What To Know About Box Jellies

Dr. Angel Yanagihara
Assistant research professor at University of Hawaii at Manoa

Where did you receive your schooling and training?

At University of Virginia, I earned bachelor’s degrees in chemistry and in biology. I did a six-year Ph.D. program in biochemistry at Georgetown University, and at University of Hawaii I earned a Ph.D. in cellular, molecular and neurosciences.

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Dr. Angel Yanagihara

What first got you interested in studying jellyfish?

July 29, 1997, was the ninth day after the full moon. I had just finished defending my Ph.D. dissertation at UHManoa and was looking forward to summer graduation, when I headed to Kaimana Beach to swim at about 6 a.m. A woman walking along the beach pointed out clear, tiny, 3-inch blobs and warned me not to swim, telling me that there were “box jellyfish.” I had on a Lycra shorty and felt that I would be fine.

But an hour later, on my way back in from my 2K swim, I was stung all over my neck, arms and legs by many nearly invisible jellies at the wind flag coral narrows off Kaimana Beach. I started to gasp and wheeze, and I had a very difficult time swimming back to shore. I lost consciousness after making it to the beach and came to in an ambulance.

After three agonizing days of horrible pain, where nothing seemed to help, I wanted to know more about box jellyfish and especially about their horrific venom. I did a basic literature search for biochemical publications and was surprised that little was known about the potentially lethal box jellyfish venom or its composition. I prepared a grant proposal to submit to Hawaii Community Foundation to do such work. I was greatly surprised to be funded because I had never worked in the field of marine biochemistry or venoms before.

My basic training as a biochemist led me to suggest fundamental research approaches. This first grant allowed me to do pioneering, hypothesis-generating work that led to the first biochemical characterization data. From those results, I composed further grant objectives, and again submitted these approaches for consideration for new funding. After 17 years and more than $4.2 million in investigator generated, extra-mural funding ―with about 35 percent overhead generated going to UH ― I have built a world-recognized research laboratory and have made many discoveries. I am most pleased to have developed technologies now in use by the U.S. Special Forces (USSOCOM) divers for the treatment of box jellyfish stings.

How does a box jellyfish sting differ from that of a Portuguese man-o-war?

Both box jellyfish and man-o-war stings lead to immediate burning pain and can result in itchy welts or scars. The box jelly sting also can result in serious systemic responses. The venom contains pore-forming (creating pores in cell membranes) toxins that are structurally similar to anthrolysin O, the pore-forming toxin produced by anthrax.

The box jelly sting is not like a bee sting. The amount of cellular rupture is more than 10,000 times that of a bee sting. The venom acts more like a snake venom and causes cellular destruction. Specifically, red blood cells, platelets and white blood cells are lysed. This causes a high rise in plasma catecholamines, histamine and cytokines. Altogether, this presents a complicated clinical outcome that looks more like bacterial shock.

The immediate reaction is not at all an IgE (Immunoglobulin E, a class of antibody that plays a role in allergic conditions, such as anaphylactic reactions) “allergy” or “allergic reaction.” Again, since box jelly venom contains these pore-forming proteins that act very quickly to break open blood cells, releasing epinephrine, and is not an IgE-based allergy, use of an EpiPen (for injecting epinephrine or adrenaline to treat serious allergic reactions) is reportedly contraindicated and can lead to dangerous paradoxical effects.

Popular home remedies for jelly stings suggest everything from cold or hot water to meat tenderizer, vinegar or urine.

What is the best treatment for jelly stings?

Double-blind controlled studies and retrospective studies have shown that hot water immersion is most effective. Laboratory work demonstrates that the venom porin ― porins are in all cnidarians, from anemones to corals to jellyfish, and the most rapid acting and potent porins are in the cubozoa or box jellies ― is irreversibly inhibited by heat. Flooding the site with vinegar or Epsom salt-saturated water can remove tentacles and non-discharged cnidae from the sting site. Magnesium sulfate (Epsom salt) I.V. or bolus (rapidly applied or as an intravenous medicine) has been shown to reduce pain and the potentially life-threatening hypertension. Urine is likely a “do no harm” approach, as it is mildly acidic and warm, and would remove the undischarged cnidae. Cold, fresh water is not helpful and can cause more stinging cells to discharge. Ice packs are perhaps the worst approach, as the pressure will increase the discharge and only temporarily slow the venom action. Once the tissue warms again in the area, venom will continue to act and the sting victim may now be out of sight of the caregiver. Alcohol or Dermoplast (that is, pain relief sprays containing menthol or any alcohols) should never be used, as alcohols cause massive discharge of stinging cells and worsen the sting.

Is the sting-stopper treatment you developed on the public market?

It is not yet commercially available. I have received a contract from USSOCOM and provide this treatment to combat divers. I provided this to U.S. swimmer Diana Nyad, enabling her to swim from Cuba to Key West ― I participated in

her 2012 attempt as her jellyfish expert and night diver, as well as during her 2013, 110-mile, 53-hour continuous successful swim.

What are some tips to avoid getting stung by a box jelly, or any jellyfish?

The best tip is to stay out of the water if there are jellies on the beach. The next-best tip to avoid box jellies is to avoid Leeward Oahu beaches mornings and evenings eight to 10 days after each full moon. Additionally, wearing a Lycra long-sleeve rash guard can protect the arms, or a full-body exposure suit will protect the body from either stinger.

Are box jellyfish and man-o-war the only two stinging jellyfish that swimmers in Hawaii’s waters need to be concerned about?

These are the main stingers. There are other smaller species of box jellies that do not correlate with the lunar cycle, but these are mainly in the marine harbors or far offshore.

How commonly do people get stung by box jellyfish each month in Hawaii?

Honolulu Advertiser reported in 1997 that up to 1,000 ambulance calls have been attributed to box jellies in a single month. Since ’97, my lab has been counting the number of box jellies washing up on key Leeward Oahu beaches each month. It is hard to estimate the number of total stings, but based on our data, with an average number of box jellies of 500 per month in a 400-meter section of Waikiki, that could indicate about 10,000 box jellies per month or 120,000 per year. Given the numbers of swimmers, it would seem that 5,000 to 10,000 stings a year might occur.

rfournier@midweek.com