In this context, the ubiquitous availability of digital cameras and internet access, even in remote localities, has provided a major advance in the ability to gather marine injury data in real time. Further, the scope of such information is now far more enriched than mere case demographics, allowing, as presented here, detailed first-hand patient descriptions of the event and its sequelae, including post-medical outcomes, geospatial and environmental referencing,

together with unprecedented ability to record the Nutlin-3a price natural history of the sting lesion itself, providing insight into the possible culprit species. The provision of an on-line focal point for such reports, such as through DAN, provides a rich resource to complement more traditional methods of data gathering. This in turn advances our understanding of marine stings in the region, allowing for development of improved safety see more assessment and delivery. In this study, blending such methods, we have gathered compelling evidence of both lethal and severe box jellyfish and, for the first time, stings producing an Irukandji-like syndrome, currently affecting travelers swimming and diving in the coastal waters of Peninsula and mainland Malaysia. This builds on sporadic, isolated historic reports of lethal and near-lethal chirodropid stings out of Penang, Labuan Island, and the island of Borneo since the

1940s.7,8,16–18 We believe that these are a significant underestimation of the true occurrence of fatal and severe stings in Malaysia. To date, to our knowledge, no cubozoan jellyfish have been captured from Malaysian waters for taxonomic identification, so the current state of knowledge is based on photographs and sting reports. However, the case histories and sting lesion photographs demonstrate unequivocally

that lethal box jellyfish Liothyronine Sodium species occur in these waters. This conclusion is not surprising considering that lethal species of box jellyfish are confirmed from the surrounding regions of Thailand, the Philippines, and northern Australia.2,7 Preliminary morphological determination of jellyfish species is based on the examination of high-resolution versions of the photographs reproduced herein. However, thorough species identification will require examination of specimens and nematocysts. The carybdeid jellyfish species captured and photographed at Frida Beach, Langkawi, in June 2010 (Figure 3) is an Irukandji-like species, possibly in the genus Malo19 or Gerongia.20 The chirodropid jellyfish species photographed at Telaga Harbour, Langkawi, on May 12, 2010 (Figure 4) is in the genus Chiropsoides or an unknown close relative.21 The total length was estimated to be 60 cm (including tentacles), considerably smaller than that normally expected for a mature lethal species.