Case Definition: Brevetoxin
Brevetoxins are a group of similar neurotoxic compounds which are tasteless and odorless. Although toxicity can result from inhalational, dermal, or oral exposure, the most common route of exposure is by oral ingestion of contaminated shellfish. Illness from oral ingestion is characterized by a combination of gastrointestinal and neurologic signs and symptoms. Gastrointestinal symptoms include abdominal pain, vomiting, and diarrhea. Neurologic signs and symptoms include paresthesias, reversal of hot and cold temperature sensation, vertigo, and ataxia. Inhalational exposure may cause respiratory symptoms such as cough, dyspnea and bronchospasm (1-4). Brevetoxin can also cause illness in aquatic wildlife.
Laboratory criteria for diagnosis (5-10)
- Biologic: The detection of brevitoxins or their metabolites in clinical specimens. There is limited analytical capability to detect selected brevitoxins or their metabolites in urine by immunoassay.
- Environmental: Brevetoxins can be detected in water and contaminated environmental samples by commercial laboratories using ELISA and LC-MS.
- Suspected: A case in which a potentially exposed person is being evaluated by health-care workers or public health officials for poisoning by a particular chemical agent, but no specific credible threat exists.
- Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for brevetoxin exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
- Confirmed: A clinically compatible case in which laboratory tests on environmental samples are confirmatory.
The case can be confirmed if laboratory testing was not performed because either a predominant amount of clinical and nonspecific laboratory evidence of a particular chemical was present or the etiology of the agent is known with 100% certainty.
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