Severe dermatonecrotic toxin and wound complications associated with box jellyfi sh stings 2008-2013

Abstract

Copyright © 2015 by the Wound, Ostomy and Continence Nurses Society. BACKGROUND: The Toxic Jellyfi sh Network and its surveillance system were set up in 2008 and in 2009, respectively. Case investigations detected 3 cases with severe cutaneous injuries described in this article. CASES: There were 57 probable cases of box jellyfi sh stings between 2008 and 2013. Three of these injuries resulted in dermal necrosis, and 2 were associated with severe wound complications. A Thai man aged 21 years sustained wounds on his left knee and thigh. He received oral antibiotics and daily wet dressings; he did not receive steroids. He subsequently developed blisters, swelling of the lower left leg, neuritis, and severe itching in the later stages. Nevertheless, his wounds did not become infected and there was no keloid scarring. An American woman aged 25 years sustained stings on her right hand and arm. She received antibiotic ointment and a tape that was placed directly on the wound without any gauze or padding underneath. She developed a wound infection 2 weeks postinjury. Surgical debridement was required twice to remove necrotic tissue; keloid scars persisted on evaluation at 4 months. An American woman aged 33 years received stings on her left upper thigh. Initial treatment was provided by local residents, who crushed morning glory leaves to extract the juice and then applied the juice (mixed with water) to her wounds. She received intravenous steroids, oral antihistamines, oral analgesics, and antibiotic cream at the hospital. Despite this aggressive treatment, the wounds became gangrenous and surgical debridement was required to remove necrotic tissue. CONCLUSION: Clinicians need to be knowledgeable regarding the potentially serious wounds that can develop following jellyfi sh stings. Additional research is needed to identify best management approaches.