Holiday hazards: common stings from New World visits

An otherwise idyllic vacation can be abruptly marred by contact with stinging organisms. In addition to discomfort, stings from many organisms can have serious medical consequences. This review outlines three hazards commonly encountered by holiday makers to North America: jellyfish stings, seabather's eruption, and fire ant stings. Ocean bound travellers should be aware of the three medically important orders of free swimming jellyfish: the common jellyfish also referred to as ‘sea nettles’; the Portuguese Man‐o‐War (MOW) or ‘blue‐bottle’; and the box‐type (cubozoan) jellyfish which are commonly referred to as ‘sea wasps’. Common to all of these organisms is the nematocyst, a specialized, contact‐triggered stinging apparatus used by jellyfish to inject toxins into their prey.1 The common jellyfish, which consists of more than 200 species, has wide distribution and can range in size from less than 1 cm to over 100 feet. Clinically lesions develop 30–60 min after contact and present as a whip‐like, zigzag pattern (Fig. 1) of painful welts where the tentacles made contact with skin. They are primarily a nuisance; systemic symptoms rarely develop. When brave volunteers were experimentally stung with jellyfish nematocyst, pain, erythema and wheal developed within 3–4 min and resolved in 1–3 days. After 1–2 weeks, linear erythema, papulovesicles and pustules developed which had a histopathology identical to that of allergic contact dermatitis. These lesions resolve completely but often leave postinflammatory hyperpigmentation.2