Management of Arthrofibrosis of the Knee after an Arthroscopic Meniscectomy with Paralytic Shellfish Poisoning Toxin. Case Report.

Objective: The purpose of this study is to evaluate the use of paralytic shellfish poisoning toxin in a patient with arthrofibrosis of the knee. Arthrofibrosis is a common complication of knee surgery that tends to manifest itself as a limitation of the musculoskeletal ranges. Paralytic shellfish poisoning toxin has been proposed as an alternative treatment for painful musculoskeletal pathologies. Subjects: Use of paralytic shellfish poisoning toxin in arthroscopic menisectomy. Case report. Methods: Three doses of paralytic shellfish poisoning toxin were administered in an intra-articular manner on different days. Functionality, musculoskeletal ranges, pain at rest and pain during motion were evaluated. Results: The current alternatives for management of arthrofibrosis include the use of oral steroids, physiotherapy, mobilization under anesthesia and the liberation of arthroscopic debris. This case is the first report of the use of paralytic shellfish poisoning toxin. The adverse effects the patient presented coincided with those described in the literature but without the presence of severe reactions. Improvement in functional tests, progress in musculoskeletal ranges and a decrease in the level of pain were achieved. Adverse effects included parenthesia and a feeling of weightlessness.

Paralytic Shellfish Poisoning Toxin-Producing Cyanobacterium Aphanizomenon gracile in Northeast Germany

ABSTRACT Neurotoxic paralytic shellfish poisoning (PSP) toxins, anatoxin-a (ATX), and hepatotoxic cylindrospermopsin (CYN) have been detected in several lakes in northeast Germany during the last 2 decades. They are produced worldwide by members of the nostocalean genera Anabaena, Cylindrospermopsis, and Aphanizomenon. Although no additional sources of PSP toxins and ATX have been identified in German water bodies to date, the observed CYN concentrations cannot be produced solely by Aphanizomenon flos-aquae, the only known CYN producer in Germany. Therefore, we attempted to identify PSP toxin, ATX, and CYN producers by isolating and characterizing 92 Anabaena, Aphanizomenon, and Anabaenopsis strains from five lakes in northeast Germany. In a polyphasic approach, all strains were morphologically and phylogenetically classified and then tested for PSP toxins, ATX, and CYN by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and enzyme-linked immunosorbent assay (ELISA) and screened for the presence of PSP toxin- and CYN-encoding gene fragments. As demonstrated by ELISA and LC-MS, 14 Aphanizomenon gracile strains from Lakes Melang and Scharmützel produced four PSP toxin variants (gonyautoxin 5 [GTX5], decarbamoylsaxitoxin [dcSTX], saxitoxin [STX], and neosaxitoxin [NEO]). GTX5 was the most prevalent PSP toxin variant among the seven strains from Lake Scharmützel, and NEO was the most prevalent among the seven strains from Lake Melang. The sxtA gene, which is part of the saxitoxin gene cluster, was found in the 14 PSP toxin-producing A. gracile strains and in 11 non-PSP toxin-producing Aphanizomenon issatschenkoi, A. flos-aquae, Anabaena planktonica, and Anabaenopsis elenkinii strains. ATX and CYN were not detected in any of the isolated strains. This study is the first confirming the role of A. gracile as a PSP toxin producer in German water bodies.