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June 1, 2005

Respiratory Illness as a Reaction to Tropical Algal Blooms Occurring in a Temperate Climate

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(21):2595-2600. doi:10.1001/jama.293.21.2599-c

To the Editor: In the summers of 2003 and 2004, 2 microalgal blooms of potentially toxic dinoflagellates (genus Ostreopsis, usually distributed in tropical waters) occurred along the coasts of Bari, south Italy. Our findings suggest an association between this phenomenon and concomitant symptoms in people exposed to marine aerosols.


During mid-August 2003 and early September 2004, symptoms of rhinorrhea, cough, wheezing, and fever were observed during periods of 7 and 5 days, respectively, in people exposed to marine aerosols by recreational activities on the beach (swimming or sunbathing) or working activities (swimming attendants involved in entertainment activities in the water and on the beach, assistance to the swimmers, and cleaning the beach and swimming pools). Although a mild macroalgal mucilage was floating on the surface, the water appeared clear. Some people described a metallic taste of the water. Three days after the onset of symptoms during both summers, marine waters to which patients had been exposed were analyzed for temperature, salinity, pH, nitrogen and phosphorus contents, and phytoplankton presence/abundance. Follow-up testing was conducted 3 to 4 days after the last patient was identified. The study was approved by the Institutional Review Board and the patients gave written informed consent.

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