Correct!
5. All of the above
Diarrhetic shellfish poisoning occurs after eating mussels, scallops, clams and is caused by okadaic acid. Symptoms include nausea, vomiting, abdominal pain, and diarrhea. This illness occurs worldwide and carries a low risk for mortality with supportive treatment alone.
Amnestic shellfish poisoning results from ingestion of domoic acid and has been reported in Canada and the US. Initial symptoms are vomiting and abdominal cramps. Short-term memory loss with severe antegrade memory deficits have been reported (6). Seizures, coma and death have been reported with 4 deaths in a 107-person outbreak after consumption of contaminated mussels in Canada.
Paralytic shellfish poisoning from saxitoxins presents with acute onset paresthesias and in severe cases, respiratory paralysis. In an outbreak in Alaska in 1973 and 1992, 29 (25%) of 117 ill persons required emergency transport to a hospital, 4 (3%) required intubation and one died (6). Case fatality rate in untreated patients is 12% but with supportive care, most patients survive (7). Paralytic shellfish poisoning is typically seen in the New England states, Alaska, California and Washington.
Ciguatera fish poisoning typically presents in the Caribbean, South Pacific, and the US Virgin Islands. It is the result of ingestion of tropical reef fish such as barracuda, grouper, snapper or eel. Ciguatoxin or ciguatoxin-like toxin is tasteless and not destroyed by cooking. Common symptoms are nausea, vomiting, abdominal pain followed by circumoral and extremity paresthesias, pain and weakness in the lower extremities. Temperature reversal also occurs with this poisoning; "ice cream tastes hot, hot coffee seems cold" (6). Respiratory arrest and coma can occur within 24 hours.
Pufferfish poisoning, typically seen in Japan, is caused by tetrodotoxin found in globefish, a delicacy. Tetrodotoxin is not removed by washing or cooking and is one of the deadliest natural toxins known. Saxitoxin, the cause of paralytic shellfish poisoning, can also be in pufferfish and can cause generalized paralysis with respiratory failure. The patient remains conscious while paralyzed. Neostigmine or edrophonium may partially reverse the paralysis.
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