Source: Annual Congress 2010 - Occupational asthma
Disease area: Airway diseases

Abstract

Introduction
Several cases of human poisoning after fish meals or after bathing at the beach in presence of a bloom of Ostreopsis algae, with patients presenting dyspnea, chest pain and severe rhabdomyolysis related to Palytoxin (PLTX) have been described. There is no literature about the dangers related to PLTX in aquarism.
Case series presentation
Two young men and a woman presented with sudden onset of dyspnea, dry cough and chills shortly after the building of a saltwater aquarium with placement of Palythoa anemones on the bottom of the aquarium. These anemones are known to carry palytoxin (PLTX). We found diffuse ground glass opacities and small patchy consolidations in both lungs on CT scan, a restrictive ventilatory pattern and a predominantly granulocytary acute alveolar inflammation causing severe hypoxemia that completely resolved in a few days after exposure.
Discussion and conclusion
We report the first small case series of three patients presenting respiratory symptoms after the building of an aquarium and the exposure to Palytoxin-containing aerosol which can provoke severe toxic reactions leading to hospitalisation under life threatening conditions. These dangers are mostly not recognized or underestimated by aquarists. The use of protective gloves and breathing masks when working with anemones is strongly recommended.

Laboratory and pulmonary function test results

	Admission	Day 2	Day 14
PaO2 (kPa)	10	5.6	12.6
PaCO2 (kPa)	5.6	6.4	5.4
C-reactive protein (mg/L)	1.4	193.3
Leucocytes (x10^9/L)	10.3	27.6
Pulmonary Function Test		% of pred.	% of pred.
TLC (L)		60.5	79.4
VC (L)		59.8	89.8
FEV1 (L)		62.8	97.9
FEV1%VCmax (%)		102.5	106.8
DLCOc (mmol/min/kPa)		85.2	84.6

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Citations should be made in the following way:
M. Bernasconi, D. Berger, M. Tamm, D. Stolz (Switzerland). Aquarism: An innocent leisure activity?. Eur Respir J 2010; 36: Suppl. 54, 1470

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