Palythoa Toxica Poisoning - One Reefkeeper's Personal Experience With Palytoxin Poisoning
This post is by Adrienne Longo-White, a reefkeeper since 1992. At the time of this incident, Adrienne was working for Marine Depot Live.
I was preparing to do a Sunday evening water change on my aquarium and was contemplating some overdue maintenance. When non-hobbyists are nearby, I am often asked questions about the aquarium as I go about my routine with it. I had been telling my boyfriend at the time about the toxic animals that people keep in their reef tanks. I pointed out my brown zoanthids and explained Palythoa toxin. He frowned and told me to be careful around them. I told him I pull them off the rocks all the time and that I was in no danger. He left that evening as I was just about to start the water change. I was clearly busy and this looked like I was about to ask him to do work so off he went – out of the way of physical labor!
I decided on impulse that it was time to remove some ugly plain brown button polyps from my tank. They were encroaching the base of my prized nano-sized cup coral so I decided that they had to go. I removed the rock and used my fingers as well as a steak knife and fingernail (fingernail brush and knife are dedicated to use in the reef only). After popping the polyps off, I rinsed the rock off in the water that I had just performed a water change with to ensure that none of the mucus from the polyps would transfer into the water when it was placed back into the tank. As a precautionary measure I placed a bag of carbon next to the power head. When I was finished I washed my hands in the sink with soap and hot water, then took a shower shortly after. All done, right?
Around 9 pm I was feeling a little tired, nauseated and constricted in the chest when I’d try to breathe in deep. I figured I was getting my first cold of the season. By the time I went to bed at 10 pm I was feeling downright awful. I tossed and turned and woke at 1 am because I felt like I was freezing but I was bundled under several blankets. I felt like I was radiating heat and I’d melt at any moment and was trembling so hard I was having a difficult time maintaining balance when I stood up. My pulse was very rapid and was feeling dizzy and nauseous and went stumbling for a thermometer. As I rustled through the bathroom looking for a thermometer I woke my room mate who poked her head out of her room and asked what was up. I told her something was wrong and one look at me in the light and she agreed. We checked my temperature and it was normal. That was NOT what my body was telling me. By all rights and symptoms I had the flu – but without the fever.
Methodically she went down a list of what I had eaten and done that day. When I got to telling her about the last thing I did; removing the button polyps in the tank I stopped suddenly. It was at that moment I became aware of a horrible throbbing pain emitting from my left thumb and looked at it. The previous day I was at work moving a chiller and broke a nail. Apparently it left a small open cut as it broke off at the base. I was unaware of this when I started on my button polyp eradication. The area was swollen, red and throbbing horribly. My room mate asked what coral it was and what she needed to look for to find the symptoms in case I was having an allergic reaction. I told her I pulled zoanthids and to look up ‘palythoa toxica’. I knew it was a bad one to have issues with and I hoped that this wasn’t it. As she looked up info on her computer I sat at mine and tried to locate info. A few people were around in the reef related chat rooms and were helpful in getting information to my roommate. At this point I was having a hard time typing clearly and my vision was blurring. My roommate came flying out of her room muttering something about a guy named ‘Anthony’ and said I was showing all the signs of a reaction to Palythoa Toxica and that it could be fatal. She was talking about Anthony Calfo, of course. I’ve heard his great zoanthid palythoa story several times. Her new found panic made me feel so much better. She grabbed my keys and my arm and dragged me out of the house and headed for the hospital.
Upon my arrival at the hospital the admitting nurse was sure I had the flu and was hinting that I should just go home and go to bed. I tried to explain to her that I should have a fever if it was indeed the flu and this felt like no flu I’d ever dealt with. Breathing was becoming more difficult yet there was no sign of congestion or any blockage I could feel – just pain when I tried to use my full lung capacity. I told her my fingers and face were fuzzy feeling and numb feeling and that my thumb was throbbing horribly. The last time I had a flu my fingers didn’t throb. She rolled her eyes at me and took my temperature and vitals and sent me to wait in the front office. Informing me I was likely to wait 4 or 5 hours before I’d get to see the doctor because the flu was not an emergency. She made me feel like I was being such a baby. At this point I was fairly sure my roommate was right … I was in deep doo-doo.
After about a 30 minute wait things progressed. Let me tell you that feeling your lungs shutting down is NOT a happy feeling at all. I was fighting to breathe. My fingers were very tingly now and I was dizzy. I could hardly breathe though there was still no clear sign of congestion. My speech got strange like I was drunk. I was unable to focus or speak coherently. Absolutely desperate my roommate jumped up and pounded on the nurses desk and went over my new increased symptoms. She raised all sorts of racket (Go Kym) and eventually caught the attention of a security guard and luckily a doctor who was passing by.
Seems the doctor owns a reef tank and knew what “Patient claims she has ingested Palythoa toxin” meant when he reviewed the admitting paperwork and read my patient notes. After taking a few minutes to talk to me and agree that is what the problem was (and finding out he had a really nice 90 gallon SPS reef with a Euro reef skimmer, 40 gallon sump and a 20 gallon refugium and his tank has been up for 2 years. He pulled me into the back on a gurney and immediately went to work on me getting an IV in and some saline thru me (Ok actually not him, but the attendant did it. I’ve been told that if a doctor tries to put an IV in you to not let them do it). He instructed me to be injected with some steroids, Benedryl and five other things that I was too fuzzy to ask details on or disagree with. I was incredibly drowsy and dizzy at this point but I recall that I got the ‘wear gloves’ lecture from the doctor – along with my very own box of latex gloves and a threat from the doctor and my room mate that I better wear them. The doctor also took the time to read my admitting paperwork enough to notice I worked in the industry and asked me about an algae problem he had been having. I guess one good turn deserves another so I gave him some algae trouble shooting advice and aimed him at the online message boards. Gosh I hope it made sense because I wasn’t feeling very coherent. The doctor told me it was a very good thing that we didn’t hesitate too much longer to go in or that I didn’t roll over and force myself back to sleep because I had reacted pretty bad.
I was out of there by 5:30 am and went home and slept most of the day and that night too. Fastest emergency room treatment I’ve ever had! The next day I was back at work, was mostly functional with only occasional nausea. My face was still swollen, prickly, red and I was a little on the disconnected side. I didn’t take the Benedryl while I was at work or I would have been worse but I did take my other meds.
Palythoa toxin can build up in your system over time. The years I spent handling zoanthids at the wholesalers and online retailer probably didn’t help my situation much. I recall 2 or 3 times in the past where I called in sick to work from having milder cases of these symptoms assuming it was a mild case of the flu. I know that I handled zoanthids on a daily basis. While one employer freely offered gloves for us to wear whenever we wanted to – the other place did not (not to their fault. Had I said something I’m sure they’d have provided them willingly).
The moral to this story is to wear gloves if you are dealing with things you know are toxic in your system. I knew those button polyps were toxic but what I didn’t know was I had that cut on my thumb. I am forbidden by friends, family members and the significant other to even touch zoanthids. From now on when I deal with button polyps, zoanthids or anything from the Palythoa family you can be sure I’ll be wearing protection – cut fingers or not!
Learn more about palytoxins: Palytoxin, The World's Second Deadliest Poison, Possibly Available at Your LFS. If you have a palytoxin story you'd like to share with Advanced Aquarist readers, let us know.