S Jiang, G Isbister. A randomised controlled trial of hot water (45°C) immersionversus ice packs for pain relief in bluebottle stings. MJA April 2006. 184(7):329-333.8. Russo, A.J.; Calton, G.J.; Burnett, J.W. The relationship of the possible allergic response to jellyfish envenomation and serum antibody titers. Toxicon, 1983, 21(4), 475-480.
+Summary
Local and systemic symptoms Treatment supportive +/- specific ?Steroid topical ?Sun exposure
+References
Wikipaedia
2. J Tibballs, A Yanagihara, H Turner, K Winkel. Immunological and Toxinological Responses to Jellyfish Stings. Inflammation & Allergy - Drug Targets, 2011, 10, 438-446.
3. Edwards, L.P.; Whitter, E.; Hessinger, D.A. Apparent membrane pore-formation by Portuguese Man-of-war (Physalia physalis). Toxicon, 2002, 40(9), 1299-1305.
4. Burnett, J.W. Treatment of Atlantic cnidarian envenomations. Toxicon, 2009, 54(8), 1201-1205.5.
5. Tibballs, J. Australian venomous jellyfish, envenomation syndromes, toxins and therapy. Toxicon, 2006, 48(7), 830-859.
6. L Cegolon, W Heymann, G Mastrangelo. Jellyfish Stings and Their Management: A Review. Marine Drugs, Feb 2013. 11(2):523-550
7. C Loten, B Stokes, D Worsley, J Seymour, S Jiang, G Isbister. A randomised controlled trial of hot water (45°C) immersion versus ice packs for pain relief in bluebottle stings. MJA April 2006. 184(7):329-333.
8. Russo, A.J.; Calton, G.J.; Burnett, J.W. The relationship of the possible allergic response to jellyfish envenomation and serum antibody titers. Toxicon, 1983, 21(4), 475-480.
