Cubozoan envenomations: Clinical features, pathophysiology and management

Cubozoa-class cnidarian (box jellyfish) envenomations constitute a complex medical challenge and public health threat. There are currently no validated standards of care for lifethreatening stings. Increasing numbers and reported geographic ranges of serious cubozoan envenomations underscore the urgent need for mechanism-based emergency therapeutic options for lifeguards, first responders and clinicians. For the most part, treatment and management approaches have been symptom-driven, utilizing therapeutics familiar to the practitioner and often based on extrapolation from other envenomation sequelae, rather than cubozoan-specific standardized protocols. Newly elucidated mechanisms of pathogenesis provide a context for directed clinical research to test novel therapeutic approaches that could greatly diminish human suffering and improve outcomes. The current state of our understanding about the pathophysiology of cnidarian envenomation and emerging therapeutic options for the medically relevant cubozoans will be presented.