Paralytic shellfish poisoning

Background

• Associated with red tides, but can occur independently
• Caused by ingestion of contaminated shellfish which harbor toxin (heat stabile) producing algae
• Shellfish typically from colder waters (New England, Pacific NW, Alaska)

Clinical Features

• Symptoms develop within minutes to hours of ingestion
• Typically neurologic symptoms only: Paresthesias, dizziness, ataxia. May progress to dysphagia and/or respiratory failure.

• Report any suspect cases to local department of health

Differential Diagnosis

Marine toxins, envenomations, and bites

• Toxins
  • Ciguatera
  • Scombroid
  • Tetrodotoxin (e.g. pufferfish)
  • Shellfish poisoning
    • Amnesic shellfish poisoning
    • Diarrheal shellfish poisoning
    • Neurotoxic shellfish poisoning
    • Paralytic shellfish poisoning
• Stingers
  • Stingray injury
• Venomous fish
  • Cone shell
  • Lionfish
  • Sea urchins
  • Crown-of-Thorns Starfish
  • Stonefish
  • Other: Catfish, zebrafish, scorpion fish
• Nematocysts
  • Coral reef
  • Fire coral
  • Jellyfish (Cnidaria)
    • Box jellyfish
      • Irukandji syndrome
    • Sea wasp
  • Portuguese man-of-war
  • Sea anemones
  • Seabather's eruption
• Phylum porifera (sponges)
• Bites
  • Alligator and crocodile attacks
  • Octopus bite
  • Shark bite
• Infections
  • Vibrio species in saltwater
  • Aeromonas species in freshwater

Evaluation

• Based on symptoms plus history of shellfish ingestion

Management

• Supportive. Some cases may require intubation / mechanical ventilation

Prognosis

• Mortality up to 12% if untreated
• Symptoms usually self resolved within hours to days

See Also

• Marine toxins and envenomations