Little M, Pereira P, Mulcahy R, Cullen P, Carrette T, Seymour J
Department of Emergency Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia.
Anaesth Intensive Care. 2003 Dec;31(6):642-7. doi: 10.1177/0310057X0303100605.
We present a retrospective review of twelve cases of Irukandji syndrome associated with pulmonary oedema. This is a life-threatening envenoming due to a presumed jellyfish sting throughout Northern Australia, although only one case occurred outside North Queensland. Patients presented with significant and ongoing pain, tachycardia and hypertension. Half the patients became hypotensive requiring inotropic support. Cardiac echocardiography revealed significant cardiac dysfunction. Six patients required ventilatory support. There was no death reported due to pulmonary oedema, but one patient died of intracerebral haemorrhage. We believe patients may develop a toxin associated cardiomyopathy, and jellyfish other than Carukia barnesi may be responsible. As there is confusion with nomenclature, Carukia barnesi should be known as the Barnes jellyfish, and the diagnosis of cardiotoxic marine envenoming is suggested for any patient who has been stung by a jellyfish, develops no or minimal skin markings, and develops cardiogenic pulmonary oedema associated with Irukandji syndrome.
我们对12例与肺水肿相关的伊鲁坎吉综合征病例进行了回顾性研究。在澳大利亚北部，这种由疑似水母蜇伤导致的中毒会危及生命，不过只有1例发生在北昆士兰以外地区。患者表现出严重且持续的疼痛、心动过速和高血压。半数患者出现低血压，需要使用正性肌力药物支持。心脏超声心动图显示存在明显的心脏功能障碍。6例患者需要通气支持。未报告因肺水肿导致的死亡，但有1例患者死于脑出血。我们认为患者可能会发展为毒素相关性心肌病，并且除了箱形水母之外的其他水母也可能是病因。由于命名存在混淆，箱形水母应称为巴恩斯水母，对于任何被水母蜇伤、皮肤无或仅有轻微痕迹且出现与伊鲁坎吉综合征相关的心源性肺水肿的患者，建议诊断为心脏毒性海洋中毒。
