Jellyfish sting web survey: clinical characteristics and management of Rhopilema nomadica envenomation in the Mediterranean Sea

Jellyfish stings affect millions of people worldwide, and development of species-specific sting management protocols is imperative. In the Mediterranean Sea, protocols thus far ignored Rhopilema nomadica. Here we report the demographic and clinical characteristics of jellyfish stings in the Eastern Mediterranean Sea and propose a first aid protocol. A public survey was conducted over 14 months using an online questionnaire and a logistic generalized model was fitted to predict clinical response to commonly applied topical treatments. Four hundred eighty-one reports were collected. Local manifestations included pain, redness, swelling, lesions, and blisters. Systemic manifestations were uncommon, primarily weakness, heat sensation, and tachycardia. Most respondents (69.2%) were mildly affected, 24.1% moderately, and 6.7% severely. No long-term effects were reported. 87.3% of respondents required only field treatment. Community clinics and emergency departments were sought by 9.56% and 3.12% of respondents, respectively. Topical application of aloe vera, dimetindenum, silver sulfadiazine, and corticosteroid preparations was significantly more efficacious than vinegar. Application of urine and vinegar was more likely to be associated with no effect or worsening. Stings were mostly mild with mainly local manifestations. No long-term loss of function was reported, even in severe cases. Checking online information sources and wearing lycra or neoprene swimwear are recommended for sting avoidance and prevention. First aid recommendations include tentacle removal by rinsing with seawater and topical application of aloe vera/silver sulfadiazine/antihistamine preparations while avoiding urine or vinegar. Patients with extensive stings or systemic manifestations should be referred to emergency departments.