Clam calamity: five concurrent cases of neurotoxic shellfish poisoning with varying presentations following ingestion of clams from Gulf of Mexico water contaminated with Karenia brevis confirmed by serum brevetoxin assays.

INTRODUCTION: Karinia brevis, a marine dinoflagellate, is the causative organism for "red-tide" on the east coast of Florida.This microbe produces brevetoxins, which bioaccumulate in filter feeding bivalve shellfish. In humans, inhalational exposure is common, while ingestion of contaminated shellfish is more rare. Ingested brevetoxin causes gastrointestinal and neurological symptoms collectively known as neurotoxic shellfish poisoning. CASE CLUSTER: A group of tourists collected clams from a beach during a red tide event. The clams were soaked in brine, microwaved, and consumed for lunch. The index patient experienced seizure-like activity postprandially prompting the cohort to present for medical attention. Five people presented to the emergency department with neurotoxic shellfish poisoning-related symptoms. All patients received supportive care only. Symptoms resolved within 24 hours. Serum brevetoxin concentrations were reported for four patients. DISCUSSION: Ingestion of brevetoxin is rare but may become more common as the frequency and severity of "red-tide" events increase. In our cluster, each person consumed a different number of clams and presented with classic and some "non-classic" symptoms. A trend toward more severe symptoms with a larger number of clams ingested was observed. CONCLUSIONS: This case cluster describes the clinical course of individuals after consumption of brevetoxin contaminated shellfish.