Shellfish poisoning, paralytic
Shellfish poisoning, paralytic is caused by saxitoxin produced by algae. Minutes to hours after ingestion of contaminated shellfish, patients have paresthesias followed by ataxia, arthralgia, dysphagia, diaphoresis, and tachycardia.
CASES/YEAR
1,200 (US); 24,000 (Global)
OTHER NAMES
Saxitoxin poisoning;
INCUBATION
30 minutes to 3 hours
INITIAL SYMPTOMS
Nausea/vomiting and paresthesias of the face and extremities resolving completely within a few days; In severe cases, respiratory paralysis can ensue within 2-12 hours of ingestion. [Harrison ID, p. 1173]
COMMENTS
The disease is associated with eating scallops, mussels, clams, oysters, chitons, limpets, starfish, and sand crabs. [Harrison ID, p. 1172] Minutes to hours after ingestion of contaminated shellfish, patients have paresthesias followed by ataxia, arthralgia, dysphagia, diaphoresis, and tachycardia. In severe cases, respiratory paralysis and sometimes death occur within 12 hours of the onset of symptoms. Paralytic shellfish poisoning is more severe than neurotoxic shellfish poisoning, but gastrointestinal symptoms (diarrhea and vomiting) are less pronounced. [Cecil, p. 700]
DIAGNOSTIC
Clinical; Concentrations of toxin >75 ug/100 g of food are considered hazardous. (Concentrations of saxitoxin in blue mussels were >9000 ug/100 g of food during the 1972 New England "red tide.") [Harrison ID, p. 1173]
SIGNS & SYMPTOMS
-
>arthralgia
-
E dysphagia
-
G abdominal pain
-
G diarrhea
-
G nausea, vomiting
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N headache
-
N muscle weakness
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N paresthesia
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R dyspnea
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*paralysis
SOURCE
Animal Tissue, Eating Contaminated Mollusks or Crustacean
RESERVOIR
Fish and Shellfish
RISK FACTORS
- Ingest toxins in food or water
- Victim--air release of toxins
- Victim--water/food release
TREATMENT
No specific antidote; [Cecil, p. 693]
REFERENCES FOR CASES/YEAR
1. (US) Every year, about 30 cases of disease caused by marine toxins are reported. These diseases include scombrotoxic, ciguatera, and shellfish poisoning (paralytic, neurotoxic, and amnesic); Some health departments test shellfish within their jurisdiction by monitoring levels of dinoflagellate toxins and may prohibit local recreational and commercial seafood harvesting when testing indicates high levels. It is estimated that about one person in the US dies every 4 years from toxic seafood poisoning. [CDC website] Guesstimate: Use cases/yr from study in Wales and divide global cases/yr by 20;
2. (Global) An analysis of all detected cases of shellfish poisoning in Wales from 1998 to 2009 found a rate of 16 cases per million per year; [Hinder2011: PMID 21645342] Guesstimate: Use the 16/million rate for the total shellfish poisoning cases = 16 X 3000 = 48,000 (24,000 for paralytic and 24,000 for amnesic-neurotoxic);