Neurotoxic shellfish poisoning
- Associated with red tide
- Seen in Southeast US, Gulf of Mexico, Caribbean, New Zealand
- Caused by brevetoxins secreted by dinoflagellates during algal blooms, which are then ingested by shellfish and/or aerosolized
- Similar to ciguatera
- GI symptoms - vomiting, diarrhea, abdominal cramping; usually within 30 minutes to 3 hours of ingestion
- Neurologic symptoms - paresthesia, dizziness, ataxia. Can also see hot/cold temperature sensation reversal 
- Upper respiratory tract irritation, rhinorrhea, bronchoconstriction
- Generally affects patients with chronic respiratory disease (ie asthma/COPD) 
- Venomous fish
- Phylum porifera (sponges)
- Based on symptoms and history of ingesting shellfish or proximity to red tide
- Most patients fully recover within 72 hours
- James KJ et al. Shellfish toxicity: human health implications of marine algal toxins. Epidemiol Infect. 2010;138(7):927-40.
- Morris PD et al. Clinical and epidemiological features of neurotoxic shellfish poisoning in North Carolina. Am J Public Health. 1991;81(4):471-4.
- Fleming LE et al. Aerosolized red-tide toxins (brevetoxins) and asthma. Chest 2007;131:187.