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![Chironex fleckeri ( Chironex Box Jellyfish ) [ Original photo copyright © Dr Jamie Seymour ]](images/marine_life/MIP04151.jpg)
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Phylum: Cnidaria
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Class: Cubozoa
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Genus: Chironex
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Species: fleckeri
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Common Names
Chironex Box Jellyfish , Box Jelly , Indringa
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Region
Unspecified
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Countries
Australia, Brunei, Indonesia, Papua New Guinea, Philippines, Vietnam
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Taxonomy and Biology
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Organism Type: Jellyfish
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Distribution
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Tropical north Australian shoreline waters from about Roebourne ( near Dampier, Western Australia ) to about Gladstone, Queensland. Specimens resembling C. fleckeri have been identified from Brunei, the Philippines, Papua New Guinea and Vietnam.
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Venom
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General: Neurotoxins
Unknown
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General: Myotoxins
Present but not clinically myotoxic
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General: Procoagulants
Not present
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General: Anticoagulants
Not present
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General: Haemorrhagins
Not present
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General: Nephrotoxins
Not present
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General: Cardiotoxins
Primary cardiotoxin
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General: Necrotoxins
Possibly present
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General: Other Toxins
Haemolysins
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Clinical Effects
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General: Dangerousness
Severe envenoming possible, potentially lethal
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General: Rate of Envenoming: Uncertain; most contacts with tentacles will induce at least minor stings.
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General: Untreated Lethality Rate: Uncertain, but clearly lethal if extensive stings.
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General: Local Effects
Moderate to very severe local pain; local erythema and sometimes blistering along tentacle contact track, in "ladder" like formation.
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General: Local Necrosis
Local necrosis along the tracks of tentacle contact can occur, but generally only in severe envenoming.
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General: General Systemic Effects
The principal recorded systemic effects, other than those secondary to pain, are cardiorespiratory (see below).
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General: Neurotoxic Paralysis
True neurotoxicity probably does not occur, but respiratory failure can occur in the acute phase in severe stings. The mechanism involved is not clear.
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General: Myotoxicity
Myotoxicity is not a feature of box jellyfish envenoming.
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General: Coagulopathy & Haemorrhages
Coagulopathy does not occur, except as a secondary complication of prolonged cardiopulmonary failure. Though the venom is haemolytic, haemolysis does not occur in human victims, at least to any clinically significant extent.
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General: Renal Damage
Renal damage can occur secondary to cardiopulmonary failure.
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General: Cardiotoxicity
Cardiotoxicity is a principal feature of severe envenoming. There may be cardiac arrhythmias or cardiac arrest.
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General: Other
Nil specific. Infection of tentacle tracks which are necrotic (severe stings) may worsen both the extent of necrosis and subsequent scars.
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First Aid
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Description: First aid for Australian box-jellyfish or sea wasp (Chironex fleckeri) envenoming
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Details
1. Remove the victim from the water, at all times being aware of the potential for further stings, both to the victim and rescuers. If possible wear protective clothing, such as stinger suits or pantyhose. Be careful not to touch undischarged tentacles on the victim with bare skin, as this may result in the rescuer also being stung.
2. Immediately douse the entire stung area with copious quantities of vinegar for at least 30 seconds.
3. Assess vital functions, especially airway, breathing and circulation. Apply respiratory and cardiac support, as appropriate. If there is cardiac arrest, commence full resuscitation in an optimistic fashion and continue until medical care is reached.
4. If there is major envenoming with cardiac complications or arrest or respiratory complications, and CSL Box Jellyfish Antivenom is available at the beach, give 3 ampoules intramuscularly (providing those administering are trained to do so). If suitably trained personnel are available to give antivenom IV, then this is preferable to IM.
5. If available, give oxygen. Entonox (nitrous oxide), if available, may be used for pain.
6. Urgently transport the victim to medical care.
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Treatment
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Treatment Summary
Box jellyfish stings can cause severe, even fatal envenoming. Massive envenoming can occur early. First aid using vinegar to deactivate tentacles and cold packs for pain relief are essential. If cardiopulmonary failure occurs, optimistic and prolonged cardiopulmonary resuscitation is required. The role of IM antivenom given pre-hospital is uncertain. IV antivenom is preferred and should be used in all cases with systemic envenoming. Antivenom is reserved for such cases; those with local envenoming only usually respond to analgesia and cold packs.
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Key Diagnostic Features
Severe immediate pain along tentacle tracks. In severe stings, rapid cardiac & respiratory collapse.
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General Approach to Management
All cases should be treated as urgent & potentially lethal. Rapid assessment & commencement of treatment including appropriate antivenom (if indicated & available) is mandatory. Admit all cases.
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Antivenom Therapy
Antivenom is only part of the treatment for systemic envenoming. Its role in managing severe cardiac and respiratory effects of box jellyfish envenoming is uncertain and controversial. Multiple doses may be required IV.
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| 1. Antivenom Code: MAuCSL01
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Antivenom Name: Box jellyfish antivenom
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Manufacturer: CSL Limited
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Phone: ++61-3-9389-1911
Toll free: 1800 642 865
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Address: 45 Poplar Road
Parkville
Victoria 3052
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Country: Australia
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