Paralytic shellfish poisoning (PSP) is one of the four recognized syndromes of shellfish poisoning, which share some common features and are primarily associated with bivalve mollusks (such as

mussel Mussel () is the common name used for members of several families of bivalve molluscs, from saltwater and freshwater habitats. These groups have in common a shell whose outline is elongated and asymmetrical compared with other edible clams, which ...

clam Clam is a common name for several kinds of bivalve molluscs. The word is often applied only to those that are edible and live as infauna, spending most of their lives halfway buried in the sand of the seafloor or riverbeds. Clams have two sh ...

oyster Oyster is the common name for a number of different families of salt-water bivalve molluscs that live in marine or brackish habitats. In some species, the valves are highly calcified, and many are somewhat irregular in shape. Many, but not a ...

s and

scallop Scallop () is a common name that encompasses various species of marine bivalve mollusks in the taxonomic family Pectinidae, the scallops. However, the common name "scallop" is also sometimes applied to species in other closely related familie ...

s). These shellfish are

filter feeder Filter feeders are a sub-group of suspension feeding animals that feed by straining suspended matter and food particles from water, typically by passing the water over a specialized filtering structure. Some animals that use this method of feedin ...

s and accumulate

neurotoxin Neurotoxins are toxins that are destructive to nervous tissue, nerve tissue (causing neurotoxicity). Neurotoxins are an extensive class of exogenous chemical neurological insult (medical), insultsSpencer 2000 that can adversely affect function ...

s, chiefly

saxitoxin Saxitoxin (STX) is a potent neurotoxin and the best-known paralytic shellfish toxin (PST). Ingestion of saxitoxin by humans, usually by consumption of shellfish contaminated by toxic algal blooms, is responsible for the illness known as paralytic ...

, produced by microscopic

alga Algae (; singular alga ) is an informal term for a large and diverse group of photosynthetic eukaryotic organisms. It is a polyphyletic grouping that includes species from multiple distinct clades. Included organisms range from unicellular mi ...

e, such as

dinoflagellate The dinoflagellates ( Greek δῖνος ''dinos'' "whirling" and Latin ''flagellum'' "whip, scourge") are a monophyletic group of single-celled eukaryotes constituting the phylum Dinoflagellata and are usually considered algae. Dinoflagellates ...

diatom A diatom ( Neo-Latin ''diatoma''), "a cutting through, a severance", from el, διάτομος, diátomos, "cut in half, divided equally" from el, διατέμνω, diatémno, "to cut in twain". is any member of a large group comprising se ...

s, and

cyanobacteria Cyanobacteria (), also known as Cyanophyta, are a phylum of gram-negative bacteria that obtain energy via photosynthesis. The name ''cyanobacteria'' refers to their color (), which similarly forms the basis of cyanobacteria's common name, blue ...

. Dinoflagellates of the genus ''

Alexandrium Alexandreion (Greek), or Alexandrium (Latin), called Sartaba in the Mishna and Talmud and Qarn Sartaba in Arabic, was an ancient hilltop fortress constructed by the Hasmoneans between Scythopolis and Jerusalem on a pointy barren hill towering ...

'' are the most numerous and widespread saxitoxin producers and are responsible for PSP blooms in subarctic, temperate, and tropical locations. The majority of toxic blooms have been caused by the morphospecies '' Alexandrium catenella, Alexandrium tamarense'', '' Gonyaulax catenella'' and '' Alexandrium fundyense'', which together comprise the ''A. tamarense'' species complex. In Asia, PSP is mostly associated with the occurrence of the species ''Pyrodinium bahamense''. Some pufferfish, including the chamaeleon puffer, also contain saxitoxin, making their consumption hazardous.

PSP and cyanobacteria

PSP toxins (of which saxitoxin is the most ubiquitous) are produced in eukaryotic dinoflagellates and prokaryotic cyanobacteria (usually referred to as blue-green algae). Within the freshwater marine ecosystem, the largest contribution in the accumulation of PSP toxins derives from saxitoxin produced by cyanobacteria. The biosynthesis of saxitoxin is well-defined in cyanobacteria, while within dinoflagellates it remains mostly unknown. Cyanobacterial saxitoxin biosynthesis has been studied in radioisotope tracing experiments, and turns out to be highly complex, involving many steps, enzymes and chemical reactions. The starting reagent, L-arginine, goes through several chemical reactions (among which is a rare chemical reaction known as a Claisen condensation), going through four intermediates before resulting in saxitoxin. The Australian freshwater mussel ''Alathyria condola'' is highly susceptible to neurotoxin accumulation. After two to three days of exposure to the cyanobacterium ''A. circinalis' it may contain upwards of 80 micrograms of neurotoxins per 100 grams of mussel, a level high enough to cause significant health risks to humans.

Pathophysiology

PSP affects those who come into contact with the affected shellfish by ingestion. The toxins responsible for most shellfish poisonings --mainly

, although several other toxins have been found, such as neosaxitoxin and gonyautoxins I to IV-- are water-insoluble, and heat- and acid-stable. Therefore, ordinary cooking methods will not eliminate the toxins. Symptoms typically appear within ten to 30 minutes after ingestion, and may include

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of th ...

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenterit ...

diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Common causes of pain in the abdomen include gastroenteritis and irritable bowel syndrome. About 15% of people have a more ...

, and tingling or burning lips, gums, tongue, face, neck, arms, legs, and toes.

Shortness of breath Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...

dry mouth Xerostomia, also known as dry mouth, is dryness in the mouth, which may be associated with a change in the composition of saliva, or reduced salivary flow, or have no identifiable cause. This symptom is very common and is often seen as a side eff ...

, a choking feeling, confused or slurred speech, and loss of coordination are also possible. PSP toxins, such as saxitoxin, are able to bind near the sodium ion channel, blocking passage of potassium and/or sodium into (and out of) the cell. This restricts (or outright prevents) transmission of signals between neurons. If the exposure, this can result in (partial or complete) paralysis. PSP can be fatal in extreme cases, particularly in

immunocompromised Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...

individuals; children are known to be more susceptible. Most shellfish can store saxitoxin for several weeks after a

harmful algal bloom A harmful algal bloom (HAB) (or excessive algae growth) is an algal bloom that causes negative impacts to other organisms by production of natural algae-produced toxins, mechanical damage to other organisms, or by other means. HABs are sometimes ...

passes, but some, such as butter clams, can store the toxin for up to two years.

PSP in wild marine mammals

PSP has been implicated as a possible cause of sea otter mortality and

morbidity A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ar ...

in Alaska, as one of its primary prey items, the butter

''( Saxidomus gigantea)'' bioaccumulates saxitoxin as a chemical defense mechanism. In addition, ingestion of saxitoxin-containing

mackerel Mackerel is a common name applied to a number of different species of pelagic fish, mostly from the family Scombridae. They are found in both temperate and tropical seas, mostly living along the coast or offshore in the oceanic environment. ...

has been implicated in the death of

humpback whales The humpback whale (''Megaptera novaeangliae'') is a species of baleen whale. It is a rorqual (a member of the family Balaenopteridae) and is the only species in the genus ''Megaptera''. Adults range in length from and weigh up to . The hum ...

. Additional cases where PSP was suspected as the cause of death in

Mediterranean monk seal The Mediterranean monk seal (''Monachus monachus'') is a monk seal belonging to the family Phocidae. , it is estimated that fewer than 700 individuals survive in three or four isolated subpopulations in the Mediterranean, (especially) in the Ae ...

s (''Monachus monachus'') in the

Mediterranean Sea The Mediterranean Sea is a sea connected to the Atlantic Ocean, surrounded by the Mediterranean Basin and almost completely enclosed by land: on the north by Western and Southern Europe and Anatolia, on the south by North Africa, and on ...

have been questioned due to lack of additional testing to rule out other causes of mortality.

Detection and treatment

Several detection methods can be used in order to determine the concentration of saxitoxin within an organism (be it shellfish or human), both ''in vivo'' and ''in vitro''. The most commonly used ''in vivo'' method is the mouse bioassay, which provides quantitative and qualitative data in case of a (suspected) PSP neurotoxin exposure; ''in vitro'' receptor binding assays provide equivalent data, while being animal-friendly. PSP neurotoxins can also be detected by high-performance liquid chromatography (HPLC), amongst other forms of chromatography. Shellfish containing 80 or more micrograms of saxitoxin per 100g of edible shellfish tissue are deemed to be unsafe for human consumption. Currently, there is no antidote for PSP neurotoxins. Most PSP patients suffer only minor symptoms, these lasting until the toxin is eliminated from the body. With minor exposure, spontaneous recovery can thus be expected. In the relatively rare case of clinically significant respiratory paralysis, symptomatic treatment in the form of oxygen suppletion and/or mechanical ventilation should be employed until symptoms subside.

References

External links