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.

Doença de Haff complicada por falência de múltiplos órgãos após ingestão de lagostim: estudo de caso / Haff disease complicated by multiple organ failure after crayfish consumption: a case study

A doença de Haff é uma síndrome que consiste de rabdomiólise não explicada. Pacientes que apresentam a doença de Haff relatam ter ingerido pescado nas últimas 24 horas antes do início da doença. A maioria dos pacientes sobrevive apresentando breve recuperação. O presente artigo é o primeiro relato de doença de Haff complicada por falência de múltiplos órgãos após ingestão de lagostim. Um homem chinês de 66 anos de idade ingeriu lagostim cozido na noite de 23 de junho de 2013. Chegou ao hospital 2 dias mais tarde, sendo admitido à unidade de terapia intensiva. Após a admissão, o paciente recebeu o diagnóstico de doença de Haff complicada por falência de múltiplos órgãos. Apesar dos tratamentos de suporte e sintomático, a condição do paciente deteriorou, vindo o mesmo a falecer em consequência da doença. A doença de Haff é uma rara síndrome clínica que é, às vezes, mal diagnosticada. O diagnóstico precoce e o tratamento adequado são essenciais para prevenir a progressão para falência de múltiplos órgãos.

Haff disease is a syndrome consisting of unexplained rhabdomyolysis. Patients suffering from Haff disease report having eaten fish within 24 hours before the onset of illness. Most patients survive and recover quickly. The present study is the first report of Haff disease complicated by multiple organ failure after crayfish consumption. A 66-year-old Chinese man ate cooked crayfish on the night of June 23, 2013. He arrived at our hospital 2 days later and was admitted to the intensive care unit. After admission, the patient was diagnosed with Haff disease complicated by multiple organ failure. Despite supportive and symptomatic treatments, the condition of the patient deteriorated, and he died due to his illness. Haff disease is a rare clinical syndrome that is sometimes misdiagnosed. Early diagnosis and proper treatment are essential to prevent progression to multiple organ failure.

Haff disease complicated by multiple organ failure after crayfish consumption: a case study.

Haff disease is a syndrome consisting of unexplained rhabdomyolysis. Patients suffering from Haff disease report having eaten fish within 24 hours before the onset of illness. Most patients survive and recover quickly. The present study is the first report of Haff disease complicated by multiple organ failure after crayfish consumption. A 66-year-old Chinese man ate cooked crayfish on the night of June 23, 2013. He arrived at our hospital 2 days later and was admitted to the intensive care unit. After admission, the patient was diagnosed with Haff disease complicated by multiple organ failure. Despite supportive and symptomatic treatments, the condition of the patient deteriorated, and he died due to his illness. Haff disease is a rare clinical syndrome that is sometimes misdiagnosed. Early diagnosis and proper treatment are essential to prevent progression to multiple organ failure.

Highly toxic Microcystis aeruginosa strain, isolated from São Paulo-Brazil, produce hepatotoxins and paralytic shellfish poison neurotoxins.

While evaluating several laboratory-cultured cyanobacteria strains for the presence of paralytic shellfish poison neurotoxins, the hydrophilic extract of Microcystis aeruginosa strain SPC777--isolated from Billings's reservoir, São Paulo, Brazil--was found to exhibit lethal neurotoxic effect in mouse bioassay. The in vivo test showed symptoms that unambiguously were those produced by PSP. In order to identify the presence of neurotoxins, cells were lyophilized, and the extracts were analyzed by HPLC-FLD and HPLC-MS. HPLC-FLD analysis revealed four main Gonyautoxins: GTX4(47.6%), GTX2(29.5%), GTX1(21.9%), and GTX3(1.0%). HPLC-MS analysis, on other hand, confirmed both epimers, with positive Zwitterions M(+) 395.9 m/z for GTX3/GTX2 and M(+) 411 m/z for GTX4/GTX1 epimers.The hepatotoxins (Microcystins) were also evaluated by ELISA and HPLC-MS analyses. Positive immunoreaction was observed by ELISA assay. Alongside, the HPLC-MS analyses revealed the presence of [L: -ser(7)] MCYST-RR. The N-methyltransferase (NMT) domain of the microcystin synthetase gene mcyA was chosen as the target sequence to detect the presence of the mcy gene cluster. PCR amplification of the NMT domain, using the genomic DNA of the SPC777 strain and the MSF/MSR primer set, resulted in the expected 1,369 bp product. The phylogenetic analyses grouped the NMT sequence with the NMT sequences of other known Microcystis with high bootstrap support. The taxonomical position of M. aeruginosa SPC777 was confirmed by a detailed morphological description and a phylogenetic analysis of 16S rRNA gene sequence. Therefore, co-production of PSP neurotoxins and microcystins by an isolated M. aeruginosa strain is hereby reported for the first time.