Learning and memory difficulties after environmental exposure to waterways containing toxin-producing Pfiesteria or Pfiesteria-like dinoflagellates

Grattan, Lynn M.; Oldach, David; Perl, Trish M.; Lowitt, Mark H.; Matuszak, Diane; Dickson, Curtis W.; Parrott, Colleen; Shoemaker, Ritchie C.; Kauffman, C. Lisa; Wasserman, Martin P.; Hebel, J. Richard; Charache, Patricia; Morris, J. Glenn

doi:10.1016/s0140-6736(98)02132-1

Cited by 148 publications

(118 citation statements)

References 14 publications

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“…Anecdotal evidence indicates that some individuals with acute PEAS do not go on to develop chronic PEAS, whereas Cases 1, 4, and 5 did so. Of the 10 cases seen at the 3-month follow-up reported by Grattan et al (14), two cases had not returned to the normal range of cognitive function, Case 1 was in the normal range following CSM treatment, and 7 cases had returned to the normal range without treatment (14). Seventh, CSM use as a prophylactic may prevent the acquisition of acute PEAS, as apparently seen in Case 1.…”

Section: Discussionmentioning

confidence: 91%

“…Furthermore, it is highly unusual for the clinical course of pneumonia in a previously healthy 41-year-old male to include fever and cough reduction in response to antibiotic treatment, followed paradoxically by a strong increase in snoring and death from respiratory arrest. Although eosinophilic infiltration is a nonspecific response associated with Addison's disease, asthma, and parasitic and other conditions, eosinophilia was previously observed in skin biopsies from two patients with acutely acquired, TPC-related skin lesions (20) and in the study of Grattan et al (14). Although speculative, the upper airway eosinophilic infiltration seen in Case 2 at autopsy (21) may have been in response to TPC toxin(s)-induced inflammation, which led to upper airway obstruction and respiratory failure.…”

Section: Discussionmentioning

confidence: 91%

“…Recent evidence has suggested that the estuarine dinoflagellates Pfiesteria piscicida and P. shumwayae not only kill fish (8-10) on the Eastern Seaboard from Delaware to Florida (11) but also may pose a human health risk in laboratory (12) and natural settings (13)(14)(15). Humans who were exposed to estuaries of the Chesapeake Bay, Maryland, around the time of fish kills in 1997 had severe exposure-and duration-related reductions in neuropsychologic tests of cognitive and motor functions relative to unexposed, matched-control study participants (14).…”

Section: Discussionmentioning

confidence: 99%

“…Humans who were exposed to estuaries of the Chesapeake Bay, Maryland, around the time of fish kills in 1997 had severe exposure-and duration-related reductions in neuropsychologic tests of cognitive and motor functions relative to unexposed, matched-control study participants (14). Although the test scores of affected individuals returned to within normal ranges in 3-6 months (14), little is known about the potential acute and chronic health effects of PEAS (16).…”

Section: Discussionmentioning

confidence: 99%

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Possible estuary-associated syndrome: symptoms, vision, and treatment.

Shoemaker

Hudnell

2001

Environ Health Perspect

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The human illness designated as possible estuarine-associated syndrome (PEAS) by the Centers for Disease Control and Prevention (CDC) has been associated with exposure to estuaries inhabited by toxin-forming dinoflagellates, including members of the fish-killing toxic Pfiesteria complex (TPC), Pfiesteria piscicida and Pfiesteria shumwayae. Humans may be exposed through direct contact with estuarine water or by inhalation of aerosolized or volatilized toxin(s). The five cases reported here demonstrate the full spectrum of symptoms experienced during acute and chronic stages of this suspected neurotoxin-mediated illness. The nonspecific symptoms most commonly reported are cough, secretory diarrhea, headache, fatigue, memory impairment, rash, difficulty in concentrating, light sensitivity, burning skin upon water contact, muscle ache, and abdominal pain. Less frequently encountered symptoms are upper airway obstruction, shortness of breath, confusion, red or tearing eyes, weakness, and vertigo. Some patients experience as few as four of these symptoms. The discovery that an indicator of visual pattern-detection ability, visual contrast sensitivity (VCS), is sharply reduced in affected individuals has provided an objective indicator that is useful in diagnosing and monitoring PEAS. VCS deficits are present in both acute and chronic PEAS, and VCS recovers during cholestyramine treatment coincident with symptom abatement. Although PEAS cannot yet be definitively associated with TPC exposure, resolution with cholestyramine treatment suggests a neurotoxin-mediated illness.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Possible estuary-associated syndrome: symptoms, vision, and treatment.

Shoemaker

Hudnell

2001

Environ Health Perspect

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“…In general, algal blooms result from the rapid reproduction and localized dominance of phytoplankton. Marine and estuarine HABs can cause shellfish and tropical fish poisoning, wildlife disease and mortality, and disease in humans who ingest contaminated seafoods (99)(100)(101). Ciguatoxin (from a few reef fish species), scombrotoxin (from tuna, mackerel, bluefish, and a few other species), and raw mollusc consumption represent more than 90% of outbreaks and 75% of individual cases of seafoodborne illnesses reported to the CDC from 1978 to 1987 (43).…”

Section: Coastal Water Issuesmentioning

confidence: 99%

Climate variability and change in the United States: potential impacts on water- and foodborne diseases caused by microbiologic agents.

Rose

Epstein

Lipp

et al. 2001

Environ Health Perspect

201

156

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Exposure to waterborne and foodborne pathogens can occur via drinking water (associated with fecal contamination), seafood (due to natural microbial hazards, toxins, or wastewater disposal) or fresh produce (irrigated or processed with contaminated water). Weather influences the transport and dissemination of these microbial agents via rainfall and runoff and the survival and/or growth through such factors as temperature. Federal and state laws and regulatory programs protect much of the U.S. population from waterborne disease; however, if climate variability increases, current and future deficiencies in areas such as watershed protection, infrastructure, and storm drainage systems will probably increase the risk of contamination events. Knowledge about transport processes and the fate of microbial pollutants associated with rainfall and snowmelt is key to predicting risks from a change in weather variability. Although recent studies identified links between climate variability and occurrence of microbial agents in water, the relationships need further quantification in the context of other stresses. In the marine environment as well, there are few studies that adequately address the potential health effects of climate variability in combination with other stresses such as overfishing, introduced species, and rise in sea level. Advances in monitoring are necessary to enhance early-warning and prevention capabilities. Application of existing technologies, such as molecular fingerprinting to track contaminant sources or satellite remote sensing to detect coastal algal blooms, could be expanded. This assessment recommends incorporating a range of future scenarios of improvement plans for current deficiencies in the public health infrastructure to achieve more realistic risk assessments.

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Pfiesteria: The Toxic Pfiesteria Complex

Burkholder¹

2003

Encyclopedia of Environmental Microbiology

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General Characteristics, Systematics, and Life Cycle Systematics and Cellular Characteristics Complex Life Cycles Culturing Pfiesteria Assessment of Toxic Pfiesteria Involvement in Fish Kills Distribution, Nutritional Ecology, and Predation Sublethal and Chronic Impacts of Toxic Pfiesteria on Fish and Mammalian Health

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Learning and memory difficulties after environmental exposure to waterways containing toxin-producing Pfiesteria or Pfiesteria-like dinoflagellates

Cited by 148 publications

References 14 publications

Possible estuary-associated syndrome: symptoms, vision, and treatment.

Possible estuary-associated syndrome: symptoms, vision, and treatment.

Climate variability and change in the United States: potential impacts on water- and foodborne diseases caused by microbiologic agents.

Pfiesteria: The Toxic Pfiesteria Complex

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