To the Editor.—The excellent review by Eastaugh and Shepherd on infectious and toxic syndromes from fish and shellfish consumption1 failed to include the diarrhetic shellfish poisoning that is caused by the ingestion of mussels, clams, and scallops contaminated by okadaic acid and other toxins produced by Dinophysis algae.2 The authors possibly excluded this syndrome because of the absence of reported US cases. But the Archives' readers have the same wide geographical distribution as the implicated algae. So, some information on diarrhetic shellfish poisoning could be useful.
Symptoms begin usually within 4 hours (range, 30 minutes to 12 hours) after eating the contaminated shellfish, and include diarrhea, nausea, vomiting, and abdominal cramps. No fatal cases have been reported. The disease is self-limited and the treatment is supportive.2
During the period 1976 to 1982, more than 1300 cases were diagnosed in Japan, while sporadic cases were observed in