Post on 13-Jun-2020
Marine Toxins & Intoxications Brian J Ward
JD MacLean Centre for Tropical Diseases
Colloque Blue 2012
Overview of talk ◗ Toxins
• fish (eg: ciguatera scromboid) • shellfish (eg: domoic acid) • phyto/zooplankton
◗ Stings/envenomations • vertebrates (eg: rays, lionfish) • invertebrates (eg: jellys, cones,corals) • phyto/zooplankton
You Never Really Know Who You’ll be Sharing the Water With ...
travel.webshots.com/photo
Toxins & Intoxications
◗ Fish • ciguatera • scromboid • puffer fish
◗ Shellfish • PSP, DSP, ASP, etc
◗ Phyto/zooplankton • Pfisteria spp
◗ Amnesic Shellfish Poisoning (ASP) ◗ Paralytic Shellfish Poisoning (PSP) ◗ Neurotoxic Shellfish Poisoning (PSP) ◗ Ciguatera Fish Poisoning (CFP) ◗ Diarrhetic Shellfish Poisoning (DSP) ◗ Pfiesteria Intoxication
Human Illnesses Associated with Marine & Estuarine Plankton
Ciguatera Intoxication
◗ Ingestion of bioaccumulated dinoflagellate toxins in tropical reef fish (snapper, barracuda….)
◗ Dinoflagellate species (various) • Gambierdiscus toxicus, Prorocentrum spp.,
Amphidinium.spp. ◗ Major Toxins
• Ciguatoxin --opens voltage dependent Na channels
• Maitotoxin --Calcium channel activator
Ciguatera
Plankton - Dinoflagellates
Reef Fish - Snapper http://www.missbonita2.com/
www.botany.ut.ee
Ciguatera Incidence/Prevalence Reported Incidence and Prevalence of CFP
Geographic Region Incidence/10,000/year Data time period Reference Reunion Island 0.78 1986–1994 Quod 1996 [25] Queensland, Australia 3 1965–1984 Gillespie 1986 [4] Hawaii 0.3 1975–1981 Anderson 1983 [96] US Virgin Islands 7.6 1982 Morris 1982 [97] Guadeloupe 30 1984 Czernichow 1984 [98] South Pacific Region 970 1973–1983 Lewis 1986 [99] Marshall Islands 2,820 1982–1983 Lewis 1986 [99] French Polynesia 5,850 1979–1983 Lewis 1986 [99] Dade County, FL 5 1974–1976 Lawrence 1980 Culebra, Puerto Rico 73.6–169.5 2005–2006 Luber, In prep [100]
Geographic Region Prevalence (%) Time range Citation US Virgin Islands 4.4 Annual (1980) McMillan 1980 [101] Puerto Rico 7 Lifetime Holt 1984 [102] Tahiti 8.45 Annual (1966) Bagnis 1979 [16] Hao (Tuamotos) 43 Annual (1978) Lewis 1986 [99] Polynesian Islands 70 Lifetime Lewis 1986 [99]
Mar Drugs. 2008 September; 6(3): 456–479.
Ciguarera - Clinical Presentation
◗ Constellation of neurologic, GI, and cardiovascular symptoms • nausea, vomiting, diarrhea • paresthesias, headache, numbness, weakness • (paralysis and coma may ensue) • arrhythmias, hypotension, brady/tachycardia
◗ Neurologic Sx: median duration 2-3 weeks, but chronic or relapsing syndromes can occur for years
Reef Russian Roulette
www.photographersdirect.com
Eat me … you lose
www.informaction.org
Treatment ◗ IV mannitol (0.5-1 g/kg over 30-45 minutes)
• Little convincing evidence of benefit • Little risk • Very little evidence of effect >72 hours
◗ Avoidance of certain foods (idiosyncratic) including fish, alcohol, nuts, caffeine, pork … ◗ Supportive
Mar Drugs. 2008 September; 6(3): 456–479.
Mattei C et al. Brevenal inhibits pacific ciguatoxin-1B-induced neurosecretion from bovine chromaffin cells. PLoS One. 2008;3(10):e3448. Epub 2008 Oct 20.
Department of Fisheries and Oceans, the Canadian Food Inspection Agency and Environment Canada
Executive Summary Consumer Awareness and Perceptions of Shellfish Consumption and Recreational Harvesting: Findings from the Baseline Survey Prepared for Canadian Food Inspection Agency December 15, 2006
• Telephone survey 1400 (390 coastal): 37% of non-coastal visited coast(s)
• 27% had eaten shellfish harvested by themselves: 9% in last 12 months
• 10% had bought shellfish from the back of a truck and 10% from fisherman
• 70% thought all shellfish sold in Canada is safe
• 16% thought shellfish caught by themselves or friends might be unsafe
• Most thought that ‘pollution was the main risk (23% said mercury)
• 54% didn’t think that eating any shellfish was a serious risk for healthy adults
• 70% believe shellfish are safe after cooking
Canadian Shellfish Sanitation Program (CSSP)
Paralytic Shellfish Poisoning
◗ Ingestion of bioaccumulated dinoflagellate toxins in shellfish (mussels, clams, oysters….)
◗ Dinoflagellate species • Alexandrium spp • Gonyaulax spp
◗ Major Toxins: • Saxitoxins: Voltage dependent • Na channel blockade (extremely potent toxins)
www.chemgapedia.de
PSP - clinical presentation
◗ Predominantly neurologic syndrome: tingling, burning, numbness, drowsiness, dysarthria, and paralysis: can be life-threatening.
◗ Signs & symptoms usually appear within ~one hour of eating contaminated shellfish
◗ Residual sequelae uncommon ◗ Prevention through shellfish monitoring
Red Tide
pathtosustainable.wordpress.com
Eutrophication ◗ an increase in chemical
nutrients in an ecosystem to an extent that increases the primary productivity of the ecosystem.
Neurotoxic Shellfish Poisoning ◗ Ingestion of bioaccumulated dinoflagellate toxins
in shellfish (bivalves). Rarely, aerosol exposure to toxins
◗ Dinoflagellate: Karenia breve (Gymnodinium) ◗ Toxin:
• brevetoxins: linear polycyclic ethers • (similar structure to ciguatoxins) • Voltage dependent Na channel activation
NSP - Clinical presentation ◗ Clinical symptoms include both neurologic
and gastrointestinal effects: • circumoral paresthesias, dizziness, ataxia • nausea, abdominal pain, vomiting, diarrhea • respiratory symptoms with aerosol exposure
◗ Clinical onset within minutes to hours; recovery usually complete.
◗ Prevention: monitoring G. breve counts Errera RM et al. Variation in brevetoxin and brevenal content among clonal cultures of Karenia brevis may influence bloom toxicity. Toxicon. 2010 Feb-Mar;55(2-3):195-203
Bivalves - Natures Filters
Filter-concentration of up to 40 GALLONS of water per day
• Plankton toxins • Hepatitis A • Polio (?) • Other viruses (?) • Cholera • Cryptosporidium
Diarrhetic Shellfish Poisoning
◗ Ingestion of bioaccumulated dinoflagellate toxin in shellfish (mussels, scallops, clams.)
◗ (Japan, Europe. Not reported in U.S.) ◗ Dinophysis fortii, D. acuminata ◗ Toxin: okadaic acid
• polycyclic ether compound • protein phosphatase 1 & 2A inhibitor
DSP - Clinical presentation
◗ DSP produces gastrointestinal symptoms, usually within 30 minutes of consumption of contaminated shellfish.
◗ Diarrhea (may be incapacitating), nausea, vomiting, abdominal cramps, chills.
◗ Recovery within 2-3 days, with or without treatment. No sequelae identified
Amnestic Shellfish Poisoning ◗ Ingestion of bioaccumulated diatom toxins in
shellfish (mussels, clams, oysters..) ◗ Nitzschia pungens & Pseudo-nitzchia sp ◗ Recognized outbreaks: Maritime Canada, U.S.
northern Atlantic & Pacific coasts ◗ Toxin: domoic acid (water soluble)
• structurally related to the excitatory amino acid neurotransmitter glutamic acid
www.orhab.org/education/Pseudo_nitzschia_sp.htm
ASP - Clinical presentation
◗ Life-threatening disorder with both gastrointestinal and neurologic symptoms
◗ GI: nausea, vomiting, diarrhea, cramps ◗ Neurological: dizziness, headache, seizures,
diorientation, short-term memory loss, coma • information encoding, generally intact • delayed recall significantly impaired • hippocampal & amygdaloid nucleus necosis
ASP - Clinical presentation II
◗ Disease most severe in the elderly and those with renal impairment.
◗ Among survivors, sequelae may include significant memory deficits and motor neuropathy
◗ Prevention through water and shellfish monitoring (diatom counts, toxin assays)
Pfiesteria piscicida ◗ 1988 - cause of fish deaths in aquaria at North
Carolina University Veterinary School ◗ 1991 - cause of natural habitat fish kills in the
estuarine system of North Carolina. ◗ Since then, repeatedly identified as a cause of fish
kills in North Carolina (106-109 fish)
http://www.uncwil.edu/riverrun/river_tutorial/12pfiesteria.jpg www.whoi.edu/.../pfiesteriafishsores.html
‘Ambush’ or ‘Predator’ Dinoflagellates
◗ Dinoflagellate species which are induced, upon chemical detection of prey, to: • undergo stage transformations • ‘swarm’ or multiply • (for Pfiesteria)... produce toxin (s) • exploit nutritional source • then, re-encyst, or disperse
Trophic controls of Pfiesteria
◗ Heterotrophic with cleptochloroplasts ◗ Benthic forms (amoebae, cysts) predominant ◗ Factors influencing Pfiesteria toxin production
(and stage transformation) not fully known, but include: • presence of live fish • abundance of algal prey species • water nutrient levels (phospates, nitrates)
Pfiesteria Toxins ◗ Several toxins have been isolated, and
partially characterized ◗ Lipid soluble toxins (fractions)
• one kills fish rapidly; is difficult to isolate • one peels skin off fish (takes time)
◗ Water soluble toxin • appears to be unique (i.e. not one of the above) • icthyotoxic, cytotoxic in cell culture
http://blog.mlive.com/chronicle/2008/04/07deadfish.jpg
Pfiesteria - Clinical presentation
◗ ‘Cardinal Signs & Symptoms’ • Memory Loss, OR • Confusion, OR • Skin ‘burning’ on contact with water, OR
◗ ‘Secondary Signs & Symptoms’ • 3 or more of the following:
• headache skin rash • eye irritation upper respiratory irritation • muscle cramps gastrointestinal complaints
http://news.bbc.co.uk/olmedia /images/_20403_human.jpg
www.flickr.com/photos/38832546@N00/3848358627/
www.unep.org/dewa/vitalwater/article177.html
Why is this happening?
Why is this happening - II?
geology.com/news/2006/01/global-warming-graph
Scromboid
◗ Commonest poisoning worldwide ◗ Dark-fleshed, fatty fish
• Common - tuna, bonito, mackerel, barracuda • Rare - sardines, anchovies, salmon, herring
◗ ‘Histamine’ poisoning (?? unclear) ◗ Biogenic amines (histamine, putrescine,
cadaverine, and tyramine) ◗ ? bacterial metabolism of histidine ◗ ? histamine-spiked fish - minimal toxicity
Scromboid - Clinical presentation
◗ Non-specific symptoms ◗ Tingling of lips/mouth/tongue ◗ Flushing, sweating, bright red rash ◗ Swelling of face/tongue swelling, wheezing ◗ GI distress: nausea, vomiting, diarrhea ◗ Tachycardia --> cardiovascular collapse
Other Toxins
◗ Puffer fish (tetrodotoxin) • 50 deaths/year in Japan • ? Bacterial (Vibrio spp) toxin concentrated in fish
◗ Red Whelk (tetramine) • Curare-like effects
◗ Cyanobacteria (microcystins, nodularin, anatoxins) ◗ Mussels (azaspiracid)
Other agents • Jellyfish of all sizes & shapes • Corals (eg: fire coral) • Sea urchin spines • Fish spines (eg: lion fish, sting ray, catfish) • Conidiae • Sea snakes
thestashbox.wordpress.com
life-sea.blogspot.com
firstaid.about.com
Jellyfish Stings
lifestyle.ca.msn.com
diveinstead.com
Urine Acidification
Diabetes
Diarrhea
Dehydration
Acidosis
Starvation
Meat eater
Treatment?
Other agents - Corals
Fire Coral
Various Corals
www.bluezooaquatics.com
www.usdivetravel.com
Other agents - Corals
Fire Coral Stings www.scubaboard.com
Other agents - Sea Urchin (& Other) Spines
Black Sea Urchin
Crown-of-Thorns Starfish
bcrc.bio.umass.edu
spressivo.com/isa/coralreef/animals.htm
Other agents - Stonefish
Masters of ...
… Disguise jaysdaysaway.blogspot.com
aquaviews.net
Other agents - Fish Spines
Lionfish/Zebrafish
Triggerfish
Ray - Tail barb
www.amnh.org
www.beachhunter.netps3029.k12.sd.us/State/trigger%20fish.jpg
Other agents - Cones
home.comcast.net/
www-tc.pbs.org
Other agents - Seasnakes
Green Seasnake
Yellow Seasnake
• >80% of bites envenomed • potent myotoxins & (less) neurotoxins
fieldherpforum.com
divehappy.com
Other agents
Octopus Seaworms exxxplorer.files.wordpress.com
greennature.com
The marine environment isn’t always ‘safe’ … but there are benefits too.
Doucette GJ, etal. Endangered North Atlantic right whales (Eubalaena glacialis) experience repeated, concurrent exposure to multiple environmental neurotoxins produced by marine algae. Environ Res. 2012 Jan;112:67-76.
Right Whale poop for exposure to • paralytic shellfish toxins (PSTs) • domoic acid (DA)
140 Fecal Samples studied • 70-80% + PSTs • 25-30% + domoic acid
It’s Not Just Us …