Paralytic Shellfish Poisoning: Global Epidemiology, Clinical Manifestations, Management and Emerging Health Challenges – A Narrative Review

Abstract

Paralytic Shellfish Poisoning (PSP) is a potentially fatal marine toxin-mediated illness resulting from the consumption of seafood contaminated with saxitoxins and related paralytic shellfish toxins. These neurotoxins are primarily produced by harmful algal bloom-forming dinoflagellates of the genera Alexandrium, Gymnodinium, and Pyrodinium, and accumulate in filter-feeding shellfish and other marine organisms. PSP has been reported worldwide and remains an important public health concern, particularly in coastal communities dependent on shellfish harvesting and seafood consumption. Clinical manifestations range from mild perioral paresthesia and gastrointestinal symptoms to severe neuromuscular paralysis and respiratory failure. Diagnosis is largely based on clinical suspicion, exposure history, and laboratory confirmation of toxins in seafood or environmental samples. As no specific antidote is currently available, management remains primarily supportive, with early airway protection and mechanical ventilation being critical in severe cases. The increasing frequency of harmful algal blooms, climate change, expanding seafood trade, and the emergence of novel toxin analogues have contributed to renewed global interest in PSP. This narrative review summarizes the historical background, epidemiology, toxin classification, pathophysiology, clinical manifestations, diagnosis, management, prevention strategies, and emerging public health challenges associated with PSP. Improved surveillance, rapid diagnostic techniques, and multidisciplinary public health interventions are essential to reduce the burden of this potentially life-threatening intoxication. Future directions include artificial intelligence–based outbreak prediction, rapid biomarker-driven diagnostics, investigation of chronic low-dose neurotoxicity, and development of targeted antidotal therapies for saxitoxin poisoning. Future advances may include environmental DNA surveillance, toxin neutralizing nanotechnology, microbiome-based detoxification, synthetic biology approaches to reduce toxin bioaccumulation, and wearable neurophysiological monitoring systems, potentially transforming PSP prevention, early diagnosis, and therapeutic intervention.