An outbreak of toxic encephalopathy caused by eating mussels contaminated with domoic acid

Trish M. Perl, Lucie Bédard, Tom Kosatsky, James C. Hockin, Ewen C.d. Todd, Robert S. Remis

Research output: Contribution to journalArticle

528 Citations (Scopus)

Abstract

In Canada in late 1987 there was an outbreak of an acute illness characterized by gastrointestinal symptoms and unusual neurologic abnormalities among persons who had eaten cultivated mussels. Health departments in Canada solicited reports of this newly recognized illness. A case was defined as the occurrence of gastrointestinal symptoms within 24 hours or of neurologic symptoms within 48 hours of the ingestion of mussels. From the more than 250 reports received, 107 patients met the case definition. The most common symptoms were vomiting (in 76 percent of the patients), abdominal cramps (50 percent), diarrhea (42 percent), headache, often described as incapacitating (43 percent), and loss of short-term memory (25 percent). Nineteen patients were hospitalized, of whom 12 required intensive care because of seizures, coma, profuse respiratory secretions, or unstable blood pressure. Male sex and increasing age were associated independently with the risks of hospitalization and memory loss. Three patients died. Mussels associated with this illness were traced to cultivation beds in three river estuaries on the eastern coast of Prince Edward Island. Domoic acid, which can act as an excitatory neurotransmitter, was identified in mussels left uneaten by the patients and in mussels sampled from these estuaries. The source of the domoic acid appears to have been a form of marine vegetation, Nitzschia pungens, also identified in these waters in late 1987. The contaminated mussels from Prince Edward Island were removed from the market, and no new cases have occurred since December 1987. We conclude that the cause of this outbreak of a novel and severe intoxication was the ingestion of mussels contaminated by domoic acid, a potent excitatory neurotransmitter. (N Engl J Med 1990; 322:1775–80.)

Original languageEnglish (US)
Pages (from-to)1775-1780
Number of pages6
JournalNew England Journal of Medicine
Volume322
Issue number25
DOIs
StatePublished - Jun 21 1990

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Neurotoxicity Syndromes
Bivalvia
Disease Outbreaks
Eating
Prince Edward Island
Estuaries
Canada
Neurotransmitter Agents
Nervous System Malformations
Colic
Memory Disorders
Critical Care
Coma
Neurologic Manifestations
domoic acid
Short-Term Memory
Rivers
Vomiting
Headache
Diarrhea

ASJC Scopus subject areas

  • Medicine(all)

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An outbreak of toxic encephalopathy caused by eating mussels contaminated with domoic acid. / Perl, Trish M.; Bédard, Lucie; Kosatsky, Tom; Hockin, James C.; Todd, Ewen C.d.; Remis, Robert S.

In: New England Journal of Medicine, Vol. 322, No. 25, 21.06.1990, p. 1775-1780.

Research output: Contribution to journalArticle

Perl, Trish M. ; Bédard, Lucie ; Kosatsky, Tom ; Hockin, James C. ; Todd, Ewen C.d. ; Remis, Robert S. / An outbreak of toxic encephalopathy caused by eating mussels contaminated with domoic acid. In: New England Journal of Medicine. 1990 ; Vol. 322, No. 25. pp. 1775-1780.
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