“Algal-dromes”: a novel conceptual approach to illness in humans exposed to harmful algal bloom toxins

Although adverse health effects from harmful algal bloom (HAB) toxins have been described since antiquity, the true worldwide incidence and disease burden has yet to be defined. This is in part due to lack of reporting and under-recognition of exposure. Furthermore, when human exposure does occur, there exists little consensus on optimal treatment strategies for specific HAB events or confirmatory laboratory testing capabilities. Current management strategies largely rely on primary prevention through public health efforts, often undertaken at the state and local level. As serious illness is rare, current management of acute algal poisoning is mostly based on expert opinion and case reporting. Despite this, known incidence of human exposure to HAB toxins is increasing due to shifting environmental conditions, rising global seafood demand, and growing population density and development along coastal and freshwater bodies. This rise in human exposures underscores the pressing public health need to address current knowledge gaps. This paper provides a comprehensive review of many of the major algal toxins (specifically ciguatoxin, saxitoxin, azaspiracid, brevetoxin, okadaic acid, dinophysistoxin, domoic acid, and cyanotoxins), the management strategies associated with suspected poisoning, and presents a novel term to describe the unique syndromes associated with their illness; "algal-dromes."