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Home , Maitotoxin, Pfiesteria piscicida, Shellfish poisoning

Learning Objectives • Understand the linkage between marine algal and human food . • Examine Scombroid fish poisoning Marine Toxins in Food • Examine • Understand paralytic poisoning (PSP), neurotoxic shellfish poisoning, Food Toxicology diarrhetic shellfish poisoning, Instructor: Gregory Möller, Ph.D. encephalopathic or amnesic University of Idaho shellfish poisoning. • Examine Fugu poisoning (). • Explore other marine toxins. 2

Food Toxicology Food Toxicology Introduction Major Causes of -borne Illness • Some marine animals produce Toxic Cone Snail • Live molluscan shellfish a large number of secondary metabolites – Vibrio species bacteria – Prey capture, defense, pheromones – Norwalk-like viruses • Many are avoided K.S. Matz – Natural marine toxins*** – Starfish, sea cucumbers… • Scombroid fish poisoning • from ingestion • Ciguatera fish poisoning of seafood – Epidemics – major public – health issues – Severe economic impact – Severe impact on marine life – ∼ 14% of all food-borne outbreaks 3 4 Price

Food Toxicology Food Toxicology Estimated US Cases Per Year Natural Marine Toxins • Norwalk-like virus 100,000 • Scombroid fish poisoning (histamine) • Scombroid fish poisoning 8,000 • Ciguatera fish poisoning • Ciguatera fish poisoning 1,600 • Vibrio species 1,060 • Shellfish toxins (ASP, DSP, NSP, PSP) • 1,000 • Tetrodotoxin • 200 • Gempylotoxin • Shigella 200 • • 200

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•1 Food Toxicology Food Toxicology Scombroid Fish Poisoning Histamine Formation • Named for the family Scomberidae ( and mackerels) • Can involve any fish containing high levels of free histidine • Bacteria break down free histidine into histamine

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Food Toxicology Food Toxicology Diamines Scombroid Fish Poisoning Cadaverine • Source: improperly handled (time/temperature abuse) mahi mahi, , bluefish, sardines, mackerel H2N–CH2–CH2–CH2–CH2–CH2–NH2 • Range: worldwide Putrescine

H2N–CH2–CH2–CH2–CH2–NH2

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Food Toxicology Food Toxicology Scombroid Fish Poisoning Scombroid Fish Poisoning • Onset: immediate to 30 minutes • Treatment: antihistamines • Initial symptoms: tingling or burning sensation in the • Control: proper chilling and temperature control mouth, rash on the upper body, drop in blood pressure, headache, itching of the skin • FDA guideline: 50 ppm • Later symptoms: nausea, vomiting, and diarrhea • Duration: 3 hours to several days

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•2 Food Toxicology Food Toxicology Scombroid Poisoning Outbreaks (CDC) Ciguatera Fish Poisoning • 5% of all food-borne outbreaks reported and 37% of • The most commonly reported all seafood-related food-borne illnesses marine disease in the • Approximately 200 outbreaks of involving nearly 1400 world. people from 1973-87. – Associated with consumption of contaminated reef fish. • Between 1988-1997, 145 reported • 50,000 people per year. outbreaks involved 811 persons in 20 states. – Debilitating neurologic symptoms, including profound weakness, • Most in HI, FL, CA, temperature sensation WA, NY, CT. changes, pain, and numbness in the extremities.

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Food Toxicology Food Toxicology Ciguatera Fish Poisoning Fukuyo • Four toxins: complex structures • The , • Source: certain species of fish feeding on several Gambierdiscus toxicus produces algae species including Gambierdiscus ciguatoxin throughout tropical

• Range: 20 μm regions of the world. – Tropical and subtropical waters worldwide – U.S.: East coast, Puerto Rico, Hawaii, Virgin Islands • Toxins: heat stable

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Food Toxicology Food Toxicology Ciguatoxin Ciguatoxin CH • The two most common toxins associated with 3

Ciguatera are Ciguatoxin and Maitotoxin CH HO H3C O O 3 – Some of the most lethal natural substances known O O O CH (mice 0.45 μg/kg ip). HO 3 HO O O O O • Ciguatoxin, a lipid soluble substance, opens HO O O O voltage dependant sodium H C channels in cell membranes O 3 CH3 which induces membrane OH depolarization. – Lethality is usually seen with ingestion of the most toxic parts of fish. – Heat stable.

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•3 Food Toxicology Food Toxicology Ciguatera Fish Poisoning Ciguatera Fish Poisoning • Ciguatoxin biomagnifies • Onset: <6 hours up the food chain • Symptoms: • Larger, carnivorous fish – Gastrointestinal: nausea, vomiting, diarrhea –Neurological:numbness and tingling around are primary vectors mouth, joint pain, muscle ache, headache, temperature sensory reversal – Cardiovascular: arrhythmia, bradycardia, tachycardia, reduced blood pressure

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Food Toxicology Food Toxicology Ciguatera Fish Poisoning Ciguatera Fish Poisoning • Duration: • Control: – Usually self-limiting within several days – Mouse bioassay – Rarely some neurological symptoms may persist for months – “Cigua-check” test kit available or years – Enzyme immunoassay • Treatment: – Obtain fish from safe harvest areas – Treat symptoms • Commonly implicated species: – , barracudas, snappers, jacks, mackerel, and triggerfish • FDA guideline: no guideline

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Food Toxicology Food Toxicology Ciguatera Outbreaks Shellfish • 1981: Puerto Rico, 49 cases, 2 deaths • Four categories: paralytic, neurologic, diarrheal, and (barracuda, amberjack, blackjack) amnestic shellfish poisonings. • 1987: Caribbean, 57 cases (fish casserole) • Toxins are found in microscopic and • 1988: Florida, >100 cases (hogfish) with concentrations occurring in filter • 1992: California, 25 cases (flag cabrilla) • 1994: California, several cases (yellowtail) feeding bivalves, such as or mollusks • 1995: Guam (sea weed?) • Harmful algal blooms (HAB; red tides) are not well-correlated to outbreaks of shellfish poisoning – HABs contain toxins

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•4 Food Toxicology Food Toxicology Harmful Algal Blooms (HAB) What Triggers the Blooms? • Most due to • Multifactorial dinoflagellates – – / unicellular microscopic – – Vitamins – vitamin B12, – Plant / animal thiamin, biotin properties – Temperature – Motile –pH – Chloroplast – Quiet, calm conditions – High toxin level – Oxygen • feeders – ‘Pristine waters’ (shellfish) filter from water → accumulate → up the food chain 25 26

Food Toxicology Food Toxicology Where Do Red Tides Occur? Major US HAB Related Events • World wide distribution • Type of dinoflagellate varies with geographical area • Ocean currents mix with open coast • Seasonal – Warmer conditions – May to October – west – July to September - east

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Food Toxicology Food Toxicology Shellfish are the Common Vector Four Major Syndromes • Filter feeders • Paralytic shellfish poisoning (PSP) – Clams, , , • Neurotoxic shellfish poisoning • Comprise 7% of all marine • Diarrhetic shellfish poisoning intoxications • Encephalopathic or amnesic shellfish poisoning • Heat stable • Little effect on the host • Kills fish, , mammals • Mortality rates: – 8-23% – 6% - hospitalization, mechanical ventilation, life support

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•5 Food Toxicology Food Toxicology Paralytic Shellfish Poisoning (PSP) Paralytic Shellfish Poisoning • Most common – severe – fatal • (12-20 analogs) – ∼ 10 per year – CDC • Dinoflagellates – Alexandrium – not readily visible – Karenia brevis –red • – blockers – Heat stable

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Food Toxicology Food Toxicology Paralytic Shellfish Poisoning Paralytic Shellfish Poisoning • Source: contaminated molluscan shellfish feeding on • Onset: ½ to 2 hours algae (Alexandrium, Pyrodinium, Gymnodinium spp.) • Symptoms: tingling, burning, numbness, drowsiness, • Range: tropical to temperate waters worldwide incoherent speech, respiratory paralysis • Duration: respiratory support within 12 hours of exposure results in complete recovery; full resolution in a few days to weeks

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Food Toxicology Food Toxicology High Dose PSP Paralytic Shellfish Poisoning • High dose • Control: – Difficulty swallowing – Mouse bioassay; 10 minute kit; HPLC – Difficulty breathing – Monitoring of coastal waters and shellfish – Respiratory paralysis – Obtain molluscan shellfish from approved waters Alga Alexandrium fundyense – Death – early as 3 to • FDA guideline: 12 hours – 0.8 ppm saxitoxin equivalent • Case fatality rate: 5% (80μg/100g) in all fish

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•6 Food Toxicology Food Toxicology PSP Outbreaks Neurotoxic Shellfish Poisoning • 1976-89: 42 outbreaks in Alaska • Similar to PSP • 1980: California, 98 cases, 2 deaths (oysters) • Milder • 1990: Massachusetts, 6 cases (mussels) • Dinoflagellate – Karenia brevis • 1990: Alaska, 11 cases • Toxin – – – Not as potent

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Food Toxicology Food Toxicology Neurotoxic Shellfish Poisoning Neurotoxic Shellfish Poisoning • Source: molluscan shellfish feeding on algae (Gymnodinium breve) • Range: gulf of Mexico and southern Atlantic coast in U.S.; New Zealand • Toxins: heat stable

(1,000 fold less toxicity)

Polyether

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Food Toxicology Food Toxicology Neurotoxic Shellfish Poisoning Neurotoxic Shellfish Poisoning • Onset: a few minutes to a few hours • Control: • Symptoms: tingling and numbness of the lips, tongue, – Mouse bioassay and throat, muscular aches, dizziness, cold hot –HPLC sensation reversal, diarrhea, vomiting – Commercial immunoassay • Duration: a few hours to – Obtain molluscan shellfish from approved waters several days • FDA guideline: • Fatalities: rare – 0.8 ppm brevetoxin-2 equivalent (20 mouse units/100g) in clams, mussels and oysters

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•7 Food Toxicology Food Toxicology Neurotoxic Shellfish Poisoning Diarrhetic Shellfish Poisoning • Outbreaks: • Europe and Japan – Sporadic and continuous along the gulf coast of Florida, • Dinoflagellates , and Texas – Dinophysis – Prorocentrum • Toxin: okadaic acid derivatives • Within minutes to hours – Diarrhea (92%), Nausea (80%), Vomiting (79%) • Recovery – 3 days – treat supportively

1996 southwest Florida: over 150 43Manatee are killed by brevetoxin 44

Food Toxicology Food Toxicology Diarrheic Shellfish Poisoning Diarrheic Shellfish Poisoning • Source: molluscan shellfish feeding on algae (Dinophysis and Prorocentrum spp.) • Range: Japan, southeast Asia, Scandinavia, western Europe, Chile, New Zealand, eastern Canada • Toxins: heat stable

Okadaic acid and its derivatives

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Food Toxicology Food Toxicology Diarrheic Shellfish Poisoning Diarrheic Shellfish Poisoning • Onset: 30 minutes to 3 hours • Control: • Symptoms: mild diarrhea, nausea, vomiting, – Mouse bioassay abdominal pain, chills, headache, fever – HPLC procedure • Duration: 2-3 days with or without treatment – Molluscan shellfish from approved waters • FDA guideline: – 0.2 ppm okadaic acid plus 35-methyl okadaic acid (DXT 1) in all fish

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•8 Food Toxicology Food Toxicology Amnesic shellfish poisoning Amnesic Shellfish Poisoning • : Pseudo-nitzschia sp.(7) in mussels • Toxin: • Neurotoxin that acts on excitatory amino acid receptors and on synaptic transmission

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Food Toxicology Food Toxicology Amnesic Shellfish Poisoning Amnesic Shellfish Poisoning • Source: Molluscan shellfish (mussels) feeding • Onset: on algae (Pseudo-nitzschia spp.), – Gastrointestinal symptoms within 24 hours viscera of Dungeness crab and anchovies – Neurological symptoms within 48 hours • Range: Northeast and northwest North America • Symptoms: – Gastrointestinal: vomiting, diarrhea, vomiting – Neurological: confusion, memory loss, disorientation, seizure coma

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Food Toxicology Food Toxicology Amnesic Shellfish Poisoning Amnesic Shellfish Poisoning • Duration: • FDA guideline: – Self-limiting within several days – 20 ppm domoic acid in all fish – Short-term memory loss can be permanent – 30 ppm domoic acid in viscera of Dungeness crab • Control: • Outbreaks: – HPLC laboratory procedure 1987: Prince Edward – Obtain shellfish from approved waters Island, Canada (mussels) – Monitoring of coastal water and shellfish – 156 cases, 3 deaths, 12 with permanent short-term memory loss 1991: Washington state (razor clams) – 24 cases

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•9 Food Toxicology Food Toxicology Fugu (Puffer Fish) Poisoning Tetrodotoxin • Porcupine fish, ocean sun fish, puffer fish • Japan – Incidence ↓ Puffer fish – Training cooks – chicken? – Sense of exhilaration and euphoria – Paraesthesia

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Food Toxicology Food Toxicology Tetrodotoxin Tetrodotoxin • Tetrodotoxin • Source: – Highest in liver, gonads – Gonads, liver, intestines, and skin of about 80 species of – Potent sodium channel blocker puffer fish, blowfish or fugu • Signs within 15 minutes – Also found in the California newt, parrotfish, frogs – Paraesthesia (Atelopus genus), blue-ringed octopus, starfish, octopus, –Nausea and xanthid crabs – Respiratory paralysis

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Food Toxicology Food Toxicology Tetrodotoxin Tetrodotoxin • Range: • Onset: 20 minutes to 3 hours – Primarily the Indo-Pacific Ocean • Initial symptoms: numbness of the lips and tongue – Other cases and deaths have occurred from puffer fish from • Secondary symptoms: prickling of the face and the Atlantic Ocean, Gulf of Mexico, and Gulf of California extremities, a sensation of lightness or floating, headache, epigastric pain, nausea, diarrhea and/or vomiting • Tertiary symptoms: increasing paralysis and death within 4-6 hours

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•10 Food Toxicology Food Toxicology Tetrodotoxin Tetrodotoxin Outbreaks • Control: • Japan: – Mouse bioassay – 1974-1983, 646 cases, 179 deaths –HPLC method – 30-100 persons per year mostly from home preparation and – Do not eat pufferfish or avoid improperly prepared pufferfish consumption • FDA guideline: – Mortality about 50% – Puffer fish may not be • California: imported except under – 1996, 3 cases, no deaths specific authorization from FDA

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Food Toxicology Food Toxicology Case Study: Puffer Fish Consumption, 2002 Gempylotoxin • On March 18, a woman aged 65 years was brought to the • Toxin: a strong purgative oil contained in the flesh hospital by her husband. • Hours earlier, they had eaten a meal of pufferfish caught in and bones of specific species Titusville, FL. Several minutes after eating the fish, both • Source: Gemplids, escolars or pelagic mackerels persons experienced tingling around their lips. • During the next 2 hours, the woman's symptoms worsened, (escolar; oilfish, castor oil fish or purgative fish; and she developed vomiting. snek; ‘Ex-Lax fish’) 18-21% oil (waxy esters) • The woman developed increasing chest pain and had mild tachycardia and blood pressure of 160/70 mmHg; she was • Range: almost worldwide treated with topical nitroglycerine. • During the next 4--6 hours, she developed an ascending muscular paralysis. A test of her respiratory function indicated carbon dioxide retention and a rapid decrease to <20% of normal vital capacity for a woman her age. She was electively intubated and placed on a ventilator. Over the next day, she regained her reflexes and voluntary movement. Escolar • She was extubated at approximately 72 hours and discharged. 63 MMWR (2002) 51(15);321-3 Price

Food Toxicology Food Toxicology Gempylotoxin Pfiesteria Complex Organisms (PCO) • Symptoms: diarrhea, generally without pain or • Pfiesteria piscicida discovered in 1988 cramping; ½ to 36 hrs • Phytoplankton (dinoflagellate) – “Keriorrhoea" caused by the wax esters may include oily – Up to 24 life stages (4 may be toxic) orange diarrhea, discharge, or leakage from the rectum that – Eats other organisms, usually algae may smell of oil. • Control: avoid specific fish species • FDA guideline: escolar should not be imported • Outbreaks: California, 8+ cases, March 2000

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•11 Food Toxicology Food Toxicology Pfiesteria Blooms Feeding • Pfiesteria may produce toxins that numb fish, allowing the microbes to feed on the fish – 2002 micro-predation research • High concentrations of Pfiesteria can cause deep lesions on fish and may kill them • Blooms usually exist for only a few hours – Several massive fish kills in along coastal North Carolina 67 Price 68

Food Toxicology Pfiesteria • No cases of seafood-borne illness have been reported • Human health effects have occurred in laboratories where researchers were working in close proximity to high concentrations of the • Anglers, water skiers, fish-kill monitors have complained of skin lesions, headaches, lightheadedness, short-term memory loss • Avoidance recommended

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