The “Irukandji syndrome” and acute pulmonary oedema

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Abstract
Envenomation by jellyfish that cause the “Irukandji syndrome” must now be regarded as life‐threatening. Three cases are reported of acute pulmonary oedema that developed in previously‐healthy adults after envenomation by a jellyfish that produced the “Irukandji syndrome”. Direct myocardial depression and pulmonary capillary leakage are suggested as the possible causes of the acute pulmonary oedema. Probably, this is venom‐ mediated, as are the severe muscular pains and symptoms of catecholamine excess that have been reported previously. Serum immunoglobulin levels were measured on several occasions after envenomation. A positive result of testing for the presence of Carukia antigen was obtained in the most recent case but the test was not available for the earlier cases; however, the possibility of envenomation by a number of other venomous species of jellyfish that were present in the waters at this time was excluded. A jellyfish that is similar to Carukia barnesi, and possibly was responsible for these enveno‐ mations, was captured later in an area adjacent to the one in which one patient was stung. Experiments with the nematocysts of this animal showed that their discharge was inhibited by vinegar (4%‐6% acetic acid). In the current state of knowledge, a treatment plan for a severe case of “Irukandji syndrome” involves pain relief; the management of apparent endogenous catecholamine excess; and the aggressive treatment of pulmonary oedema and hypoxia, which should include oxygen, Swan‐Ganz catheterization and consideration of early intubation with intermittent positive‐pressure ventilation, together with standard drug support.