ciguatera toxin / ciguatoxin (CTX) => ciguatera
disease. At present, 24 related ciguatoxins are known and these
were found in different fishes from the Pacific.
Food chain : Gambierdiscus toxicus produces gambiertoxin-4A
=> microalgae => herbivorous fish and invertebrates make biotransformation
and acid-catalysed spiroisomerisation of gambiertoxin-4A to create
ciguatoxin => carnivorous warm-water fishesref
:
=> Homo sapiens.
Pathogenesis : ciguatoxins bind to site
5-6 on a-subunit of voltage-gated
Na+ channels
and close them (except for an isoform which opens).
The term ciguatera originated in the Caribbean area to designate intoxication
induced by the ingestion of the marine snail Turbo
pica (called cigua). Today, the term is widely used to denote a particular
type of fish poisoning that results from ingestion of primarily reef fishes
encountered around islands in the Caribbean and the Pacific. The clinical
symptoms
Symptoms & signs (ciguatera fish
poisoning (CFP)) can be classified into 4 broad groups:
neurologic
cardiovascular
gastrointestinal
general symptoms.
They usually begin within10' to 12 hours, but can occur up to 36 hours
after eating a poisonous fish. The disease commonly begins with nausea
and vomiting
and diarrhea,
generalized weakness, a decreased sensation to pain or touch, unusual or
painful sensations produced by ordinary stimuli, a burning or tingling
of the hands and legs or around the mouth, muscle pain and temperature
reversal sensation (hot things feel cold and cold things feel hot). Other
less common symptoms include: chills, itching, dizziness,
sweating, headache
and taste disturbances (a metallic taste or fuzzy sensation). The nausea
and vomiting,
and other gastrointestinal symptoms last for approximately 1 to 2 days.
Weakness may last for 1 to 7 days. Neurologic symptoms such as tingling
or temperature reversal generally persist for up to 1 week, but it is not
unusual for these symptoms to periodically re-occur for a month or more.
The poisoned victim may note an increased or decreased heart rate. Medical
personnel may also note systemic
arterial hypotension,
mydriasis,
and cardiac arrhythmia.
These symptoms resolve in 2 to 3 days
Therapy : the best treatment for ciguatera
poisoning during the early phase of poisoning (1-3 days after eating a
toxic fish) has been mannitol
infusion, which relieves many of the severe symptoms of poisoning, except
for diarrhea
in some patients. The long term chronic symptoms such as muscle ache, joint
pains and a weak, tired feeling in some patients have been successfully
treated with tocainide
and amitriptyline.
Currently gabapentin
was used as effective therapeutics of ciguatera intoxication.
Prognosis : if consumed in sufficient
dose, can cause symptoms persisting for weeks, months or years. In some
patients, long term symptoms occur or reoccur after generally eating fatty
foods, seafood products and alcohol.
Prevention : ciguatoxins are not destroyed
by cooking
Routes of intoxication : Mytilus
spp. feed on them
Gonyaulacales
Gonyaulacaceae
Alexandrium blooms generally do not involve large-cell accumulations
that discolor the water and may instead be invisible below the water surface.
Low-density populations can cause severe problems due to the high potency
of the toxins produced. Furthermore, Alexandrium spp. can grow in
relatively pristine waters, and it is difficult to argue that anthropogenic
nutrient inputs are stimulating the blooms. These characteristics are important
when considering mitigation and control strategies.
=> saxitoxins
(STX) are so named due to the mollusk in which it was first identified,
Saxidomus
giganteus (a.k.a. toxic butter clam). It is paradoxical that as civilization
has advanced, the incidences of red tides and PSP have also increased.
Oceanic nutrients from pollution have increased, providing greater nutrient
levels for dinoflagellate phytoplanktons, which in turn depelet the oxygen
in the water resulting in eutrophication. There are molecules with 2 guanidino
groups with pKa of 11.3 and 8.2, respectively. At physiological
pH then, the first-guanidino carries a positive charge, whereas the second-guanidino
group is partially deprotonated. Because of this polar nature, the saxitoxin
molecule readily dissolves in water and lower alcohols but is insoluble
in organic solvents. It is stable in solution at neutral and acidic pH,
even at high temperatures, but alkaline exposure oxidizes and inactivates
the toxin. There are a number of STX variants generally divided into groups
based on their structure or organism of origin :
single sulphated STXs
gonyautoxins (GTX) 1-4 (produced
by Moraxella
spp. symbionts of Protogonyaulax spp. ?)
B-toxins
doubly sulphated STXs (C-toxins)
decarbamyl STXs (dcSTX)
The US federal limit is 80 µg per 100 grams of shellfish tissue.
LD50 for guinea pigs = 5 µg/kg when injected i.m. The
LD50 for mice are very similar with varying adminastration routes
: i.p. (LD50 = 10 µg/kg), i.v. (LD50 = 3.4
µg/kg) or p.o. (LD50 = 263 µg/kg)
Routes of intoxication : Mytilus
spp. and other marine mollusks bioaccumulate STXs by filter feeding
upon the microalgae during red tides (an explosive growth of dinoflagellate
phytoplanktons whose red pigments color the water). Although mussels themselves
are apparently unafffected by saxitoxin, mussel predators quickly develop
NSP. Normally, shellfish beds are closed if there are > 80 mg
of toxin per 100 grams of shellfish meat.
Epidemiology : Texas' 1st recorded red
tide occurred in 1935 and affected waters from Port Aransas to Mexico.
It was 20 years before the next episode at Galveston and nearly another
2 decades before a bloom was reported off Brownsville. In 1986, a red tide
bloom killed an estimated 22 million fish from Galveston to the Rio Grande,
and then a series of blooms occurred in 1987, 1990-91, 1993-97 and 2000.
They all bind to site 1 (or 5-6 ?) on voltage-gated
Na+ channels
and block Na+ flux. They can be detected by using crown ethers,
which become fluorescent under UV light when bound to saxitoxins.
Karenia
brevis (formerly Gymnodinium breve). Karenia was chosen
in honor of Dr. Karen Steidinger, a prominent red tide scientist from the
Florida Marine Research Institute in St. Petersburg, FLref.
=> brevetoxins (BVX). The algae
proliferate during red tide incidents (in high
concentration can make the water look red). BVX and related toxins
are believed to have been responsible for massive fish kills from red tides
in several regions. There are 2 types of brevetoxins
type I : 11 rings (8 6-membered rings, 2 heptameric and 1 8-membered
ring)
type II : 10 rings, with variation in the size of the rings ranging
from 5 bonds to 9 bonds
These toxins bind to site 5 on voltage-gated
Na+ channels
in cell walls, changing the voltage at which this opening occurs nearer
to the voltage threshold that triggers this process essentially making
the Na+ channel, and consequently, the affected nervous and
muscular cells hyperexcitable. Brevetoxins are unusually stable materials
in the dry state. They are stable as well as in different solvents (acetone,
acetonitrile, alcohol, ethyl acetate or DMSO), including water, where half-lives
for active material range from 4-6 months. Solutions with pH < 2 or
> 10 degrade the toxins.
< 1,000 cells/L : no effects
5,000 cells/L : shellfish harvesting closed
10,000 cells/L : respiratory irritation
50,000 cells /L : respiratory irritation and possible fish kills
> 1 million cells/L : respiratory irritation, fish kills and water discoloration.
Environmental experts have closed a stretch of beach near the northern
Italian city of Genoa after toxic algae poisoned around 80 people needed
hospital attention Sun Jul 17 and Mon Jul 18 2005 because of the microscopic
algae, which is usually found in the tropics. No one was reported to be
seriously ill, but experts said the 6-km (3.7-mile) stretch of Ligurian
coastline would remain closed until Wed Jun 20 to allow time for further
tests. It has been very hot recently and the sea has been very calm, which
probably encouraged this phenomenon. People who come into contact with
the algae can suffer fever, nausea and coughing fits.