Department of Pediatrics, Division of Pediatric Emergency Medicine, Dana-Dwek Children Hospital, University of Tel Aviv.
Denver Health and Hospital Authority, Rocky Mountain Poison and Drug Center, Denver, Colorado, USA.
Eur J Emerg Med. 2018 Dec;25(6):434-439. doi: 10.1097/MEJ.0000000000000479.
Several species of jellyfish native to the western Indian Ocean have entered the Mediterranean Sea through the Suez Canal. Since the late 1980s, each summer Rhopilema nomadica forms swarms as long as 100 km in the southeastern Levant and since the millennium aggregations of additional nonnative jellyfish have been sighted. The aim of this study was to evaluate children seen in the emergency department after jellyfish envenomations and to establish patterns of toxicity associated with this organism.
A retrospective chart review was performed of all children presenting after jellyfish envenomations to the pediatric emergency department during the jellyfish swarming seasons (June-August) between 2010 and 2015. Extracted data included age, location of envenomation, pain scores, local and systemic manifestations, treatment provided in the emergency department and hospital, and disposition.
Forty-one patients fulfilled the inclusion criteria; their ages ranged from 1 to 16 years and the median age was 9.4 years. Clinical manifestations were evident in all patients. Pain, present in 100% of patients, and an erythematous, whip-like, linear rash present in 87.8%, were the most common manifestations. The majority of 'burns' associated with jellyfish stings were first and second degree. The upper limb was affected in 34% and the lower limb was affected in 61% of cases. One patient suffered a sting to the abdomen and three patients suffered a sting to the face. Treatment in the emergency department included pain control, with nonsteroidal anti-inflammatory drugs and opiates, and antihistamines and topical corticosteroids in some cases. Nearly 49% of patients were seen during the summer of 2015 alone and seven patients in this group needed hospitalization. Reasons for hospitalization included systemic symptoms such as fever, chills, tachycardia, and muscle spasms. Two patients developed severe cellulitis, one patient had an anaphylactic reaction, and one was admitted to the ICU after suffering an anaphylactic reaction to a sting sustained while surfing.
The prevalence of the jellyfish swarms and the severity of clinical manifestations because of their envenomations suggest that it should be considered as a health hazard in the Mediterranean Sea. We call for public health authorities in affected countries to initiate a health hazards database, familiarize medical and healthcare staff with the clinical syndromes, train medical and healthcare staff` in appropriate treatment, and initiate and continue public awareness campaigns.
几种原产于西印度洋的水母通过苏伊士运河进入地中海。自 20 世纪 80 年代末以来，每年夏天，nomadica 水母都会在黎凡特东南部形成长达 100 公里的长队，而自千年之交以来，已经发现了其他外来水母的聚集。本研究旨在评估在东南黎凡特的儿童医院急诊室就诊的被水母蜇伤的儿童，并确定与该生物相关的毒性模式。
对 2010 年至 2015 年期间在水母群集季节（6 月至 8 月）期间在儿童医院急诊室就诊的所有被水母蜇伤的儿童进行回顾性图表审查。提取的数据包括年龄、蜇伤部位、疼痛评分、局部和全身表现、在急诊室和医院接受的治疗以及处置。
41 名患者符合纳入标准；他们的年龄在 1 至 16 岁之间，中位数年龄为 9.4 岁。所有患者均出现临床表现。疼痛（100%的患者）和呈鞭状、线状、红斑（87.8%的患者）是最常见的表现。与水母蜇伤相关的“灼伤”大多为 1 度和 2 度。上肢受累占 34%，下肢受累占 61%。1 名患者腹部被蜇伤，3 名患者面部被蜇伤。急诊室的治疗包括疼痛控制，使用非甾体抗炎药和阿片类药物，以及在某些情况下使用抗组胺药和局部皮质类固醇。仅 2015 年夏季就有近 49%的患者就诊，其中 7 名患者需要住院治疗。住院的原因包括发热、寒战、心动过速和肌肉痉挛等全身症状。两名患者发生严重蜂窝织炎，一名患者发生过敏反应，一名患者在冲浪时被蜇伤后发生过敏反应，被送往 ICU 治疗。
水母群集的流行和因被蜇伤而导致的临床表现的严重程度表明，应将其视为地中海地区的健康危害。我们呼吁受影响国家的公共卫生当局启动健康危害数据库，使医疗和保健人员熟悉临床综合征，培训医疗和保健人员进行适当的治疗，并启动和继续开展公众意识运动。
