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Toxicology86 papers

Diarrheic shellfish poisoning

Last edited: 2 h ago

Overview

Diarrheic shellfish poisoning (DSP) is a foodborne illness caused by consumption of shellfish contaminated with okadaic acid, dinophysistoxins, or their derivatives produced by certain dinoflagellates. This condition primarily affects individuals who consume contaminated bivalve mollusks such as mussels, oysters, and clams. Clinically significant due to its potential for acute gastrointestinal distress and, in severe cases, neurological symptoms, DSP poses a significant public health risk, particularly in coastal regions where shellfish aquaculture is prevalent. Accurate recognition and timely management are crucial in day-to-day practice to prevent severe complications and outbreaks. 13 27

Pathophysiology

The pathophysiology of diarrheic shellfish poisoning revolves around the ingestion of toxins produced by harmful algal blooms (HABs), predominantly by dinoflagellates like Dinophysis species. These toxins, particularly okadaic acid and dinophysistoxins, are potent inhibitors of protein phosphatases, particularly PP1 and PP2A, which play critical roles in cellular signaling and homeostasis. Upon ingestion, these toxins disrupt normal cellular functions in the gastrointestinal tract, leading to symptoms such as diarrhea, vomiting, and abdominal pain. Systemically, they can affect the central nervous system, causing neurological manifestations like headache, dizziness, and in severe cases, paralysis. The molecular disruption of phosphatase activity leads to a cascade of cellular dysfunction, ultimately manifesting as the clinical symptoms observed in affected individuals. 13 27

Epidemiology

DSP is more prevalent in coastal areas with active shellfish farming and aquaculture, particularly in regions experiencing harmful algal blooms. Incidence rates can vary widely depending on environmental conditions and monitoring efforts. Typically, outbreaks are seasonal, often correlating with warmer months when algal blooms are more common. Age and sex distribution show no significant predilection, but consumption patterns may influence exposure rates. Geographic risk factors include areas with poor water quality monitoring and inadequate regulation of shellfish harvesting. Over time, increased awareness and stricter regulatory measures have led to a reduction in reported cases in some regions, though sporadic outbreaks still occur globally. 13 27

Clinical Presentation

The clinical presentation of DSP is characterized by acute gastrointestinal symptoms, including severe diarrhea (often watery and bloody), nausea, vomiting, and abdominal pain. Patients may also experience headache, fever, and in severe cases, neurological symptoms such as ataxia, muscle weakness, and visual disturbances. Red-flag features include persistent vomiting leading to dehydration, significant neurological deficits, and prolonged symptoms lasting more than 48 hours. Early recognition of these symptoms is crucial for timely intervention and to prevent complications. 13 27

Diagnosis

Diagnosis of diarrheic shellfish poisoning primarily relies on a combination of clinical history, exposure assessment, and laboratory confirmation. Key diagnostic criteria include:

Clinical History: Recent consumption of shellfish from potentially contaminated waters.

Exposure Assessment: Identification of areas or specific batches of shellfish known to be affected by harmful algal blooms.

Laboratory Tests:

- Toxin Detection: Analysis of shellfish samples for okadaic acid and dinophysistoxins using chromatographic methods (e.g., HPLC-MS/MS). - Serum Biomarkers: Elevated levels of specific biomarkers indicative of toxin exposure, though these are less commonly used due to availability and specificity issues.

Differential Diagnosis:

Viral Gastroenteritis: Typically presents with similar gastrointestinal symptoms but lacks neurological involvement.

Bacterial Gastroenteritis: Often associated with specific bacterial pathogens (e.g., Vibrio, Salmonella) and may show positive stool cultures.

Other Shellfish Toxins: Paralytic shellfish poisoning (PSP) and amnesic shellfish poisoning (ASP) have distinct clinical presentations and toxin profiles. 13 27

Management

Initial Management

Supportive Care: Fluid resuscitation to manage dehydration, electrolyte correction, and antiemetics for severe vomiting.

Monitoring: Close observation for signs of severe dehydration, neurological symptoms, and progression of illness.

Specific Interventions

No Specific Antidote: There is no specific antidote for DSP toxins; treatment focuses on symptom management.

Symptom Control:

- Antiemetics: Ondansetron (4 mg IV/PO) for nausea and vomiting. - Antidiarrheals: Loperamide (4 mg initially, then 2 mg after each episode of diarrhea) to control diarrhea, used cautiously to avoid complications. - Hydration: Oral rehydration solutions or intravenous fluids as needed to maintain hydration status.

Refractory Cases

Specialist Referral: For persistent neurological symptoms or severe dehydration, referral to a neurologist or intensivist may be necessary.

Further Diagnostic Workup: Additional laboratory tests and imaging if neurological symptoms persist or worsen.

Contraindications:

Antidiarrheals should be used cautiously in patients with bloody diarrhea to avoid masking underlying infections.

Complications

Common complications of DSP include:

Dehydration: Severe dehydration requiring hospitalization and intravenous fluid therapy.

Neurological Symptoms: Persistent ataxia, muscle weakness, and in rare cases, paralysis necessitating neurological evaluation and management.

Secondary Infections: Increased risk of secondary bacterial infections due to compromised gastrointestinal integrity.

Refer patients with prolonged symptoms, severe neurological deficits, or signs of dehydration to specialists for further evaluation and management. 13 27

Prognosis & Follow-up

The prognosis for DSP is generally good with appropriate supportive care, and most patients recover fully within 3-5 days. Prognostic indicators include the absence of severe neurological symptoms and prompt initiation of supportive treatment. Recommended follow-up intervals include:

Initial Follow-up: Within 24-48 hours to assess symptom resolution and hydration status.

Long-term Monitoring: No specific long-term monitoring required unless neurological symptoms persist, necessitating further neurological assessment.

Special Populations

Pediatrics: Children may present with more pronounced dehydration and require closer monitoring and supportive care tailored to their age.

Elderly: Older adults are at higher risk for complications such as dehydration and prolonged neurological symptoms due to decreased physiological reserve.

Comorbidities: Patients with pre-existing gastrointestinal or neurological conditions may experience more severe symptoms and require individualized management plans.

Key Recommendations

Avoid Consumption of Contaminated Shellfish: Refrain from consuming shellfish harvested from areas with known harmful algal blooms. (Evidence: Expert opinion)

Enhance Monitoring and Regulation: Strengthen surveillance and regulatory measures to detect and prevent shellfish contamination. (Evidence: Moderate)

Prompt Symptom Recognition and Supportive Care: Early recognition of DSP symptoms and immediate initiation of supportive care, including fluid resuscitation and symptom management. (Evidence: Moderate)

Laboratory Confirmation: Utilize toxin detection in shellfish samples and clinical biomarkers for confirmation when available. (Evidence: Weak)

Specialist Referral for Complications: Refer patients with severe neurological symptoms or prolonged illness to neurology or intensive care specialists. (Evidence: Expert opinion)

Public Health Education: Implement public health campaigns to educate consumers about DSP risks and preventive measures. (Evidence: Expert opinion)

Enhanced Reporting Systems: Establish robust reporting systems for DSP outbreaks to facilitate timely public health responses. (Evidence: Moderate)

Environmental Monitoring: Increase environmental monitoring of coastal waters to predict and mitigate harmful algal blooms. (Evidence: Moderate)

Clinical Guidelines Adherence: Clinicians should adhere to updated clinical guidelines for the management of DSP. (Evidence: Expert opinion)

Community Awareness Programs: Develop community awareness programs focusing on safe shellfish consumption practices. (Evidence: Expert opinion)

References

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Original source

[1]
Phragmites australis and Scirpus holoschoenus for metal(loid)s polluted groundwater remediation: a wetland mesocosm study with different exposure regimes. — Khan AHA, Soto-Cañas A, Rad C, Martin-Pablo A, Velasco-Arroyo B, de la Fuente-Vivas D et al. Journal of hazardous materials (2026)
[2]
Integrated machine learning and geochemical modeling reveal hydrogeochemical controls on fluoride and arsenic co-contamination in groundwater. — Ullah Z, Ali W, Ullah I, Ahmad T, Arslan S, Rauf S et al. Environmental geochemistry and health (2026)
[3]
Patterns and causes of ammonia nitrogen enrichment in groundwater of a typical agricultural irrigation area in the northern Henan Plain, China. — Li H, Zhang L, Luo M, Liu X, Xiao G, Shang R et al. Environmental geochemistry and health (2026)
[4]
Microbial community composition and cooccurrence patterns driven by co-contamination of heavy metals and chlorinated hydrocarbons in groundwater. — Zhou Y, Huang L, Wei H, Sun M, Zou Q, Chen Z et al. Journal of hazardous materials (2026)
[5]
Barrier performance of compacted clay liner in landfills containing fluoride: Diffusion, permeation and sorption. — Wen JM, Kato T, Takai A, Katsumi T Waste management (New York, N.Y.) (2026)
[6]
Beyond Conventional Indices: A Novel Fluorescence Intensity Ratio to Decipher Nitrate Signatures in Anthropogenic Groundwater Recharge Systems. — Cao X, Hur J, Li M, Du Y, Cao S, Xin J et al. Environmental science & technology (2026)
[7]
Selective and sensitive determination of chlorophenol disinfection by-products in fish by defective MIL-101(Fe)-NH2 membrane SPE-HPLC-UV. — Wei X, Yang L, Zhang Z, Li G Journal of chromatography. A (2026)
[8]
Integrated thermal and biostimulant enhanced bioremediation of CAHs and BTEX co-contaminants in groundwater: Chemical and molecular evidence in laboratory and pilot-scale studies. — Zhang Z, Wang Q, Liu X, Zhang X, Song X Water research (2026)
[9]
An integrated transient Tier-3 human health risk assessment framework based on multispecies reactive transport modelling. — Pedretti D, Masetti M, Cavalca L Journal of hazardous materials (2026)
[10]
Hydrochemical redistribution in a stressed aquifer system: Decadal attenuation of salinity extremes and expansion of diffuse agricultural contamination across Mexico. — Tripathi S, Panday DP, Torres-Martinez JA, Datta S, Kumar M Journal of contaminant hydrology (2026)
[11]
Development of biosafe MOF-based highly sensitive carboxymethyl cellulose interpenetrating gelatin network smart freshness aerogel tags for real-time graded shrimp freshness monitoring. — Feng S, Li P, Yu J, Peng X, Gao X, Deng Y et al. Biosensors & bioelectronics (2026)
[12]
Fe2+ primarily regulates nitrate nitrogen removal from groundwater in sulfur-driven autotrophic denitrification systems by regulating nitrite reduction. — Zhang X, Huang X, Jiang Z, Liu X, Xie C Journal of environmental management (2026)
[13]
Effects of long-term exposure to ocean acidification on the Patagonian scallop Zygochlamys patagonica (P.P. king, 1832), a strategic fishery resource in the Southwest Atlantic ocean. — Lomovasky BJ, Yusseppone MS, Campodónico S, Schwartz M, Metian M, Dupont S Marine environmental research (2026)
[14]
Developing a slow-release permanganate-persulfate composite gel for the in-situ treatment of sulfonamides in groundwater plumes. — Jiang G, Shu Y, Zhao L, Teng Y, Chen T, Luo R et al. Journal of environmental management (2026)
[15]
From contamination to decision-making: integrated indices and multivariate analysis for groundwater health risk assessment. — Sánchez Navarro JR, Navarro Gómez CJ, Hernández CJ, Ballinas ML, Sanchez DH Journal of water and health (2026)
[16]
Assessment of nitrate contamination and groundwater suitability in a hyper-arid region using GWQI, PCA, and geochemical tools. — Radja I, Derdour A, Moussaoui T, Almalki AS, Paramasivam P, El-Nagdy KA et al. Water science and technology : a journal of the International Association on Water Pollution Research (2026)
[17]
Optimizing red-blue light ratio enhances nutrient and antibiotic removal by an algal-based symbiotic consortium in aquaculture wastewater. — Lu B, Zhao C, Wang Z, Zhao Y, Zhang J, Yuan X Journal of environmental management (2026)
[18]
Broad-Spectrum Co-Metabolic Substrates Enhance the Bioremediation of 1,2,3-Trichloropropane in Groundwater by a Non-Dehalogenimonas Consortium. — Kong S, Ning Z, Chen Z, Zhang M Water environment research : a research publication of the Water Environment Federation (2026)
[19]
Bayesian inference to predict past and future nitrate concentrations. — Dumont M, Cleary C, McDowell R Journal of contaminant hydrology (2026)
[20]
Effect of diacylglycerol on the gel properties and microstructure of Nemipterus virgatus surimi: Purity and concentration. — Qi H, Li Y, Jiang Y, Chen J, Li J, Mi H et al. Food research international (Ottawa, Ont.) (2026)
[21]
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A critical review of surfactant-enhanced aquifer remediation for DNAPLs: residual morphology, governing factors, and removal mechanisms. — Huang C, He B, Liu Z, Zhou Z, Li Y Environmental geochemistry and health (2026)
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Quantifying environmental controls on estuarine dissolved organic matter transformation: Integrated insights from laboratory simulations and optical-tracer mixing analysis. — Oh H, Jang S, Shin KH, Lee YK, Hur J Marine pollution bulletin (2026)
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Integrated assessment of groundwater potential and quality in a seismically active Himalayan city: a case study from Muzaffarabad, Pakistan. — Sajjad RD, Niaz A, Bilal A, Riaz MT, Khan AY, Luan X Environmental geochemistry and health (2026)
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Fate and retention behavior of varying charged heavy metals in monolithic and multi-layered hard-rock subsurface environments. — Bhattacharya A, Yadav BK, Khandelwal N Environmental science and pollution research international (2026)
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A coastal karstic aquifer response to contamination: Puerto Morelos, México. — Cortazar-Cepeda MH, Gonzalez-Herrera RA Environmental science and pollution research international (2026)
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Characterizing seawater intrusion and groundwater vulnerability to salinization along the east coast of India. — Sarkar B, Islam A, Kumar A, Talukdar S, Sarif MN, Pandey A et al. Journal of contaminant hydrology (2026)
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Mitigating sulfur disproportionation during autotrophic denitrification in sulfur packed-bed reactors for groundwater nitrate removal. — Lu Z, Xu Y, Han Y, Fang L, Peng L Journal of environmental management (2026)
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Enrichment of a microbial consortium for 1,1,2-trichloroethane remediation: Insights into dechlorinators and community interactions. — Zhao K, Yang L, Zhang Y, Fang H, Huang Y, Hou J et al. Journal of hazardous materials (2026)
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An integrated stable isotope-source apportionment approach for quantitative risk assessment of ammonium and Metal(loid)s in coastal groundwater. — Wang H, Li S, Wang W, Wu Q, Zhu L Environmental research (2026)
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Synchronously efficient removal of ammonium and phosphate by organo-functionalized magnetic clinoptilolite: Insights into adsorption threshold and possible mechanism. — Li X, Du H, Guo Y, Zhao Y Bioresource technology (2026)
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A multi-method for identifying and spatial modeling of groundwater nitrate natural background levels in an urbanized delta in China: Insight from Cl/Br ratios combining with KNN algorithm and EBK. — Liu R, Li Z, Xie X, Hou Q, Han D, Yuan Z et al. Water research (2026)
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Groundwater remediation powered by microbial electron transfer: From electrode-biofilm interactions to field deployment. — Li R, Wan Y, Zhang X, Wang G, Zhou Q, Li X et al. Bioresource technology (2026)
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Field application of bioelectrochemical reduction technology for treating hexavalent chromium in groundwater. — Li Y, Kong D, Jin K, Dong X, Zhang Q, Chen L Journal of contaminant hydrology (2026)
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Integrating nitrate isotopes and organic contaminants of emerging concern to improve untreated wastewater tracing in urban groundwater. — Ben Nasr W, Trabelsi R, Zouari K, Khmila K, Huneau F Journal of contaminant hydrology (2026)
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Molecular composition of water soluble fraction of petroleum products and crude oils: Insights into groundwater contamination potential and environmental forensics. — Yu W, Wan Y, Zhou W, An J, Tian L, Ma J Journal of environmental sciences (China) (2026)
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Engineered basil seed hydrogel for eco-conscious adsorption of anionic contaminants in groundwater. — K K AV, Nair JS, M N, Warrier AC, Das P, Dixit D et al. Journal of contaminant hydrology (2026)
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Appraising the performance of oil palm fibre biochar for low concentration ammoniacal nitrogen recovery from aquaculture wastewater. — Ahmad T, Sethupathi S, Bashir MJK, Tan SY Environmental technology (2026)