Neurotoxic shellfish poisoning

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  • 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[1]


  • Based on symptoms and history of ingesting shellfish or proximity to red tide
  • If Ingested
    • Similar to ciguatera
    • GI symptoms - vomiting, diarrhea, abdominal cramping; usually within 30 minutes to 3 hours of ingestion
    • Neurologic symptoms - parethesias, dizziness, ataxia. Can also see hot/cold temperature sensation reversal [2]
  • If Inhaled
    • Upper respiratory tract irritation, rhinorrhea, bronchoconstriction
    • Generally affects patients with chronic respiratory disease (ie asthma/COPD) [3]

Differential Diagnosis

Marine toxins and envenomations


  • Symptomatic


  • Most patients fully recover within 72 hours

See Also


  1. James KJ et al. Shellfish toxicity: human health implications of marine algal toxins. Epidemiol Infect. 2010;138(7):927-40.
  2. Morris PD et al. Clinical and epidemiological features of neurotoxic shellfish poisoning in North Carolina. Am J Public Health. 1991;81(4):471-4.
  3. Fleming LE et al. Aerosolized red-tide toxins (brevetoxins) and asthma. Chest 2007;131:187.