Systemic reaction associated with Iramo scyphopolyp, Stephanoscyphus racemosum Komai

A morphological review of the jellyfish genus Nausithoe Klliker, 1853 (Nausithoideae, Coronatae, Scyphozoa, Cnidaria)

In this study we address the diversity of the scyphozoan jellyfish genus Nausithoe Klliker, 1853 (Nausithoidae, Coronatae), questioning the feasibility of using some characters of the medusa stage to identify species and filling in gaps concerning species of the genus and their distributions. Like most scyphozoans, the vast majority of the 21 Nausithoe species have a metagenetic life cycle, but similarity of most polyps within the genus highlights the need for studying morphology of the medusa stage. By analyzing morphological features on preserved and live specimens (polyps and medusae) and comparing these data with the original descriptions, we were able to validate twenty species of the group, providing new information for some of them.

Watch Out for Wild Animals: A Systematic Review of Upper Extremity Injuries Caused by Uncommon Species

BACKGROUND

Across the world, many species of nondomesticated animals dwell among humans in metropolitan areas. Rare animal bites pose a dilemma for hand surgeons, as they often result in operative injuries and recalcitrant infections. The authors treated an 85-year-old man who experienced severe cellulitis of the index finger following an opossum bite. This case prompted a systematic review of upper extremity injuries caused by species other than dogs, cats, snakes, and insects.

METHODS

The authors conducted a systematic review of PubMed and Scopus databases to identify relevant articles published between 1980 and 2016. Two reviewers critically appraised the studies that met inclusion and exclusion criteria.

RESULTS

The hand infection in the man who sustained an opossum bite at the authors' institution was successfully treated with targeted antibiotic therapy, hand elevation, and splinting. Seventy-one articles met inclusion criteria for and were included in this systematic review. The vast majority of existing articles represent level IV and level V evidence. The relevant literature suggests that the majority of hand infections attributable to animal bites and stings are polymicrobial.

CONCLUSIONS

Injuries secondary to aquatic animals appear to be the most frequently described in the literature, and hot water immersion should be used for the majority of envenomation attributable to aquatic species. Infections can often be treated with an aminopenicillin antibiotic combined with a beta-lactamase inhibitor. Given the variability in presentation and potential for sequelae such as soft-tissue necrosis and systemic reactions, hand surgeons should approach such upper extremity injuries with a high degree of caution.

Treatment of Atlantic cnidarian envenomations

Envenomation syndromes induced by Atlantic cnidaria have been tabulated and their therapy discussed. The pharmacokinetics of the venom has been emphasized. Pain occurs instantly and reaches a zenith rapidly in the surf. The nematocysts have already penetrated the dermis and disease proceeds before help can arrive. This fact plus the relative impermeability of human epidermis hampers the efficacy of topical agents. Oral analgesics, the agents of choice, are seldom offered and systemic administration of these drugs is usually not necessary. The use of hot or cold applications has not been settled. Measures to inactivate nematocysts within tentacles adherent to skin post-sting have been demonstrated in vitro, but the clinical significance of these actions has not been shown. Using an abrader (sand, crystalline papain) to counter-irritate nearby skin might provide relief. Antivenoms for Atlantic cnidaria are not available. The instances when verapamil might be employed are very rare. The reasons for the increasing case load of these injuries are discussed and the need to discover more effective therapeutic agents is emphasized.