Palytoxin

Epidemiology

History

  • Palytoxin Poisoning was Originally Reported in Hawaii

Incidence

  • Difficult to Estimate the True Incidence of Palytoxin, Given the Co-Occurrence of Palytoxin with Other Marine Toxins (Ciguatoxins, Saxitoxins, and Tetrodotoxin) (Toxicon, 2010) [MEDLINE]
    • Approximately 171 Cases (Inhalational or Dermal Toxicity) were Reported in the US Via the National Poison Data System Between 2000-2014 (Environ Toxicol Pharmacol, 2017) [MEDLINE]

Exposures

  • Dermal Exposure
    • Skin Contact with Corals Which Elaborate the Toxin
      • Cases Have Been Reported (Environ Toxicol Pharmacol, 2017) [MEDLINE]
  • Ingestion-Related Exposure
    • Ingestion of Fish/Crabs/Shellfish Which Have Fed on Palytoxin-Containing Algae or Coral
      • Clinical Symptoms Following the Ingestion of Fish/Crabs/Shellfish Have Been Described (Toxicon, 2010) [MEDLINE]
  • Inhalational Exposure
    • Inhalation of Aerosols from the Cleaning of Home Aquariums Containing Soft Corals
      • Cases Have Been Reported in Association with Zoanthid Corals in Aquariums in Alaska (MMWR Morb Mortal Wkly Rep, 2015) [MEDLINE]
    • Inhalation of Sea Air
      • Cases Have Been Reported Following Algal Blooms in Italy (Anal Chem, 2006) [MEDLINE]
  • Ocular Exposure
    • Ocular Contact with Hands After Touching Corals Which Elaborate the Toxin
      • Ocular Manifestations Due to Exposure Have Been Described (Arch Ophthalmol, 2010) [MEDLINE]

Physiology

Palytoxin

  • Palytoxin is Formed by the Microalgae (Ostreopsis Ovate, Ostreopsis Siamensis), Corals, and Sea Anemones
    • Palytoxin was First Isolated from the Zoanthid Coral, Palythoa Toxica
    • Palytoxin is One of the Most Potent Toxins Known (Environ Toxicol Pharmacol, 2017) [MEDLINE]
    • In Animal Models, Palytoxin Has Been Found to Be Most Toxic Via Intravenous, Intraperitoneal, and Intratracheal Exposures and of Lesser Toxicity Via Dermal and Ocular Exposures
  • Palytoxin Binds to and Disables the Sodium/Potassium ATPase Pump
    • Efflux of Potassium
    • Influx of Calcium
    • Membrane Depolarization

Diagnosis

  • Predominantly Historical

Clinical Manifestations

Cardiovascular Manifestations

Dermatologic Manifestations

Gastrointestinal Manifestations

Hematologic Manifestations

Neurologic Manifestations

Ophthalmologic Manifestations

Pulmonary Manifestations

Rheumatologic Manifestations

Other Manifestations


Treatment

Supportive Care


Prognosis

  • Mortality Rate: may be as high as 10% (Toxicon, 2010) [MEDLINE]

References

  • The Genoa 2005 outbreak. Determination of putative palytoxin in Mediterranean Ostreopsis ovata by a new liquid chromatography tandem mass spectrometry method. Anal Chem. 2006;78(17):6153 [MEDLINE]
  • 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. 2007;12(6):E070607.1. Epub 2007 Jun 7 [MEDLINE]
  • Human risk associated with palytoxin exposure. Toxicon. 2010;56(2):150. Epub 2009 Jun 6 [MEDLINE]
  • Aquarium coral keratoconjunctivitis. Arch Ophthalmol. 2010;128(10):1360 [MEDLINE]
  • Palytoxin poisoning after dermal contact with zoanthid coral. J Emerg Med. 2011;40(4):397. Epub 2009 Jul 9 [MEDLINE]
  • Aquarism: an innocent leisure activity? Palytoxin-induced acute pneumonitis. Respiration. 2012;84(5):436. Epub 2012 Jun 29 [MEDLINE]
  • Case series: inhaled coral vapor–toxicity in a tank. J Med Toxicol. 2013;9(3):282 [MEDLINE]
  • Suspected Palytoxin Inhalation Exposures Associated with Zoanthid Corals in Aquarium Shops and Homes – Alaska, 2012-2014. MMWR Morb Mortal Wkly Rep. 2015;64(31):852 [MEDLINE]
  • Prevalence and characteristics of inhalational and dermal palytoxin exposures reported to the National Poison Data System in the U.S. Environ Toxicol Pharmacol. 2017;55:107. Epub 2017 Aug 18 [MEDLINE]
  • Corneal Toxicity Associated With Aquarium Coral Palytoxin. Am J Ophthalmol. 2017;174:119. Epub 2016 Oct 25 [MEDLINE]
  • Palytoxin-induced acute respiratory failure. Respir Med Case Rep. 2017;20:4. Epub 2016 Oct 21 [MEDLINE]