Gastroenteritis associated with shellfish.
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During May 20-July 31, 2006, New York City, New York state, Oregon, and Washington health departments reported a total of 177 cases of Vibrio parahaemolyticus infection, of which 122 have been associated with 17 clusters. A cluster has been defined as a group of two or more ill persons who were linked to the same shellfish source (e.g., shared a meal at the same restaurant or obtained shellfish from the same seafood market). Certain clusters were associated with restaurants, certain clusters with seafood markets, and certain clusters with recreational harvesting. Three patients were hospitalized; no fatalities have been reported. No demographic (e.g., age, sex, or race) or medical history (e.g., predisposing conditions) information is yet available regarding affected persons.
Vibrio vulnificus is an extremely invasive gram-negative bacillus that causes bacteremia and shock. It should be suspected in any patient who is immunocompromised or has liver disease or hemochromatosis. Reduced gastric acidity may also increase the risk of infection if a patient presents with a history of ingesting raw shellfish (especially oysters) or trauma in brackish waters and skin lesions. Patients most commonly present with one of three clinical syndromes: primary septicemia, wound infection, or gastroenteritis. Treatment includes aggressive wound debridement, antibiotic therapy, and supportive care. Rapidly diagnosing and promptly initiating therapy are critical because V vulnificus infection is rapidly progressive and mortality approaches 100% if septic shock occurs.
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On January 2, 1991, 12 of 24 persons who attended one or more of three New Year's celebrations in Honolulu, Hawaii, had onset of gastrointestinal illness. An investigation by the Epidemiology Branch of the Hawaii Department of Health (HDOH) determined that the only common foods shared by participants were oysters and clams provided by one distributor.
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The causative agent of toxicity in cultured mussels from a localized area of eastern Prince Edward Island has been identified as domoic acid, a neuroexcitatory amino acid. The toxin was isolated by a number of different bioassay-directed separation techniques including high-performance liquid chromatography (HPLC), high-voltage paper electrophoresis (HVPE), and ion-exchange chromatography, and characterized by a number of spectroscopic techniques including ultraviolet, infrared, mass spectrometry, and nuclear magnetic resonance. The isolation and purification methods are described in detail and some new analytical data for domoic acid are reported. A plankton bloom at the time of the outbreak gave positive mouse bioassays and consisted almost entirely of the pennate diatom, Nitzschia pungens f. multiseries. A positive correlation was found between the number of N. pungens cells and the concentration of domoic acid in the plankton. N. pungens f. multiseries isolated from Cardigan Bay produced domoic acid de novo during stationary phase culture at levels (1 to 10 pg/cell) comparable to values estimated for N. pungens in the plankton samples. We conclude that N. pungens was the major source of the domoic acid in toxic mussels in eastern Prince Edward Island. The recurrence, in November 1988, of a monospecific bloom of N. pungens and the presence of domoic acid in plankton and mussels reinforces this conclusion.
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