The next day she had severe oedema below her thighs and developed cellulitis above the stung area, which appeared to clear with antibiotics. The wounds blistered and took 3 months to heal, although neuropathic pain and slight ankle swelling remained.13 Many aspects of this case are highly consistent with Selleck SP600125 severe chirodropid envenomation. Two British

tourists were both stung. Lifeguards applied vinegar and a cream. Within half-an-hour, they developed unpleasant chest pains and severe “waves of pain” throughout their bodies and were taken to hospital by ambulance for a “pain-killing injection” (unknown) and IV “serum” (again, unknown). They reported severe on-going pain and tremors and re-presented for further analgesia but, despite this, it was another 2 days before they felt

better. No warning signs were present at the beach and it was reported that at least two other people were stung that day, one reportedly remaining in hospital overnight with breathing difficulties.14 A 30-year-old Norwegian female, taking no medications and with no prior history of allergy Obeticholic Acid molecular weight or serious illness, was stung on her left leg and foot while walking in shallow, murky water. A jellyfish captured there shortly afterwards is shown in Figure 3. She initially had some skin pain and discomfort but was otherwise well. Bystanders scraped the wound site and flushed it with fresh water to remove the tentacles. A doctor was consulted and she was given an antihistamine

(clemastinum) and 30 mg prednisolone. Some 50 minutes later, the sting area was edematous with an intense red color. Local pain had intensified and she became nauseous. Over the next 2 to 3 hours she developed generalized Rho pain in her skin and subcutaneous tissues, spreading from the foot to the rest of her body. Her nausea increased but she did not vomit. She described regular waves of burning pain throughout her entire body “almost like labor pains,” as well as “flu-like” symptoms with muscle pain and generalized discomfort. She was given oral tramadol for analgesia. She was monitored until the following day and required further oral tramadol for generalized soft tissue pain. Her pain and other symptoms gradually disappeared over the next 3 to 4 days.15 The DAN AP (www.danasiapacific.org) is a non-profit diving safety association that is part of an international network of similar organizations. DAN AP has been operating since 1994 and provides a contact point for the diving community in the Asia-Pacific concerning diverse regional health issues and events. It has become apparent, through numerous and persistent reports, through the Network and its affiliates, from affected individuals, concerned witnesses, as well as tour operators, that it is overwhelmingly likely the frequency and severity of jellyfish stings in Southeast Asian waters have been significantly underestimated.