Marine Toxins & Intoxications - Groupe Santأ© Marine Toxins & Intoxications Brian J Ward JD...

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Transcript of Marine Toxins & Intoxications - Groupe Santأ© Marine Toxins & Intoxications Brian J Ward JD...

  • 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

    ◗  Dinofl