Various Shellfish-Associated Toxins
 

1. Name of the Organism: Various Shellfish-Associated	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 a group of high molecular weight polyethers, including 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.
2. Nature of Acute Disease:	Types of Shellfish Poisoning.
	Paralytic Shellfish Poisoning (PSP)
	Diarrheic Shellfish Poisoning (DSP)
	Neurotoxic Shellfish Poisoning (NSP)
	Amnesic Shellfish Poisoning (ASP)
3. Nature of Disease:	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).
4. Diagnosis of Human Illness:	Diagnosis of shellfish poisoning is based entirely on observed symptomatology and recent dietary history.
5. Associated Foods:	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.
6. Relative Frequency of Disease:	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.
7. Course of Disease and 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.
8. Target Populations:	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.
9. Food Analysis:	The mouse bioassay has historically been the most universally applied technique for examining shellfish (especially for PSP); other bioassay procedures have been developed but not generally applied. Unfortunately, the dose-survival times for the DSP toxins in the mouse assay fluctuate considerably and fatty acids interfere with the assay, giving false-positive results; consequently, a suckling mouse assay that has been developed and used for control of DSP measures fluid accumulation after injection of the shellfish extract. In recent years considerable effort has been applied to development of chemical assays to replace these bioassays. As a result a good high performance liquid chromatography (HPLC) procedure has been developed to identify individual PSP toxins (detection limit for saxitoxin = 20 fg/100 g of meats; 0.2 ppm), an excellent HPLC procedure (detection limit for okadaic acid = 400 ng/g; 0.4 ppm), a commercially available immunoassay (detection limit for okadaic acid = 1 fg/100 g of meats; 0.01 ppm) for DSP and a totally satisfactory HPLC procedure for ASP (detection limit for domoic acid = 750 ng/g; 0.75 ppm).
10. Selected Outbreaks:	Literature references can be found at the links below.
MMWR 40(10):1991 and Errata Notice MMWR 40(14):1991	Paralytic shellfish poisoning (PSP) is a foodborne illness caused by consumption of shellfish or broth from cooked shellfish that contain either concentrated saxitoxin, an alkaloid neurotoxin, or related compounds. This report summarizes outbreaks of PSP that occurred in Massachusetts and Alaska in June 1990.
	PSP is associated with relatively few outbreaks, most likely because of the strong control programs in the United States that prevent human exposure to toxic shellfish. That PSP can be a serious public health problem, however, was demonstrated in Guatemala, where an outbreak of 187 cases with 26 deaths, recorded in 1987, resulted from ingestion of a clam soup. The outbreak led to the establishment of a control program over shellfish harvested in Guatemala.
	ASP first came to the attention of public health authorities in 1987 when 156 cases of acute intoxication occurred as a result of ingestion of cultured blue mussels (Mytilus edulis) harvested off Prince Edward Island, in eastern Canada; 22 individuals were hospitalized and three elderly patients eventually died.
	The occurrence of DSP in Europe is sporadic, continuous and presumably widespread (anecdotal). DSP poisoning has not been confirmed in U.S. seafood, but the organisms that produce DSP are present in U.S. waters. An outbreak of DSP was recently confirmed in Eastern Canada. Outbreaks of NSP are sporadic and continuous along the Gulf coast of Florida and were recently reported in North Carolina and Texas.
Morbidity and Mortality Weekly Reports	For more information on recent outbreaks see the CDC.
11. Education and Background Resources:	Literature references can be found at the links below.
Loci index for genome Gonyaulax spp.	Available from the GenBank Taxonomy database, which contains the names of all organisms that are represented in the genetic databases with at least one nucleotide or protein sequence.
12. Molecular Structural Data:	These structures were created by Fred Fry, Ph.D, CFSAN.
	Dinophysis Toxin
	Brevotoxin
	Saxitoxin
	Okadaic Acid
	Domoic
	Yesserotoxin
	Pectenotoxin

CDC/MMWR

The CDC/MMWR link will provide a list of Morbidity and Mortality Weekly Reports at CDC relating to this organism or toxin. The date shown is the date the item was posted on the Web, not the date of the MMWR. The summary statement shown are the initial words of the overall document. The specific article of interest may be just one article or item within the overall report.

NIH/PubMed

The NIH/PubMed button at the top of the page will provide a list of research abstracts contained in the National Library of Medicine's MEDLINE database for this organism or toxin.

AGRICOLA

The AGRICOLA button will provide a list of research abstracts contained in the National Agricultural Library database for this organism or toxin.

mow@cfsan.fda.gov
January 1992 with periodic updates

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