Various shellfish-associated poisoning

Shellfish poisoning is caused by a group of toxins elaborated by planktonic algae (dinoflagellates, in most cases) upon which the shellfish feed. The toxins are accumulated and sometimes metabolized by the shellfish.

The 20 toxins responsible for paralytic shellfish poisonings (PSP) are all derivatives of saxitoxin. Diarrheic shellfish poisoning (DSP) is presumably caused by okadaic acid, the dinophysis toxins, the pectenotoxins, and yessotoxin. Neurotoxic shellfish poisoning (NSP) is the result of exposure to a group of polyethers called brevetoxins. Amnesic shellfish poisoning (ASP) is caused by the unusual amino acid, domoic acid, as the contaminant of shellfish.

What are the symptoms of shellfish poisoning?

Ingestion of contaminated shellfish results in a wide variety of symptoms, depending upon the toxins(s) present, their concentrations in the shellfish and the amount of contaminated shellfish consumed. In the case of PSP, the effects are predominantly neurological and include tingling, burning, numbness, drowsiness, incoherent speech, and respiratory paralysis. Less well characterized are the symptoms associated with DSP, NSP, and ASP. DSP is primarily observed as a generally mild gastrointestinal disorder, i.e., nausea, vomiting, diarrhea, and abdominal pain accompanied by chills, headache, and fever. Both gastrointestinal and neurological symptoms characterize NSP, including tingling and numbness of lips, tongue, and throat, muscular aches, dizziness, reversal of the sensations of hot and cold, diarrhea, and vomiting. ASP is characterized by gastrointestinal disorders (vomiting, diarrhea, abdominal pain) and neurological problems (confusion, memory loss, disorientation, seizure, coma).

How is shellfish poisoning diagnosed?

Diagnosis of shellfish poisoning is based entirely on observed symptomatology and recent dietary history.

What foods are associated with shellfish poisoning?

All shellfish (filter-feeding molluscs) are potentially toxic. However, PSP is generally associated with mussels, clams, cockles, and scallops; NSP with shellfish harvested along the Florida coast and the Gulf of Mexico; DSP with mussels, oysters, and scallops, and ASP with mussels.

How common is shellfish poisoning?

Good statistical data on the occurrence and severity of shellfish poisoning are largely unavailable, which undoubtedly reflects the inability to measure the true incidence of the disease. Cases are frequently misdiagnosed and, in general, infrequently reported. Of these toxicoses, the most serious from a public health perspective appears to be PSP. The extreme potency of the PSP toxins has, in the past, resulted in an unusually high mortality rate.

What is the course of the disease and what are the complications?

PSP: Symptoms of the disease develop fairly rapidly, within 0.5 to 2 hours after ingestion of the shellfish, depending on the amount of toxin consumed. In severe cases respiratory paralysis is common, and death may occur if respiratory support is not provided. When such support is applied within 12 hours of exposure, recovery usually is complete, with no lasting side effects. In unusual cases, because of the weak hypotensive action of the toxin, death may occur from cardiovascular collapse despite respiratory support.

NSP: Onset of this disease occurs within a few minutes to a few hours. Duration is fairly short, from a few hours to several days. Recovery is complete with few after effects; no fatalities have been reported.

DSP: Onset of the disease, depending on the dose of toxin ingested, may be as little as 30 minutes to 2 to 3 hours, with symptoms of the illness lasting as long as 2 to 3 days. Recovery is complete with no after effects; the disease is generally not life threatening.

ASP: The toxicosis is characterized by the onset of gastrointestinal symptoms within 24 hours; neurological symptoms occur within 48 hours. The toxicosis is particularly serious in elderly patients, and includes symptoms reminiscent of Alzheimer's disease. All fatalities to date have involved elderly patients.

Who is susceptible to shellfish poisoning?

All humans are susceptible to shellfish poisoning. Elderly people are apparently predisposed to the severe neurological effects of the ASP toxin. A disproportionate number of PSP cases occur among tourists or others who are not native to the location where the toxic shellfish are harvested. This may be due to disregard for either official quarantines or traditions of safe consumption, both of which tend to protect the local population.