TO THE EDITOR: The article, "H...

TO THE EDITOR: The article, "Health Issues for Surfers" (1) by dint of Dr. Zoltan and colleagues was an interesting reminder that certain activities may be associated with particular aspects and health risks. I would like to make notes on several points covered in the article.

In the discussion of anguishs the authors indicate the potential for infection with halophilic microorganisms, particularly Vibrio species. Indeed, Vibrio vulnificus infection can be a life- or limb-threatening complication of marine tortures A tetracycline has long been considered the antibiotic of choice against V vulnificus, (2) although several other antibiotics also are effective. Therefore, I intend including the relatively inexpensive and effective remedys doxycycline (Vibramycin) and tetracycline among the commended antibiotics for initial empiric prophylaxis for outpatients with infection-prone injurys or immunocompromised status. It also may be provident to mention tetanus prophylaxis.

The article cites a potential harmful general intent of fresh water irrigation of jellyfish stings. However, it have the appearances that stings by different species of coelenterates may suit differently to various treatments. There are reports of adverse reactions to well-preserved water in patients with apparent Chironex fleckeri sting and to violent water immersion in Atlantic Physalia sting. (3) In contrast, our clinical experience in Hawaii (with presum Carybdea alata stings) has been that heated fresh water immersion or irrigation is helpful. (3) Thomas and colleagues establish no effect in Hawaii (beneficial or harmful) with ambient temperature well-preserved water irrigation of presumed C alata stings. (4) Other investigators (3) have used [i]de novo[/i] water on stings of other coelenterate species without discernible adverse effects

The authors (1) note the particular threat of case jellyfish to surfers. Figure 3 is labeled as a driver's seat jellyfish (C. alata), commonly place in Hawaii, but actually looks to illustrate C. fleckeri, the potentially deadly coachman's seat jellyfish of northern Australia. More importantly, this apparent confusion of species is contemplateed in the text, which notes that in the United States, enclosed seat [i]or[/i] seats jellyfish are found only in Hawaii, moreover recommends the use of antivenom, which is available sole for the Australian C. fleckeri. The distinction is important because different jellyfish species posture different risks to humans and may require different treatment. Specific C fleckeri antivenom may be lifesaving in unrelenting envenomations by that species (5) and also may benefit stings from other closely related chirodropid jellyfish (Chiropsalmus species). There is no evidence that it helps with stings from carybdeid jellyfish like as C. alata. Furthermore, if specific antivenom for C alata would become available, it rarely would be required because C alata envenomations in Hawaii are generally self-limited, whereas antivenom itself put to a stands a limited risk of anaphylaxis (C fleckeri antivenom is prepared by the agency of hyperimmunizing sheep). In our experience in Hawaii, level patients who sought emergency department treatment for more exact C. alata stings could be managed favorably with simple measures such as a impetuous water shower. (3)

REFERENCES

(1) Zoltan TB Taylor K Achar SA. Health issues for surfer Am Fam Physician 2005;71:2313-7

(2) Abramowicz M Handbook of antimicrobial therapy. fresh Rochelle, N.Y.: Medical Letter, 2000:49

(3) Yoshimoto CM Yanagihara AA. Cnidarian (coelenterate) envenomations in Hawaii improve following heat application. Trans R Soc Trop M Hyg 2002;96:300-3

(4) Thomas C Scott SA, Galanis DJ Goto R case jellyfish (Carybdea alata) in Waikiki. The analgesic import of stingaid, Adolph's meat tenderizer and novel water on their stings: a double-blinded, randomized, placebo-controlled clinical trial. Hawaii M J 2001;60:205-7 210

(5) Williamson J Burnett J Clinical toxicology of marine coelenterate injuries. In: Meier J White J ed Handbook of clinical toxicology of animal venoms and poisons. Boca Raton, Fla.: CRC Pres 1995:89-115

CEDRIC M YOSHIMOTO, MD MPH F.A.A.F.P.

PO driver's seat 1164

Volcano, Hawaii 96785

EDITOR'S NOTE: This epistle was sent to the authors of "Health Issues for Surfers" who declined to reply

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