Paralytic shellfish poisoning and palytoxin poisoning in dogs.

BACKGROUND: Fatal cases of exposure to paralytic shellfish toxins and palytoxins have occurred in companion animals but are poorly described. METHODS: We describe one case of paralytic shellfish poisoning (PSP) and three cases of palytoxin poisoning in dogs. RESULTS: Mild PSP occurred following ingestion of crab while walking on a beach. Analysis confirmed the presence of paralytic shellfish toxins, particularly decarbamoyl saxitoxin, in clinical samples and marine organisms. This case occurred shortly after an outbreak of PSP in dogs on the eastern coast of England. Palytoxin poisoning occurred in a dog after it chewed coral removed from an aquarium. Signs included collapse, hypothermia, bloody diarrhoea and respiratory distress. The dog was euthanised due to rapid deterioration and poor prognosis. Palytoxin was not detected in a premortem blood sample. Two other dogs in a separate incident developed only mild signs (fever and respiratory distress) after suspected exposure to aerosolised palytoxin and recovered within a few hours. CONCLUSION: Cases of PSP are episodic and not common in dogs. Cases of palytoxin exposure are reportedly increasing in humans, and there is presumably also an increased risk to pets. There is no specific treatment for PSP or palytoxin poisoning.

Inhalation poisoning with palytoxin from aquarium coral: case description and safety advice.

Palythoa spp. corals and some other marine organisms contain one of the most poisonous substances ever known - palytoxin (PTX). Due to their modest life requirements and ease of breeding, these corals are popular in home aquariums. Here we refer to a case of PTX poisoning of a middle-aged woman who inhaled poisonous vapours while brushing the corals from live rock and compare it with the available literature. As the case revealed that the symptoms of PTX poisoning are not specific and neither is treatment, our aim was to give a brief tabulated review of the symptoms that may indicate such poisoning. Cases of palytoxin poisoning have been reported worldwide, and severe ones (mostly due to ingestion of contaminated sea food) can end in death. As it appears, most (if not all) poisonings result from unawareness of the risk and reckless handling by aquarists. This is one of the first articles which provides some practical advice about the use of personal protection equipment, including gloves, masks, eyewear, and other clothing during any coral manipulation to minimise the risk. We also draw attention to the lack of marketing/trading regulations for dangerous coral species and/or regulations or instructions dealing with their removal and health protection.

Toxic corneal reaction due to exposure to palytoxin. / Toxicidad corneal por exposición a palitoxina.

A case is presented of corneal toxicity after exposure to palytoxin. A 42 year-old man came with symptoms of pain and blurred vision in his right eye. He reported that a zoanthid coral from a saltwater aquarium had squirted into his eye. Slit-lamp examination showed a prominent central ring infiltrate of 4×6mm without epithelial defect and satellite sub-epithelial micro-infiltrates. After 2 months of topical treatment with steroids, the stromal ring infiltrate was resolved, but a stromal thinning and residual fibrosis remained. Palytoxin is a potent vasoconstrictor that damages the ionic gradient of the cells, causing cell death. It is crucial to remove the toxin and start an aggressive topical therapy as soon as possible. In addition, considering the potential ocular and systemic adverse effects that this toxin can produce, it would be advisable to inform people of its existence and regulate the distribution of this type of corals.

An aquarium hobbyist poisoning: Identification of new palytoxins in Palythoa cf. toxica and complete detoxification of the aquarium water by activated carbon.

Palytoxin (PLTX) is a lethal natural toxin often found in Palythoa zoantharians that, together with its congeners, may induce adverse effects in humans after inhalation of toxic aerosols both in open-air and domestic environments, namely in the vicinity of public and private aquaria. In this study, we describe a poisoning of an aquarium hobbyist who was hospitalized after handling a PLTXs-containing zoantharian hexacoral. Furthermore, we provide evidence for water detoxification. The zoantharian was morphologically and genetically identified as Palythoa cf. toxica (Cnidaria: Anthozoa). Palytoxin itself and two new PLTX congeners, a hydroxyPLTX and a deoxyPLTX, were detected and structurally identified by liquid chromatography high resolution multiple stage mass spectrometry (LC-HRMSn, n = 1, 2). Total and individual toxins were quantified by LC-HRMS and sandwich ELISA both in the zoantharian (93.4 and 96.80 µg/g, respectively) and in the transport water (48.3 and 42.56 µg/mL, respectively), with an excellent mean bias of 1.3% between the techniques. Activated carbon adsorbed 99.7% of PLTXs contained in the seawater and this represents a good strategy for preventing aquarium hobbyist poisonings.

Palytoxin-Containing Aquarium Soft Corals as an Emerging Sanitary Problem.

Palytoxin (PLTX), one the most potent marine toxins, and/or its analogs, have been identified in different marine organisms, such as Palythoa soft corals, Ostreopsis dinoflagellates, and Trichodesmium cyanobacteria. Although the main concern for human health is PLTXs entrance in the human food chain, there is growing evidence of adverse effects associated with inhalational, cutaneous, and/or ocular exposure to aquarium soft corals contaminated by PLTXs or aquaria waters. Indeed, the number of case reports describing human poisonings after handling these cnidarians is continuously increasing. In general, the signs and symptoms involve mainly the respiratory (rhinorrhea and coughing), skeletomuscular (myalgia, weakness, spasms), cardiovascular (electrocardiogram alterations), gastrointestinal (nausea), and nervous (paresthesia, ataxia, tremors) systems or apparates. The widespread phenomenon, the entity of the signs and symptoms of poisoning and the lack of control in the trade of corals as aquaria decorative elements led to consider these poisonings an emerging sanitary problem. This review summarizes literature data on human poisonings due to, or ascribed to, PLTX-containing soft corals, focusing on the different PLTX congeners identified in these organisms and their toxic potential.

Determination of Palytoxins in Soft Coral and Seawater from a Home Aquarium. Comparison between Palythoa- and Ostreopsis-Related Inhalatory Poisonings.

Anecdotal reports exist of aquarium hobbyists that experienced severe respiratory distress and/or skin injury following cleaning operation of home aquaria containing Palythoa sp. soft corals. Hundreds of cases of respiratory illness and/or dermatitis have been recorded in proximity to the sea concomitantly with algal blooms of Ostreopsis spp. in the Mediterranean area. Both Palythoa spp. and Ostreopsis spp. contain congeners of palytoxin, a highly potent toxin whose inhalation hazard is however unknown. In this study, we demonstrate the presence of high levels of palytoxins (palytoxin and hydroxypalytoxin) in both soft coral and seawater from a home marine aquarium involved in the poisoning of a whole family. Due to the high toxin levels found in seawater, a procedure for a rapid and efficient determination of palytoxin in seawater was setup. A comparison of symptoms of Palythoa- and Ostreopsis-related inhalatory poisonings showed many similarities including fever, respiratory distress, nausea, and flu-like symptoms. From the chemical and symptomatological data reported herein it is reasonable to hold palytoxins responsible for respiratory disorders following inhalation. Although the exact mechanism through which palytoxin congeners exert their inhalatory toxicity is still unknown, this represents a step toward demonstrating that palytoxin congeners exert toxic effects through inhalation both in natural environments and in the surroundings of private and public aquaria.

Suspected Palytoxin Inhalation Exposures Associated with Zoanthid Corals in Aquarium Shops and Homes - Alaska, 2012-2014.

On August 12, 2014, an Anchorage hospital notified the Alaska Section of Epidemiology (SOE) that a middle-aged male resident of Anchorage (patient A) had arrived in the emergency department with possible palytoxin exposure. Patient A complained of a bitter metallic taste, fever, weakness, cough, and muscle pain 7-8 hours after introduction of live zoanthid coral into his home aquarium. Palytoxin, a potent toxin known to produce the reported effects, is contained in zoanthid marine corals.

Hyperkalemia, hyperphosphatemia, acute kidney injury, and fatal dysrhythmias after consumption of palytoxin-contaminated goldspot herring.

Severe electrolyte disturbances caused by fish poisoning are rarely reported in the literature. We present an unusual outbreak of palytoxin poisoning associated with the consumption of Goldspot herring (Herklotsichthys quadrimaculatus). Four family members became ill after eating 2 species of marine fish. The presenting symptoms and signs included bitter taste, oral numbness, nausea, vomiting, abdominal pain, and hypertension, which were followed by myalgia, limb numbness, sensorimotor polyneuropathy, and abnormal cold and warm sensations. The index case manifested hyperkalemia, hyperphosphatemia, and acute kidney injury, and developed severe cardiac dysrhythmias. He died 21 hours postingestion. Palytoxin and related compounds were identified by liquid chromatography tandem mass spectrometry in one of the leftover fish. Palytoxin poisoning is rarely reported and is difficult to diagnose in the absence of laboratory confirmation. Palytoxin poisoning should be considered in patients who manifest hyperkalemia and hyperphosphatemia after the consumption of marine fish, and timely laboratory analysis should be sought.

[Family with fever after cleaning a sea aquarium]. / Een gezin met koorts na reiniging van zeeaquarium.

BACKGROUND: Improved aquarium techniques are enabling sea aquariums to imitate reality even better. This means that they sometimes contain known and unknown marine toxins. Aquarium keepers and their families may then develop potentially severe poisoning. CASE DESCRIPTION: A 37-year-old man presented at the Emergency Department with fever, hypotension and symptoms of a metallic taste in the mouth, nausea, headache, shivering and severe muscle cramps. Symptoms appeared after he had tried to remove a colony of Zoanthids (soft corals) from his aquarium by pouring boiling water over them. His wife (35-year-old) and two children (10-year-old twins) had also inhaled the offensive-smelling steam coming from the aquarium and had similar symptoms. On physical examination, all family members had low blood pressure and fever > 38.5 degrees Celsius. Blood analysis showed leucocytosis and an elevated CRP. We diagnosed palytoxin poisoning. All family members recovered within 48 hours after receiving supportive therapy only. CONCLUSION: Manipulation of certain soft corals found in sea aquariums can cause emission of palytoxin. This may cause a potentially severe episode of poisoning. When working in a sea aquarium protective measures should be taken. There is no specific therapy for or antidote to palytoxin poisoning and for this reason, treatment is supportive.

Case definitions for human poisonings postulated to palytoxins exposure.

A series of case reports and anecdotal references describe the adverse effects on human health ascribed to the marine toxin palytoxin (PLTX) after different exposure routes. They include poisonings after oral intake of contaminated seafood, but also inhalation and cutaneous/systemic exposures after direct contact with aerosolized seawater during Ostreopsis blooms and/or through maintaining aquaria containing cnidarian zoanthids. The symptoms commonly recorded during PLTX intoxication are general malaise and weakness, associated with myalgia, respiratory effects, impairment of the neuromuscular apparatus and abnormalities in cardiac function. Systemic symptoms are often recorded together with local damages whose intensity varies according to the route and length of exposure. Gastrointestinal malaise or respiratory distress is common for oral and inhalational exposure, respectively. In addition, irritant properties of PLTX probably account for the inflammatory reactions typical of cutaneous and inhalational contact. Unfortunately, the toxin identification and/or quantification are often incomplete or missing and cases of poisoning are indirectly ascribed to PLTXs, according only to symptoms, anamnesis and environmental/epidemiological investigations (i.e. zoanthid handling or ingestion of particular seafood). Based on the available literature, we suggest a "case definition of PLTX poisonings" according to the main exposure routes, and, we propose the main symptoms to be checked, as well as, hemato-clinical analysis to be carried out. We also suggest the performance of specific analyses both on biological specimens of patients, as well as, on the contaminated materials responsible for the poisoning. A standardized protocol for data collection could provide a more rapid and reliable diagnosis of palytoxin-poisoning, but also the collection of necessary data for the risk assessment for this family of toxins.

Palytoxin poisoning after dermal contact with zoanthid coral.

BACKGROUND: Palytoxin is most commonly reported after ingestion of seafood. We report a case of palytoxin poisoning from dermal absorption with local toxicity from zoanthid coral in a patient with intact skin. CASE REPORT: A 25-year-old previously healthy woman handled a zoanthid coral from a home aquarium without any barrier protection. The patient manifested neurologic symptoms of perioral paresthesia and dysguesia. In addition, there was local dermatologic toxicity that persisted for several days. The patient was treated supportively with corticosteroids and a histamine antagonist. CONCLUSION: We report a case of palytoxin poisoning from dermal absorption after handling a zoanthid coral. Palytoxin is a potent marine toxin that affects the sodium-potassium ATPase (adenosinetriphosphatase) pump and can cause multiple clinical effects, including paresthesia, dysguesia, hypertension, respiratory depression, coma, and death.

Human risk associated with palytoxin exposure.

Palytoxin (PTX) was first isolated from the zoanthid Palythoa toxica. Evaluation of PTX toxicity using various animal models determined that PTX was extremely potent through intravenous, intraperitoneal, and intratracheal exposure. PTX was less potent by direct intragastric exposure. PTX also caused significant, non-lethal effects through dermal and ocular exposure. PTX and PTX-like compounds have now been found in additional zoanthid species, red alga, a sea anemone, and several dinoflagellates. PTXs are found throughout certain reef associated food webs, including in fish and crabs responsible for human illness and death. Many of the organisms found to contain PTXs in the environment are also sold in the home aquarium trade, and recent evidence suggests poisonings have occurred through exposure to these organisms. Due to co-occurrence with other seafood toxins, such as ciguatoxins, saxitoxins, and tetrodotoxin, it has been difficult to assess the true risk of PTX poisoning through seafood consumption in humans, but limited cases have been well documented, some involving human fatalities. Recent evidence also suggests that humans are negatively impacted through PTX exposure by inhalation and dermal routes. Continued research into the distribution and occurrence of PTX and PTX-like compounds both in seafood and marine organisms sold in the aquarium trade appears warranted.

[Survey of food poisoning incidents in Japan due to ingestion of marine boxfish and their toxicity].

From 1990 to 2008, 9 food poisoning incidents due to ingestion of marine boxfish occurred in Nagasaki, Miyazaki, Mie and Kagoshima Prefectures, Japan, and a total of 13 persons were poisoned. Their main symptom was severe muscle pain arising from rhabdomyolysis, which was usually accompanied by the discharge of black urine and abnormal elevation of serum creatine phosphokinase. Twelve out of the 13 victims recovered in a few days to two months, while one died after approximately 2 weeks. Since the symptoms were very similar to those caused by parrotfish "aobudai" Scarus ovifrons poisoning, the causative substance was considered to be parrotfish toxin, i.e., a palytoxin-like substance. Epidemic surveys after the incidents in Miyazaki and Nagasaki identified the leftovers as "hakofugu" Ostracion immaculatus. During screening tests to clarify the toxicity of boxfish from Western Japan, 47 of 129 specimens (36.4%) of O. immaculatus, and 7 of 18 specimens (38.9%) of "umisuzume" Lactoria diaphana were found to show acute and/or delayed lethal activity to mice (0.5-2.0 mouse unit/g). Among the tissues tested, the frequency of toxicity was highest in the viscera excluding liver (28.6% in O. cubicus, 33.3% in L. diaphana), followed by muscle (10.9%, 5.6%) and liver (6.2%, 5.6%). From the above results, we conclude that O. cubicus and L. diaphana inhabiting the coast of Japan sometimes contain toxic substance(s), which can sporadically cause food poisonings very similar to parrotfish poisoning.

Neurotoxins from marine dinoflagellates: a brief review.

Dinoflagellates are not only important marine primary producers and grazers, but also the major causative agents of harmful algal blooms. It has been reported that many dinoflagellate species can produce various natural toxins. These toxins can be extremely toxic and many of them are effective at far lower dosages than conventional chemical agents. Consumption of seafood contaminated by algal toxins results in various seafood poisoning syndromes: paralytic shellfish poisoning (PSP), neurotoxic shellfish poisoning (NSP), amnesic shellfish poisoning (ASP), diarrheic shellfish poisoning (DSP), ciguatera fish poisoning (CFP) and azaspiracid shellfish poisoning (ASP). Most of these poisonings are caused by neurotoxins which present themselves with highly specific effects on the nervous system of animals, including humans, by interfering with nerve impulse transmission. Neurotoxins are a varied group of compounds, both chemically and pharmacologically. They vary in both chemical structure and mechanism of action, and produce very distinct biological effects, which provides a potential application of these toxins in pharmacology and toxicology. This review summarizes the origin, structure and clinical symptoms of PSP, NSP, CFP, AZP, yessotoxin and palytoxin produced by marine dinoflagellates, as well as their molecular mechanisms of action on voltage-gated ion channels.

Cowfish (Umisuzume, Lactoria diaphana) poisoning with rhabdomyolysis.

A 40-year-old man developed weakness and myalgia of the shoulders and brachia nine hours after eating a cowfish (Umisuzume, Lactoria diaphana). A clinical symptom showed rhabdomyolysis and serum creatine phosphokinase was elevated to 180,000 IU/L on day 3. Cardiopulmonary arrest and acute renal failure developed after 59 hours and hemodiafiltration was performed. Cerebral death was diagnosed on day 9 and the patient died on day 16. The case has the characteristic clinical course of palytoxin poisoning, which has also been reported as blue humphead parrotfish poisoning from other kinds of fish.

A case of palytoxin poisoning due to contact with zoanthid corals through a skin injury.

A case of human poisoning by palytoxin after contact with zoanthid corals (Parazoanthus sp.) in an aquarium through skin injuries on fingers is reported. The clinical symptoms include swelling, paraesthesia and numbness around the site of the injury spreading over the arm, but also signs of systemic poisoning such as dizziness, general weakness and myalgia, irregularities in the ECG and indications of rhabdomyolysis. Symptomatic treatment consisted of infusion of physiological fluids. The patient recovered within 3 days. Analysis of the zoanthid coral involved revealed extremely high concentrations of palytoxin (between 2 and 3 mg/g).