Abstract
Introduction
Palytoxin (PTX) is considered a severe marine toxin. Although rare, reports of human exposure from consumption of PTX have described significant morbidity and mortality. PTX is the suspected agent in Haff disease, in which rhabdomyolysis occurs within 24 h of eating contaminated fish such as buffalo fish. PTX is primarily present in soft corals or in dinoflagellates, and it can contaminate crustaceans and other fish as it bioaccumulates up the food chain. Only 23 cases have been reported in the USA, including two recent cases in New York City. Reports of inhalational exposure to PTX are uncommon.
Case Reports
We describe a case series of six patients, including four adults and two children, with inhalational exposure to PTX aerosolized from Palythoa corals. Their symptoms included some degree of respiratory involvement, myalgias, paresthesias, low-grade fevers, and gastrointestinal symptoms. Fortunately, there were no serious outcomes and all patients survived without sequelae.
Discussion
Although rare, exposure to palytoxin is not restricted to people visiting marine environments because of Palythoa coral in some home aquariums. Routes of exposure go beyond consumption of fish that feed on the coral and include dermal as well as inhalational exposure. Palytoxin exposure should be considered in the differential diagnosis of patients who own or work with fish tanks and present with symptoms that include respiratory complaints, myalgias, neuromuscular dysfunction, hemolysis, and cardiac toxicity. There is no known antidotal therapy and treatment should focus on meticulous supportive care.
This is a preview of subscription content, log in via an institution to check access.
References
Nicolaou KC, Frederick MO, Aversa RJ (2008) The continuing saga of the marine polyether biotoxins. Angew Chem Int Ed Engl 47(38):7182–7225
Deeds JR, Handy SM, White KD, Reimer JD (2011) Palytoxin found in Palythoa sp. zoanthids (Anthozoa, Hexacorallia) sold in the home aquarium trade. PLOSone 6(4):e18235
Moore RE, Scheuer PJ (1971) Palytoxin: a new marine toxin from a coelenterate. Science 172:495–498
Khoo HE (2002) Bioactive proteins from stonefish venom. Clin Exp Pharmacol Physiol 29:802–806
Shinzato T, Furusu A, Nishino T, Abe K, Kanda T, Maeda T et al (2008) Cowfish (Umisuzume, Lactoria diaphana) poisoning with rhabdomyolysis. Intern Med 47:853–856
Deeds JR, Schwartz MD (2010) Human risk associated with palytoxin exposure. Toxicon 56:150–162
Tubaro A, Durano P, Del Favero G, Ansaldi F, Icardi G, Deeds JR et al (2011) Case definitions for human poisonings postulated to palytoxins exposure. Toxicon 57:478–495
Frelin C, Vigne P, Breittmayer JP (1990) Palytoxin acidifies chick cardiac cells and activates the Na+/H+ antiporter. FEBS Lett 264(1):63–66
Gounder P, Balter S (2011) Advisory #26, Haff disease: rhabdomyolysis associated with fish Consumption, NYC DOH and MH
Tichadou L, Glaizal M, Armengaud A, Grossel H, Lemee R, Kantin R et al (2010) Health impact of unicellular algae of the Ostreopsis genus blooms in the Mediterranean Sea: experience of the French Mediterranean coast surveillance network from 2006 to 2009. Clin Tox 48(8):839–844
Okana H, Masouka H, Kamel S, Seko T, Koyabu S, Tsuneoka K et al (1998) Rhabdomyolysis and myocardial damage induced by palytoxin, a toxin of blue humphead parrotfish. Inter Med 37(3):330–333
Kodama AM, Hokama Y, Yasumoto T, Fukui M, Manea SJ, Sutherland N (1989) Clinical and laboratory findings implicating palytoxin as cause of ciguatera poisoning due to Decapterus macrosoma (mackerel). Toxicon 27(9):1051–1053
Shinzato T, Furusu A, Nishino T, Abe K, Kanda T, Maeda T et al (2008) Cowfish (Umisuzume, Lactoria diaphana) poisoning with rhabdomyolysis. Inter Med 47:853–856
Hoffmann K, Hermanns-Clausen M, Buhl C, Buchler MW, Schemmer P, Mebs D et al (2008) A case of palytoxin poisoning due to contact with zoanthid corals through a skin injury. Toxicon 51:1535–1537
Durando P, Ansaldi F, Oreste P, Moscatelli P, Marensi L, Grillo C, Collaborative Group for the Ligurian Syndromic Algal Surveillance et al (2007) Ostreopsis ovata and human health: epidemiological and clinical features of respiratory syndrome outbreaks from a two-year syndromic surveillance, 2005–06, in north-west Italy. Euro Surveill 12(23):pii=3212
Snoeks L, Veenstra J (2012) Family with fever after cleaning a sea aquarium. Ned Tijdschr Geneeskd 156(12):A4200
Hilgemann DW (2003) From a pump to a pore: how palytoxin opens the gates. PNAS 100(2):386–388
Artigas P, Gadsby DC (2003) Na+/K+-pump ligands modulate gating of palytoxin-induced ion channels. PNAS 100(2):501–505
Hobbs AS, Albers RW, Froehlich JP (1980) Potassium-induced changes in phosphorylation and dephosphorylation of (Na+ + K+)-ATPase observed in the transient state. J Biol Chem 255(8):3395–3402
Tosteson MT, Halperin JA, Kishi Y, Tosteson DC (1991) Palytoxin induces an increase in the cation conductance of red cells. J Gen Physiol 98(5):969–985
Ito K, Karaki H, Urakawa N (1977) The mode of contractile action of palytoxin on vascular smooth muscle. Eur J Pharm 46:9–15
Frelin C, Renterghem CV (1995) Palytoxin. Recent electrophysiological and pharmacological evidence for several mechanisms of action. Gen Pharm 26(1):33–37
Yoshizumi M, Houchi H, Ishimura Y, Masuda Y, Morita K, Oka M (1991) Mechanism of palytoxin-induced Na+ influx into cultured bovine adrenal chromaffin cells: possible involvement of Na+/H+ exchange system. Neurosci Lett 130:103–106
Conflict of interest
The authors have no conflicts of interest
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sud, P., Su, M.K., Greller, H.A. et al. Case Series: Inhaled Coral Vapor—Toxicity in a Tank. J. Med. Toxicol. 9, 282–286 (2013). https://doi.org/10.1007/s13181-013-0307-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13181-013-0307-x