Biotoxins are not common exposures, but if you love aquariums, this toxin could be in your home! Palytoxin is one of the most potent biotoxins reported, posing a risk to patients via ingestion, inhalation, dermal, and even ocular routes. Aquarium hobbyists and employees in the salt water aquarium industry have the greatest risk of exposure.
Palytoxin can be produced by some one-celled algae, certain varieties of sea anemone, as well as “living coral” (containing zoanthid coral). Contact with the zoanthid coral is the most common route of exposure and occurs when handling the coral to place it in the tanks; misting of vapor in the surrounding air when there is a bloom of the zoanthids, and by vapor produced when attempting to clean the polyps from the coral with hot water.
Symptoms seen with dermal exposure include irritation, pain, edema, and erythema. Symptoms seen upon inhalation of vapor/mist can include fever, cough, dyspnea, tachycardia, and muscle weakness.
In New York, a 53 year old male, his wife, and daughter presented to the emergency department with dyspnea and cough which began about six hours prior to arrival and worsened. Chills and myalgias also ensued. Symptoms began 1 to 2 hours following the cleaning of salt water coral with hot water in the sink within the residence. He identified the coral as containing zoanthids. The man did not wear any protective gear when cleaning. His wife was in an adjoining room and the daughter was upstairs. The severity of the family’s symptoms corresponded to the distance from the main cleaning area – the members presented with fever, tachycardia, and elevated blood pressure. The man’s condition deteriorated, requiring oxygen and albuterol. He was admitted to the ICU because of respiratory distress. By day 4 he began to show improvement and was discharged on day seven.. He was sent home with portable oxygen, albuterol, and steroids. The wife and daughter had also been hospitalized but improved after 24 hours and were discharged home.
While this is not the typical clinical course, there have been similar cases requiring medical treatment reported throughout the literature. The Tennessee Poison Center is available and able to answer all your coral questions. Please don’t hesitate to call!
REFERENCES:
Hall C, Levy D, Sattler S. Case Reports in Emergency Medicine, Volume 2015, Article ID 621815.
Thakur L K, Jha K K. Palytoxin-induced acute respiratory failure. Respiratory Medicine Case Reports 20 (2017), 4-6.
Murphy L T, Charlton N P. Environmental Toxicology and Pharmacology 55 (2017) 107-109
This Question was prepared by: Scott Muir, RN, CSPI
I am interested in any questions you would like answered in the Question of the Week. Please email me with any suggestion at donna.seger@vanderbilt.edu
Donna Seger, MD
Medical Director
Tennessee Poison Center
Poison Help Hotline: 1-800-222-1222