Jellyfish sting in Maldives?

[Mrs talbot]

hi,
In early March this year, my husband and 10 year old daughter and myself went to Maldives on a snorkling holiday. Beautiful as it was , unfortunately my daughter received a bad jellyfish sting . She was just about to get out of the water when she started screaming ,she ran out screaming and shouting , we were very close to our beach villa so I put her under the shower while my husband called the doctor , at that point she was screaming my legs my legs , but there was no swelling or marks . About 4 minutes later the doctors buggy from the island arrived and took us straight to his surgery . By that time you could lash marks up her thigh and across her knees and one along her arm red and swelled . The doctor applied shaving cream and actually shaved her legs over the sting to try and pull out the poison. He then applied a cream , she was in severe pain . After 40 mins the pain eased off a little she was given strong pain killers and a cream . Was painful for a few days , and scary moment for every one, serve pain bless her . The doctor inform us that she would need to carry a eppee pen for the rest of her life just incase she was stung again. Now back in England our doctor believes that's not true and I have had to fight for a appointment at a allergies clinc to ask more about this , obviously I do not want my daughter to be at high risk without one , but as we do not know what kind of jelly fish stung her there are not helping us !! they keep saying doughtful to be a box or Portuguese man of war ! And was out of season . Has any one experienced any thing like this .?? My daughter still has the scars now 3 months on and I can't see that they will fade either I have tried resertching Maldives - jelly fish but just keeps seeing very rare it happens ! Her scars do resemble lash marks like the box jellyfish leaves , ?? Any information will be greatly appreciated, we live in Cornwall close to sea and she loves the sea , but I'm scared to let her go in now in summer

 

[DocVikingo]

Hi Mrs Talbot,

Let's open by appreciating that it is often difficult, if not impossible, to identify the type of jellyfish involved in an envenomation solely on the basis of the pattern of tentacle wounds.

Moving on, at this point it really doesn't matter much what specific type it was. What is important is that the snorkeler reacted with severe pain (and perhaps other symptoms) to the envenomation, and likely would do so again if she had another run in. And, there is the matter that sensitivity to jellyfish venom, as with other potential antigens, can increase with repeated exposure. Obviously this is undesirable.

The recommendation by the original treating doctor that the affected snorkeler henceforth carry an "EpiPen" may have merit. The reported hesitation on the part of the current doctor to approve referral to an allergy clinic is somewhat puzzling from a medical standpoint, although there may be bureaucratic, financial or other non-medical reasons for such balking. It would not seem inappropriate to continue to press the case for a consultation with a specialist.

As for the remaining tentacle lesions on the skin, only time will tell whether they will completely fade or if permanent discoloration or scarring will exist. That clearly visible marks, described by you as scars, remain over 3 months post-sting suggests that they may be lasting. By 6-8 months out, you should have a very good idea.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[Duke Dive Medicine]

I'm sorry to hear about your daughter, that must have been frightening for all of you.

Pain in the area where the tentacles contacted the skin is an expected symptom of a jellyfish envenomation. I hope you don't ever have to care for a jellyfish sting victim again, but if you do, make sure that you rinse the area with salt water rather than in the shower - if any tentacles are stuck to the skin, fresh water will cause all the nematocysts to discharge at once. This may explain the severe pain that your daughter felt (along with the fact that most ten-year-olds have limited reference points for pain).

There is some recent literature on jellfish stings. I've linked an article below. Note that it calls into question many of the "standard" treatments for jellyfish envenomations.
Jellyfish stings: a practical approach

Re the Epi-pen: I can't speak to her case specifically, but not everyone who is stung by a jellyfish needs to carry an epinephrine auto-injector afterwards. Anaphylactic reactions to jellyfish stings are very rare. However, the physician who treated her may have noted systemic allergic symptoms and/or an unusually strong reaction to a sting, and that may be why he made the recommendation.

Best regards,
DDM

 

[tridacna]

$35 to read that article. Ouch!

 

[DocVikingo]

$35 to read that article. Ouch!

Hey tridacna, long time.

Try this --> http://www.wemjournal.org/article/S1080-6032(15)00008-3/fulltext

Cheers,

Doc

 

[tridacna]

Thanks!

 

[Duke Dive Medicine]

Oof. Sorry. Thanks, Doc. I linked it at work so it worked for me but apparently not for those outside the Duke firewall.

 

[tridacna]

When I was a kid growing up in South Africa, we would often get stung by P. Utriculus. The pain was horrible. They would swarm onto the warm Atlantic beaches in False Bay. Us stupid kids would pop their bubble on the sand with our heels. Lifeguards used to rinse some kind of blue solution onto the stings which used to leave your skin blue for a few days. Anyone have any idea what that was? This would have been in the sixties.

 

[DocVikingo]

Those interested in allergic reaction to jellyfish venom might enjoy the following discussion. It includes a case report of a 12 y/o girl who showed increasingly severe reactions to a series of jellyfish run-ins. The first 2 involved pain only. The 3rd showed features of allergic reaction, but the treating doctor did not believe that the criteria for anaphylaxis were demonstrated. Following the 3rd occurrence, he recommended carrying EpiPens in the event of future envenomations.

Possible anaphylaxis to jellyfish sting | AAAAI

Cheers,

DocVikingo