{"title":"Neurobehavioral complaints of symptomatic persons exposed to Pfiesteria piscicida or morphologically related organisms.","authors":"L M Grattan, D Oldach, J K Tracy, D R Greenberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Over the next year, additional persons in Maryland may be at risk for exposure of toxic Pfiesteria or morphologically related organisms. These persons may present with a variety of memory and other behavioral complaints. This paper examines the kinds of complaints that persons with a documented Pfiesteria-related syndrome have compared to a nonexposed control group. The exposed group was more likely to report difficulties with concentration, forgetfulness, prospective memory, and information overload as well as feelings of confusion, bewilderment, and uncertainty as direct effects of toxin exposure. The exposed group was also more likely to report feeling uneasy, on edge, nervous, and shaky, which is probably a reaction to their newly acquired cognitive deficits and uncertainty about their recovery. In contrast, retrograde memory loss, disturbances of language or social behavior, depression, anger, hostility, or diminished activity levels are not symptoms that exposed persons are likely to report.</p>","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"127-9"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Strategies for environmental monitoring of toxin producing phantom dinoflagellates in the Chesapeake.","authors":"D Oldach, E Brown, P Rublee","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Toxin-producing estuarine dinoflagellates have been linked with the occurrence of fish kills and the development of a novel clinical illness syndrome among persons exposed to waters during fish kill events. The prototype organism of this group, Pfiesteria piscicida, has an extremely complex life cycle, making traditional methods used for environmental monitoring of harmful algal blooms less reliable. The response to fish kill events and the occurrence of human illness in Maryland in 1997 is reviewed, with particular emphasis on problems in organism detection. Current and anticipated classical and molecular methodologies for the detection of Pfiesteria and Pfiesteria-like organisms are reviewed. Development of these capabilities will be of critical importance in defining the epidemiology of human illness related to environmental exposure to Pfiesteria, and in developing public health strategies to predict and prevent such illness.</p>","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"113-9"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Neurologic symptoms following Pfiesteria exposure: case report and literature review.","authors":"C T Bever, L Grattan, J G Morris","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Although the recently identified dinoflagellate, Pfiesteria piscicida, may have neurotoxic effects on humans, the precise nature of the neurologic symptoms associated with varying levels of exposure is unknown. Toward this end, we review the neurologic symptoms of three Pfiesteria-exposed laboratory workers reported to data and compare them to the evaluation of an exposed waterman from Maryland. The occupational exposure of a Maryland waterman appears to produce a mild, reversible encephalopathy which predominantly affects functions associated with the frontal and temporal lobes. A comprehensive neurologic examination is recommended for all Pfiesteria piscicida and morphologically related organism-exposed, symptomatic persons.</p>","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"120-3"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pfiesteria and the skin: a practical update for the clinician.","authors":"M H Lowitt, C L Kauffman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Skin complaints, including an episodic burning sensation on contact with river water, were common among 13 persons with exposure to Maryland's Pocomoke River in the summer of 1997. While the majority of findings on dermatologic examination were unrelated to toxic dinoflagellate exposure, a subset of patients demonstrated otherwise unexplained erythematous, edematous papules on the trunk or extremities. Histopathologic findings were suggestive of an inflammatory, toxic, or allergic process. It may be speculated that these otherwise unexplained cutaneous findings represent a cutaneous reaction to Pfiesteria or Pfiesteria-like toxin; however, further evaluation of future affected persons will be warranted.</p>","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"124-6"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A critical review of the Pfiesteria hysteria hypothesis.","authors":"D R Greenberg, J K Tracy, L M Grattan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Mass hysteria or mass psychogenic illness is the spread of the belief of an illness (symptoms and the origins of the symptoms) through a population. The characteristics of mass psychogenic illness were reviewed and compared to the recent outbreak of human illness in the Pocomoke region in Maryland in the summer of 1997. The findings suggest that the nature of the symptoms complex--the onset and recovery course; the absence of secondary gain or job-related stress for most of the symptomatic persons; the predominance of males in the symptomatic group; and the baseline emotional stability of all persons examined--are inconsistent with the reported features of psychogenic illness in response to unknown environmental or chemical toxins. Although there may be individuals who exhibited hypochondriacal, hysterical, or other functionally based reactions, the recent outbreak of Pfiesteria-related illness probably does not represent an episode of mass psychogenic illness.</p>","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"133-6"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fish lesions in the Chesapeake Bay: Pfiesteria-like dinoflagellates and other etiologies.","authors":"A S Kane, D Oldach, R Reimschuessel","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ulcerative lesions and mass mortalities of Atlantic estuarine fish, particularly menhaden (Brevoortia tyrannus), have been associated with exposure to Pfiesteria-like dinoflagellates and their toxins. We collected fish from the Chicamacomico River, Maryland, and observed solitary ulcerative lesions on the majority of menhaden sampled. One striped bass (Morone saxatilis) had an area of reddening around the base of the dorsal fin. Bluegill (Lepomis machrochirus), channel catfish (Ictalurus punctatus), yellow perch (Perca flavescens), and carp (Cyprinus carpio) were externally nonremarkable. Histologically ulcerative menhaden lesions demonstrated marked chronic inflammatory infiltrate in large areas of exposed necrotic muscle. The ulcers contained granulomata with fungal hyphae in the necrotic tissue. Gram negative rod-shaped bacteria were also observed in the lesions, a common finding in ulcers of aquatic organisms. Our data suggest that typical ulcerative lesions observed on fish from areas of Pfiesteria-like dinoflagellate blooms are reflective of dermatosis, which may be related to a variety of individual or combined environmental stressors. Exposure to dinoflagellate toxin)s) potentially represents one such stressor. The role of Pfiesteria-like dinoflagellate toxin in fish primary lesion development is currently under investigation.</p>","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"106-12"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Current status and future directions for the investigation and management of the human health effects of exposure to Pfiesteria piscicida or Pfiesteria-like dinoflagellates.","authors":"L M Grattan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"148-51"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Toxic-Pfiesteria--surveillance for human disease in Maryland.","authors":"D L Matuszak, J L Taylor, C Dickson, G C Benjamin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The presence of toxic stages of the dinoflagellate Pfiesteria piscicida and other morphologically related organisms was documented in three estuarine waterways on the lower Eastern Shore of Maryland in 1997. The Maryland Department of Health and Mental Hygiene, working closely with the local health departments, established a surveillance system to collect reports of human illnesses. Maryland's experience has formed the base on which national surveillance criteria for Estuary Associated Syndrome have been developed and regional surveillance protocols have been built. The cooperation of practicing physicians is essential to continued surveillance efforts to further delineate the extent and nature of human health effects following exposures to waters where toxic forms of these dinoflagellates are active. Physicians wishing to report persons who may have Estuary Associated Syndrome should contact their local health department. Persons wanting information or wishing to report finding lesioned fish or a fish kill in progress should call the Maryland Pfiesteria Hotline at 1- 888-584-3110.</p>","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"144-7"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J E Golub, D T Haselow, J C Hageman, A S Lopez, D W Oldach, L M Grattan, T M Perl
{"title":"Pfiesteria in Maryland: preliminary epidemiologic findings.","authors":"J E Golub, D T Haselow, J C Hageman, A S Lopez, D W Oldach, L M Grattan, T M Perl","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In the fall of 1996, fish kills in Maryland rivers were attributed to the dinoflagellate, Pfiesteria piscicida. After a group of researchers established a potential link between exposure to Pfiesteria and an illness causing memory problems, state health authorities closed a portion of the Pocomoke River. To determine the extent of illness, the range of symptoms, potential risk factors for disease, and to provide information to concerned citizens, a toll-free hotline was created. All symptomatic persons who called the toll-free number were administered a standardized questionnaire. Persons who had been exposed to Pfiesteria or Pfiesteria-laden waters were more likely to have respiratory, neurologic, dermatologic, and gastrointestinal problems than those persons without exposure. Among the persons calling the hotline, many had extensive neuropsychologic testing. Of the neuropsychologic test battery, low scores on the Rey Auditory Verbal Learning Test (RAVLT), a standardized measure of learning and memory, best characterized illness related to Pfiesteria exposure. Patients with low RAVLT scores were more likely to have neurologic symptoms and skin lesions than control subjects. Low RAVLT scores were associated with fishing (OR, 9.00, 95% CI, 106, 409.87), catching fish with lesions (OR, 6.17, 95% CI 1.27, 32.10), and handling fish with lesions (OR, 5.34, 95% CI, 1.05, 29.92), but not with consumption of seafood. While preliminary, these results do suggest that some risk factors for Pfiesteria-related illness may be easy to modify and used to prevent unnecessary human exposure.</p>","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"137-43"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychologic adjustment of watermen with exposure of Pfiesteria piscicida.","authors":"J K Tracy, D Oldach, D R Greenberg, L M Grattan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Preliminary study of the psychologic adjustment of watermen with exposure to Pfiesteria piscicida was conducted on watermen with the most severe exposures and their occupationally matched controls. Participants in the exposed group were seven symptomatic recreational and commercial fishermen who had direct exposure to the Pocomoke River or other estuarial waters on Maryland's Eastern Shore before, during, and/or after periods of documented fish kills and Pfiesteria activity. The control group included eight commercial fishermen who worked on the ocean side of the Eastern Shore and had no reported exposure to estuaries with documented Pfiesteria activity. Both exposed symptomatic and nonexposed watermen completed the Profile of Mood States to assess depression, anxiety, and other relevant mood states as part of their participation in the larger investigation of the human health effects of Pfiesteria piscicida. Preliminary results suggest that both exposed symptomatic and nonexposed watermen are psychologically healthy and exhibit what psychologists refer to as the classic Iceberg Mood Profile. The Iceberg Profile is characterized by endorsement of symptoms suggestive of high energy, enthusiasm and positive mood (e.g., lively, active, energetic, cheerful, vigorous, etc.) and relative minimization of symptoms suggestive of negative or depressed mood (e.g., tense, anxious, restless, grouchy, forgetful). Therefore, the Pfiesteria-related symptom complex documented in the exposed watermen cannot be explained by functional or psychiatric factors and is probably due to exposure.</p>","PeriodicalId":77251,"journal":{"name":"Maryland medical journal (Baltimore, Md. : 1985)","volume":"47 3","pages":"130-2"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20521212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}