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Shell Fish Neurological Poisoning

机译：贝类鱼神经中毒

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Introduction Bivalve mollusks (mussels, clams, oysters and scallops)are the usual groups associated with shell fish related poisoning. These shell fish are filter feeders and accumulate toxins produced by microscopic algae in the form of diatoms and dinoflagellates. Four distinctive neurologic syndromes – paralytic shell fish poisoning (psp), neurologic shell fish poisoning (nsp), diarroheal shell fish poisoning (dsp) and amnesic shell fish poisoning (asp) have been identified. water soluble, Heat and acid stabile toxins not inactivated by ordinary cooking methods called saxitoxin (psp), brevetoxin (nps), okadaic acid (dsp) and domoic acid (asp) have been identified. Sporadic outbreaks are reported in Europe, Asia, Africa and pacific islands. Red tide and resultant massive kills of various bird and marine animals have become an enormous concern. In addition, infectious agents like hepatitis a, Norwalk virus, vibrio parahemolyticus and vibrio vulnificus can also be transmitted through shell fish ingestion.Mortality rates in psp and asp vary from 1-12%,nsp and dsp have none. Clinical features start within 15 minutes to 18 hours after ingestion. PSP presents with distal and facial paraesthesias followed by varying degrees of paralysis, ataxia and cranial nerve dysfunction. Occasionally diarrhea is associated. Death is usually due to respiratory failure in the first 12 hours. PSP usually lasts 3 days although paralysis may persist for several weeks.NSP is milder with more prominent sensory symptoms – paraesthesias of face, trunk, limbs, reversal of hot and cold sensations, myalgias, ataxia, tremors but with less paralysis.allergic manifestations like urticaria,bronchospasm may predominate.DSP presents with short duration diarrheal illness. Only one outbreak of asp in 1987 has been reported. They present with short term memory loss with rare permanent defects although in severe cases ophthalmoplegia, seizures and coma with death in 3% have been reported.Diagnosis of these cases is based predominantly on clinical features with a temporal relation to shell fish ingestion. enzyme linked immunosorbent assay and liquid chromatography of saxi and brevotoxins can de undertaken in some advanced laboratories. Therapy is supportive with activated charcoal, monitoring of respiratory functions, oxygen and ventilation if needed.;Case report A 35 year old Indian working as a poultry farmhand presented with a history of having consumed shellfish (about 200gms)along with six of his colleagues 10 hours prior. 3 hours later he developed severe vomiting associated with dizziness, heaviness of speech, weakness and instability of the body. He found that he could not sit or stand without any support.There was no h/o headache, loss of consciousness, cranial nerve or sensory symptoms. There was no h/o fever, diarrhea, rashes or dyspnea. No prior such episodes were noted. There were no significant systemic illnesses or addictions. On examination he was conscious, oriented dysarthric with bilateral gross cerebellar signs. Th fundi were normal. No other deficits were noted.Routine blood and biochemistry and ct brain was normal.Arterial blood gas showed ph 7.4 , po2 78 mm hg, pco2 41.1 mm hg, hco3 25 mmol/l, base excess 0.2, oxygen saturation 96%. An hour later, three of his colleagues who shared the meal presented with the same symptoms, One in the same intensity with gross bilateral cerebellar signs, abg showing ph 7.41, po2 81.1 mm hg, pco2 40.8 mm hg, hco3 25.3 mmol/l, base excess 0.7, oxygen saturation 96%. and two milder with minimal ataxic signs, abg showing ph 7.41, po2 103.9 mm hg, pco2 41.3 mm hg, hco3 25.7 mmol/l, base excess 1, oxygen saturation 98% and ph 7.38, po2 110.4 mm hg, pco2 40 mm hg, hco3 23 mmol/l,base excess -1.6, oxygen saturation 98%. They were treated with iv dextrose saline, 24% nasal oxygen and activated charcoal 50 gm 8 hourly. Arterial blood gases normalized by the second day. Clinically, they made remarkable improvement and by
机译：简介双壳类软体动物（贻贝，蛤，牡蛎和扇贝）是与贝类鱼中毒有关的常见群体。这些贝类鱼类是过滤器的食料，并积聚了微观藻类以硅藻和鞭毛藻形式产生的毒素。已经确定了四种独特的神经系统综合症-麻痹性贝类中毒（psp），神经性贝类中毒（nsp），腹泻性贝类中毒（dsp）和遗忘性贝类中毒（asp）。已经确定了通过普通烹饪方法不能杀死的水溶性，热和酸稳定毒素，这些烹饪方法称为毒蛇毒素（psp），短毒素（nps），冈田酸（dsp）和多聚酸（asp）。据报道欧洲，亚洲，非洲和太平洋岛屿都有零星的暴发。赤潮和由此造成的各种鸟类和海洋动物的大量杀害已成为人们的极大关注。此外，甲型肝炎，诺沃克病毒，副溶血性弧菌和创伤弧菌等传染性病原也可通过摄食贝类鱼传播。psp和asp的死亡率在1-12％之间，nsp和dsp则没有。摄入后15分钟至18小时内开始出现临床特征。 PSP表现为远端和面部感觉异常，随后出现不同程度的瘫痪，共济失调和颅神经功能障碍。偶有腹泻。死亡通常是由于头12小时内的呼吸衰竭所致。 PSP通常持续3天，尽管麻痹可能会持续数周。NSP较轻，具有较明显的感觉症状-面部，躯干，四肢感觉异常，冷热感觉相反，肌痛，共济失调，震颤，但麻痹较少。荨麻疹，支气管痉挛可能占主导地位。DSP表现为短期腹泻病。据报道，1987年仅爆发了一次asp。尽管有严重的眼肌麻痹，癫痫发作和昏迷，但有3％的死亡报告，它们具有短期记忆丧失和罕见的永久性缺陷。这些病例的诊断主要基于与贝类食物摄入有关的临床特征。酶联免疫吸附测定和沙西毒素和短毒素的液相色谱法可以在一些高级实验室中进行。活性炭支持治疗，必要时监测呼吸功能，氧气和通气。病例报告一名35岁的印度人作为家禽农场主，曾有过食用贝类（约200克）的历史，并有6位同事10小时之前。 3小时后，他出现剧烈呕吐，伴有头晕，言语沉重，身体虚弱和不稳定。他发现没有任何支撑就无法坐着或站着，没有头痛，意识丧失，颅神经或感觉症状。没有发烧，腹泻，皮疹或呼吸困难。之前没有发现此类发作。没有明显的全身性疾病或成瘾。经检查，他有意识的定向性肌动异常，有双侧小脑总体征。眼底正常。没有发现其他缺陷，常规血液和生化指标以及ct脑均正常，动脉血气显示ph 7.4，po2 78 mm hg，pco2 41.1 mm hg，hco3 25 mmol / l，碱过量0.2，氧饱和度96％。一个小时后，他的三位共享餐的同事出现了相同的症状，其中一位出现了严重的双侧小脑体征，其abg显示了ph值7.41，po2 81.1 mm hg，pco2 40.8 mm hg，hco3 25.3 mmol / l，碱过量0.7，氧饱和度96％。和两个温和且具有最小共生征象的abg，显示ph值7.41，po2 103.9 mm hg，pco2 41.3 mm hg，hco3 25.7 mmol / l，碱过量1，氧饱和度98％，ph值7.38，po2 110.4 mm hg，pco2 40 mm hg ，hco3 23 mmol / l，碱过量-1.6，氧饱和度98％。他们每小时静脉注射右旋葡萄糖盐水，24％鼻氧和活性炭50克。第二天动脉血气恢复正常。在临床上，他们取得了显著进步，

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