Nickson Christopher P, Waugh Edith B, Jacups Susan P, Currie Bart J
Royal Darwin Hospital, Darwin, Northern Territory, Australia.
Ann Emerg Med. 2009 Sep;54(3):395-403. doi: 10.1016/j.annemergmed.2009.03.022. Epub 2009 May 5.
We describe Irukandji syndrome (a painful hypercatecholaminergic condition caused by jellyfish envenoming) in Australia's Northern Territory.
We collected prospectively a standardized data set on patients presenting to health facilities in the Northern Territory. Additional cases were identified retrospectively. Data collected included demographic, geographic, seasonal, and environmental features, as well as sting details, clinical manifestations, investigations, management, and outcomes.
From 1990 to 2007, Irukandji syndrome affected 87 people. Age ranged from 1 to 51 years (64% male victims; 41% children [63% indigenous]). Activities associated with stings included snorkeling or scuba diving (35%) and swimming (29%). Stings commonly occurred in water greater than 2 m deep (63%), with fine weather (73%) and still or light breeze (70%). Seasonal variation was bimodal; peaks in May and October corresponded to prevailing offshore winds in the Darwin and Gove areas, respectively. Pain was severe (65%), with rapid onset (<30 minutes in 79%). Sting lesions (visible in 63%) were mild, and nematocysts (detected in 7 cases) had variable morphology. Systemic features were common, including hypertension and ECG abnormalities. Severe complications included troponin-level increases (2 cases) and cardiomyopathy with ventricular tachycardia (1 case), but no fatalities. Management included vinegar as first aid (66%), parenteral opioids (70%) (range 2 to 82.5 mg morphine equivalents in adults), and magnesium sulfate (3 cases). Hospital admission (49%) and aeromedical retrieval (16%) were commonplace.
Irukandji syndrome in the Northern Territory was clinically consistent with previous studies but had distinct seasonal, geographic, and environmental features. Indigenous children in remote coastal communities are at risk, and there is room for improvement in prevention and management.
我们描述了澳大利亚北领地的伊鲁坎吉综合征（一种由水母蜇伤引起的疼痛性高儿茶酚胺能病症）。
我们前瞻性地收集了北领地卫生机构接诊患者的标准化数据集。通过回顾性研究确定了其他病例。收集的数据包括人口统计学、地理、季节和环境特征，以及蜇伤细节、临床表现、检查、治疗和结果。
1990年至2007年，伊鲁坎吉综合征影响了87人。年龄范围为1至51岁（男性受害者占64%；儿童占41%[其中63%为原住民]）。与蜇伤相关的活动包括浮潜或水肺潜水（35%）和游泳（29%）。蜇伤通常发生在水深超过2米的水中（63%），天气晴朗（73%），且无风或微风（70%）。季节变化呈双峰型；5月和10月的高峰期分别对应达尔文和戈夫地区的盛行离岸风。疼痛剧烈（65%），发作迅速（79%在30分钟内）。蜇伤部位病变较轻（63%可见），刺丝囊（7例检测到）形态各异。全身症状常见，包括高血压和心电图异常。严重并发症包括肌钙蛋白水平升高（2例）和伴有室性心动过速的心肌病（1例），但无死亡病例。治疗包括用醋进行急救（66%）、胃肠外给予阿片类药物（70%）（成人吗啡当量范围为2至82.5毫克）以及硫酸镁（3例）。住院治疗（49%）和空中医疗转运（16%）很常见。
北领地的伊鲁坎吉综合征在临床上与先前的研究一致，但具有独特的季节、地理和环境特征。偏远沿海社区的原住民儿童面临风险，在预防和治疗方面仍有改进空间。
