Palytoxin-induced acute respiratory failure

Abstract

Palytoxin is one of the most potent toxins known to mankind and poses a high risk to humans through ingestion, inhalation and dermal routes [1,2]. Although the exact mechanism of action is unknown it is postulated that palytoxin binds to the Na+/K + ATPase pump resulting in K+ efflux, Ca2+ influx and membrane depolarization leading to widespread secondary pharmacological actions [2]. Palytoxin is highly toxic and can affect multiple organs causing severe symptoms including death. Palytoxin poisoning is mainly developed after ingesting seafood. We are reporting a case of suspected inhalational palytoxin poisoning in a healthy healthcare provider from who developed severe respiratory distress within 12 hours of exposure to vapors. We have highlighted diagnostic clues and clinical features in the patients' history that may help intensivists to diagnose a case of ARDS secondary to palytoxin poisoning.

Human Poisoning from Marine Toxins: Unknowns for Optimal Consumer Protection

“…Toxicity of palytoxins in humans has been reported after exposure through ingestion, inhalation and dermal and corneal contact. The consequences of palytoxin toxicity may be life threatening mainly by ingestion or inhalation [ 222 , 223 , 224 , 225 ]. A few cases of intoxication due to ingestion of PLTX-contaminated seafood (fish or crustaceans) in tropical and subtropical areas have been published, some of them with a fatal endpoint [ 210 , 222 , 226 , 227 ].…”

“…In the last two decades, several reports of suspected or confirmed toxicity of palytoxin by inhalation and dermal contact have been published. PLTX-related toxicity has been reported after inhalation of steam generated by cleaning of Palythoa -containing aquariums with hot water [ 223 , 224 , 225 , 230 , 231 , 232 , 233 ]. Similar symptoms have been described after inhalation of aerosols during Ostreopsis blooms by beachgoers [ 234 , 235 , 236 , 237 ]; with ovatoxins being the main PLTX-analogs present in this kind of blooms [ 237 , 238 ].…”

“…Similar symptoms have been described after inhalation of aerosols during Ostreopsis blooms by beachgoers [ 234 , 235 , 236 , 237 ]; with ovatoxins being the main PLTX-analogs present in this kind of blooms [ 237 , 238 ]. Symptoms by inhalation exposure consist of fever, breathing difficulty, runny nose, cough, and weakness and myalgia among others [ 223 , 224 , 225 , 230 , 231 , 232 , 234 , 235 , 236 ]. Hospitalization for 2–3 days is necessary in cases of acute respiratory failure [ 223 , 224 , 225 ].…”

“…Symptoms by inhalation exposure consist of fever, breathing difficulty, runny nose, cough, and weakness and myalgia among others [ 223 , 224 , 225 , 230 , 231 , 232 , 234 , 235 , 236 ]. Hospitalization for 2–3 days is necessary in cases of acute respiratory failure [ 223 , 224 , 225 ]. Recovery is slow in severe cases considering that dyspnea and fatigue were reported in some patients for 1–3 months after exposure [ 224 ].…”

Ostreopsis cf. ovata (Dinophyceae) Molecular Phylogeny, Morphology, and Detection of Ovatoxins in Strains and Field Samples from Brazil

“…ovata. Aerolized palytoxin can induce severe respiratory distress [19] and putative PLTX is implicated in the fatal disease clupeotoxism [20]. Recurrent blooms of O. cf.…”