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ACUTE EXPOSURE INFORMATION

  1. WITH POISONING/EXPOSURE
    1. CDC CASE DEFINITIONS
      1. BACKGROUND
        1. Harmful algal blooms are fast growing algae that are found worldwide, which can have a negative impact on the environment, as well as the health and safety of humans and animals. As part of the ongoing efforts by the Centers for Disease Control and Prevention (CDC), the Harmful Algal Bloom-related Illness Surveillance System (HABISS) collects data on the effects to human and animal health due to the potential environmental impact of HABs. It has developed case definitions for harmful algal bloom (HABs) toxin-related diseases as part of their national surveillance efforts to support public health decision-making. The following has been created to identify pertinent information related to a potential exposure to HABs. For further information regarding the reporting of suspected human illness due to HABs, please contact: Lorraine C. Backer, PhD, MPH, Senior Scientist and Team Lead, National Center for Environmental Health, CDC, Atlanta, GA at lfb9@cdc.gov or Rebecca LePrell, MPH, HABISS Coordinator, National Center for Environmental Health, CDC, at gla7@cdc.gov.
      1. ACUTE SYMPTOMS (WITHIN 48 HOURS)
        1. HUMAN: Symptoms based on a small number of human exposures: GI: Initial symptoms include: nausea, vomiting, abdominal cramps, diarrhea, and anorexia are common. GI bleed and hiccups have occurred. NEURO: Headache, short-term memory loss, hemiparesis, visual abnormalities, ophthalmoplegia, seizures, myoclonus, confusion, lethargy, agitation, coma, mutism, areflexia, and loss of deep pain sensation. CV: Hypotension, peripheral vasodilation, tachycardia, and dysrhythmias. RESP: Pulmonary edema, excessive pulmonary secretions. DERM: Piloerection may occur during acute intoxication. SEVERE: Hypotension, dysrhythmias and bronchorrhea may develop. AGE: Patients under 40 are more likely to develop GI symptoms, while patients 50 years and older are likely to develop memory loss.
        1. ANIMAL: California sea lions have developed: ataxia, head bobbing, seizures, coma, and abortion.
      1. CHRONIC SYMPTOMS
        1. HUMAN: Symptoms may include: severe retrograde amnesia, motor or sensorimotor neuropathy, and possible seizure disorder.
        1. ANIMAL: Unusual behavior (ie, chew, circle), extreme aggression, epileptic seizures that progress to grand mal seizures.
      1. FATALITY RATE
        1. 3%
      1. TIME TO ONSET OF SYMPTOMS
        1. Usually less than 24 hours; initial symptoms can occur within 15 minutes to 38 hours after ingestion (mean 5.5 hours)
      1. DURATION
        1. HUMAN: May last days, possibly years.
        1. ANIMAL: Outbreaks in California sea lions indicate that neurologic lesions can be permanent.
      1. ROUTE OF EXPOSURE
        1. HUMAN: Eating contaminated shellfish.
        1. ANIMAL: Fetal exposure has occurred (via amniotic fluid) in California sea lions and rodent models.
      1. CAUSATIVE ORGANISM
        1. The following organisms may produce illness: diatom: pseudo-nitzschia spp., Nitzshia pungens.
      1. TOXIN
        1. The following toxins have been associated with domoic acid poisoning: domoic acid (5 congeners) - neuroexcitatory tricarboxylic amino acid (CAS 14277-79-5).
      1. VECTOR
        1. Contaminated bivalve shellfish including: scallops, mussels, clams (particularly razor clams, Siliqua patula), and oysters. Domoic acid has been found in Dungeness crab viscera. Of note, sardines and anchovies have been associated with sea lion intoxication events. Testing for domoic acid is not done in sardines or anchovies destined for human consumption.
      1. MECHANISM
        1. A glutamate receptor agonist.
      1. LIKELY GEOGRAPHIC DISTRIBUTION
        1. Organism found in temperate waters (eg, Florida).
      1. DIFFERENTIAL DIAGNOSIS
        1. Other marine toxin poisonings (eg, neurotoxic, paralytic or azaspiracid shellfish poisoning), ciguatera fish poisoning, scombroid fish poisoning, pesticide poisoning including organophosphate poisoning, cholinesterase inhibitor poisoning, microbial food poisonings, and food allergies may have potentially similar clinical findings.
      1. DIAGNOSIS
        1. Clinical presentation and shellfish test using mouse bioassay and HPLC.
      1. SUSPECT CASE
        1. Consumption of shellfish and development of gastrointestinal and neurologic symptoms.
      1. CONFIRMED CASE
        1. Suspect case and verification of domoic acid in urine OR verification of domoic acid in shellfish meal remnant OR in shellfish harvested from relevant geographic area.
      1. ANIMAL SENTINEL DATA
        1. California sea lions, common dolphins (west coast), pelicans and other shore birds.
      1. REFERENCE
        1. (HABISS Work-Group et al, Jan 12, 2009)
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