[Neurological manifestations of fish, mollusk and shellfish poisoning]

Sea-food poisoning is observed in several areas of the world. Intoxication results from ingestion of fresh fish, mollusks, or shellfish contaminated by toxins produced by microorganisms (dinoflagellates). Neurological manifestations are sometimes associated with signs and may be life-threatening. We describe here the principle toxins, their geographic distribution, clinical manifestations, therapeutic management, and possible prevention measures.

Intoxication by star fruit (Averrhoa carambola) in 32 uraemic patients: treatment and outcome

BACKGROUND

Clinical symptoms and outcomes of uraemic patients ingesting star fruit are quite variable and may progress to death. The purpose of the present report was to discuss the neurotoxic effects of star fruit intoxication in uraemic patients and to present the efficacy of different therapeutic approaches.

METHODS

We studied a total of 32 uraemic patients who had ingested star fruit. Before the intoxication episodes, 20 patients were on regular haemodialysis, eight were on peritoneal dialysis and four were not yet undergoing dialysis. Two patients were analysed retrospectively from their charts, 17 were directly monitored by our clinic and 13 were referred by physicians from many areas throughout the country, allowing us to follow their outcome from a distance. Intoxicated patients were given different therapeutic approaches (haemodialysis, peritoneal dialysis and supportive treatment), and their outcomes were analysed.

RESULTS

The most common symptoms were persistent and intractable hiccups in 30 patients (93.75%), vomiting in 22 (68.7%), variable degrees of disturbed consciousness (mental confusion, psychomotor agitation) in 21 (65.6%), decreased muscle power, limb numbness, paresis, insomnia and paresthesias in 13 (40.6%) and seizures in seven (21.8%). Patients who were promptly treated with haemodialysis, including those with severe intoxication, recovered without sequelae. Patients with severe intoxication who were not treated or treated with peritoneal dialysis did not survive.

CONCLUSIONS

Haemodialysis, especially on a daily basis, is the ideal treatment for star fruit intoxication. In severe cases, continuous methods of replacement therapy may provide a superior initial procedure, since rebound effects are a common event. Peritoneal dialysis is of no use as a treatment, especially when consciousness disorders ensue.

Diarrhea associated acute renal failure in a patient with Salmonella enteritidis sepsis

Salmonella enteritidis infection occurs primarily in animals and often results in self-limited gastroenteritis in accidental cross contamination in human. However, the acute renal failure could be a rare but serious complication of the S. enteritidis infection. We report one case of acute renal failure from severe dehydration caused by S. enteritidis food poisoning. The acute renal failure completely recovered after hydration and antibiotic treatment.

Ciguatera poisoning: a global issue with common management problems

Ciguatera poisoning, a toxinological syndrome comprising an enigmatic mixture of gastrointestinal, neurocutaneous and constitutional symptoms, is a common food-borne illness related to contaminated fish consumption. As many as 50000 cases worldwide are reported annually, and the condition is endemic in tropical and subtropical regions of the Pacific Basin, Indian Ocean and Caribbean. Isolated outbreaks occur sporadically but with increasing frequency in temperate areas such as Europe and North America. Increase in travel between temperate countries and endemic areas and importation of susceptible fish has led to its encroachment into regions of the world where ciguatera has previously been rarely encountered. In the developed world, ciguatera poses a public health threat due to delayed or missed diagnosis. Ciguatera is frequently encountered in Australia. Sporadic cases are often misdiagnosed or not medically attended to, leading to persistent or recurrent debilitating symptoms lasting months to years. Without treatment, distinctive neurologic symptoms persist, occasionally being mistaken for multiple sclerosis. Constitutional symptoms may be misdiagnosed as chronic fatigue syndrome. A common source outbreak is easier to recognize and therefore notify to public health organizations. We present a case series of four adult tourists who developed ciguatera poisoning after consuming contaminated fish in Vanuatu. All responded well to intravenous mannitol. This is in contrast to a fifth patient who developed symptoms suggestive of ciguatoxicity in the same week as the index cases but actually had staphylococcal endocarditis with bacteraemia. In addition to a lack of response to mannitol, clinical and laboratory indices of sepsis were present in this patient. Apart from ciguatera, acute gastroenteritis followed by neurological symptoms may be due to paralytic or neurotoxic shellfish poisoning, scombroid and pufferfish toxicity, botulism, enterovirus 71, toxidromes and bacteraemia. Clinical aspects of ciguatera toxicity, its pathophysiology, diagnostic difficulties and epidemiology are discussed.

[Clinical observation on multiple organ dysfunction syndrome due to fish gall bladder poisoning]

OBJECTIVE

To study the functional changes of liver, kidney, myocardium and gastro-intestine after fish gall bladder poisoning and the pathogenic mechanism of acute renal failure.

METHODS

The liver and kidney function, myocardial enzyme, urinary N-acetyl-beta-D-glucosaminidase (N-AG), 24 hrs intake and output volume of liquid and kidney B-ultrasonographic examination in 11 patients of severe acute fish gall bladder poisoning were observed. And kidney biopsy was carried out in one patient under B-ultrasonography for understanding the renal pathological changes.

RESULTS

All the 11 patients were cured with disappearance of clinical symptoms. After the poisoning the order of the severity of organ damage were kidney, liver, myocardium and gastro-intestine tract. The levels of blood creatinine, blood urea nitrogen, urinary N-AG, glutamic-pyruvic transaminase, total bilirubin were lowered significantly after treatment. Biopsy examination under light microscope showed toxic damage of renal tubules mainly in proximal tubules, and under electron microscope, the pathologic changes were mitochondrial vacuolar degeneration of tubular epithelial cells, swelling of epithelial cells, partial fusion of processes in glomeruli and narrowing of saccular cavity.

CONCLUSION

Fish gall bladder poisoning could cause acute multiple organ dysfunction syndrome (MODS), the affected organs in order of severity of damage were kidney, liver, myocardium and gastro-intestine tract. In kidney the damage was mainly at the proximal tubules. Urinary NAG is a sensitive criterion for determining the diagnosis and prognosis of renal tubular dysfunction.

[Hemolytic-uremic syndrome in a patient with bacterial food poisoning]

A rare case of a 47-year-old man with bacterial food poisoning due to Salmonella enteritidis, complicated by haemolitic-uraemic syndrome was described.

What did we learn from the Shanghai hepatitis A epidemic?

A major outbreak of hepatitis A (HAV), associated with consumption of raw clams, occurred in Shanghai, China in 1988. Over 300 000 cases were reported, of which 47 (0.015%) were fatal. An elevated mortality rate was observed in hepatitis B surface antigen (HBsAg)-positive patients (0.05%). The majority of these patients were also hepatitis B e antigen (HBeAg)-positive, indicating active liver disease and high viral replication rates. The increased mortality in hepatitis B virus (HBV)/HAV coinfected individuals is hypothesized to be the result of T-cell-mediated destruction of HBV-infected hepatocytes, enhanced by acute HAV infection. Following recovery from HAV there is an increase in HBV expression and activated cytotoxic cells and subsequent cytolysis. Patients with chronic HBV infection are clearly at considerable risk of severe disease and increased mortality in the event of HAV infection. The period of greatest risk is during the immunoeliminative phase of HBV infection, which generally occurs in early adulthood. With the prevalence of HBV approaching 10% in this group, there is a clear opportunity for benefit from vaccination.

Chloracne, goiter, arthritis, and anemia after polychlorinated biphenyl poisoning: 14-year follow-Up of the Taiwan Yucheng cohort

In 1979, a mass poisoning involving 2,000 people occurred in central Taiwan from ingestion of cooking oil contaminated by polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs). We studied the prevalence of medical conditions in the exposed individuals and in a neighborhood control group. Starting with a registry of the exposed individuals from 1983, we updated the addresses of exposed individuals and identified a control group matched for age, sex, and neighborhood in 1979. In 1993, individuals 30 years of age or older were interviewed by telephone. We obtained usable information from 795 exposed subjects and 693 control subjects. Lifetime prevalence of chloracne, abnormal nails, hyperkeratosis, skin allergy, goiter, headache, gum pigmentation, and broken teeth were observed more frequently in the PCB/PCDF-exposed men and women. The exposed women reported anemia 2. 3 times more frequently than controls. The exposed men reported arthritis and herniated intervertebral disks 4.1 and 2.9 times, respectively, more frequently than controls. There was no difference in reported prevalences of other medical conditions. We conclude that Taiwanese people exposed to high levels of PCBs and PCDFs reported more frequent medical problems, including skin diseases, goiter, anemia, and joint and spine diseases.

Vibrio species

Vibrios are an important cause of human food-borne illness associated with the consumption of seafood worldwide, and contaminated food and drinking water in developing countries. Clinical syndromes induced by vibrios such as Vibrio cholerae, V. parahaemolyticus, V. vulnificus, and others range from mild, self-limiting gastroenteritis to life-threatening primary septicemia. As natural inhabitants of the aquatic environment, these bacteria pose a continual threat to food safety.

Chloracne, goiter, arthritis, and anemia after polychlorinated biphenyl poisoning: 14-year follow-Up of the Taiwan Yucheng cohort

In 1979, a mass poisoning involving 2,000 people occurred in central Taiwan from ingestion of cooking oil contaminated by polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs). We studied the prevalence of medical conditions in the exposed individuals and in a neighborhood control group. Starting with a registry of the exposed individuals from 1983, we updated the addresses of exposed individuals and identified a control group matched for age, sex, and neighborhood in 1979. In 1993, individuals 30 years of age or older were interviewed by telephone. We obtained usable information from 795 exposed subjects and 693 control subjects. Lifetime prevalence of chloracne, abnormal nails, hyperkeratosis, skin allergy, goiter, headache, gum pigmentation, and broken teeth were observed more frequently in the PCB/PCDF-exposed men and women. The exposed women reported anemia 2. 3 times more frequently than controls. The exposed men reported arthritis and herniated intervertebral disks 4.1 and 2.9 times, respectively, more frequently than controls. There was no difference in reported prevalences of other medical conditions. We conclude that Taiwanese people exposed to high levels of PCBs and PCDFs reported more frequent medical problems, including skin diseases, goiter, anemia, and joint and spine diseases.

Foodborne infections during pregnancy

The consequences of foodborne illness can be particularly devastating during pregnancy because both the woman and her fetus are at risk. Escalated production of progesterone during pregnancy leads to down-regulation of cellular (cell-mediated) immune functions. Many foodborne pathogens (and other pathogens) are intracellular pathogens, and infections caused by these pathogens are controlled by cell-mediated immunity. The pregnancy-induced decrease in cell-mediated immune functions leads to increased susceptibility of the pregnant woman to certain infections. Hepatitis E virus, Coxiella burnetii, Listeria monocytogenes, and Toxoplasma gondii are intracellular pathogens that have a predilection for the maternal-fetal unit and may induce serious disease in the mother and/or fetus. In the United States, T. gondii and L. monocytogenes are the most important foodborne pathogens in pregnancy, and these organisms can induce death or grave disease in the fetus and newborn. The pregnant woman, in order to protect herself and her fetus from the consequences of foodborne illness, must practice a high standard of food hygiene and personal cleanliness.

[Lack of air conditioning and mycotoxin poisoning are basic co-factors in tropical spastic paraparesis]

INTRODUCTION

Chronic idiopathic spastic paraparesis (CHISPA) have been associated to HTLV-I virus infection, and unknown environmental factors have been suggested to play a role in its pathogenesis.

METHOD

Based in our previous studies we wanted to know if the lack of refrigerators and the mycotoxin contamination of food might have any relationship with the presence of CHISPA in patients living at southeastern Colombia.

RESULTS

Interestingly only four out of 15 patients with CHISPA had some method of refrigeration, in, 14 out of these 15 patients at least a metabolite of Fusarium was detected.

CONCLUSIONS

The fact that mycotoxins found in the urine samples of these patients are immunosuppressors and demyelinating allow us to suggest that these toxins could be the most important environmental cofactors leading to the susceptible people to the clinically established disease.

[The clinical and experimental evaluation of the pharmacological efficacy of the new antidiarrheal preparation ftorazol]

A clinical trial of the new antidiarrheal drug of antisecretory action fluorasol was studied with patients with salmonellosis and food toxic infections. 65 patients had moderate and 53 severe symptoms. It was established that fluorasol was superior to basic rehydration therapy in relieving diarrheal syndrome irrespective of severity of acute intestinal infections. Clinical effects on intoxication were not registered. Antidiarrheal activity of fluorasol was confirmed on the model of experimental diarrhea on isolated loops of the rat small intestine. Liquid secretion into the lumen of small intestinal isolated loops in the presence of fluorasol substance fell twofold compared to control loops.

Apparent paralytic shellfish poisoning in captive herring gulls fed commercial scallops

This report describes an acute poisoning event observed in captive herring gull (Larus argentatus) chicks fed a batch of store-bought scallops. They developed a characteristic acute syndrome, that has not hitherto been reported in birds and the cause of which remains to be identified. We suggest that it is a variant of paralytic shellfish poisoning (PSP) insofar as it was paralytic and caused by shellfish. However, analyses by the U.S. Food and Drug Administration to identify known toxins (saxitoxins, brevetoxins, domoic acid) in the scallops were negative.