Brevetoxins (PbTxs) are polyether ladder-shaped neurotoxins produced by the dinoflagellate Karenia brevis. Blooms of K. brevis have been recorded since the mid-1800s, principally in the Gulf of Mexico but occasionally along the mid and south Atlantic coasts. Blooms may be accompanied by public health issues as well as significant mortalities of marine mammals, such as bottlenose dolphins and manatees, fishes, sea birds, and sea turtles. PbTxs bind to the voltage-gated sodium channels (VGSCs), leading to persistent activation of neuronal, muscle, and cardiac cells. In humans, after consumption of contaminated shellfish (oysters, clams, whelks), these toxins cause a syndrome known as neurotoxic shellfish poisoning (NSP), characterized by nausea, diarrhea, vomiting, abdominal pain, paresthesia, myalgia, ataxia, bradycardia, loss of coordination, vertigo, and mydriasis. The ingestion of contaminated seafood represents the most dangerous route of exposure for humans. However, when PbTxs are aerosolized through the disruption of K. brevis cells by breaking waves or winds, people can suffer from respiratory effects such as conjunctivitis, rhinorrhea, and bronchoconstriction. Due to successful shellfish monitoring programs managed by the Gulf coast states, cases of human intoxications are fortunately rather rare, and no human fatalities have been attributed to NSP.
