Northwest Fisheries Science Center

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Document Type: Journal Article
Center: NWFSC
Document ID: 4365
Title: Case diagnosis and characterization of suspected paralytic shellfish poisoning in Alaska
Author: Jennifer S. Knaack, K. A. Porter, J. T. Jacob, K. Sullivan, Matthew Forester, Richard Wang, Vera L. Trainer, Steve Morton, Ginny Eckert, E. McGahee, J. Thomas, J. McLaughlin, R. C. Johnson
Publication Year: 2016
Journal: Harmful Algae
Keywords: saxitoxin,paralytic shellfish toxin,paralytic shellfish poisoning,PSP,gonyautoxins,Alaska,

 Paralytic shellfish poisoning (PSP) in humans results from the unintentional consumption of shellfish that have bioaccumulated small molecule toxins from phytoplankton in harmful algal blooms. PSP typically occurs from the consumption of recreationally-harvested shellfish from unmonitored beaches. Clinical manifestations present rapidly and include nausea, paresthesia, and weakness. In severe cases, PSP can result in death from respiratory failure. The diagnosis of PSP is presumptive based on the recent ingestion of shellfish and the presence of manifestations consistent with PSP, and it is confirmed with the detection of a paralytic shellfish toxin in a clinical specimen or food sample. Using a new laboratory urinary test we evaluated eleven patients for saxitoxin (STX)-induced PSP from June 2010 to November 2011 in Alaska. Nine of these cases had presumptive PSP based on recent consumption of shellfish and presentation of symptoms consistent with PSP including nausea, paresthesia, and lightheadedness or dizziness. Four cases were confirmed to have STX-PSP by urinalysis (24 to 364 ng STX/g creatinine). Three cases had clinical manifestations of PSP that improved though no STX was detected in their urine. These cases had no dysphagia or dysarthria, which were reported in the cases with confirmed STX-PSP. Another four cases were confirmed not to have STX-PSP based on non-detected STX in the urine and either the lack of clinical findings or determination of another cause of the outcome.