Fish poisoning (
) by consumption of members of
is one of the most violent
intoxication from marine species. The gonads, liver, intestines,
and skin of pufferfish can contain levels of tetrodotoxin
sufficient to produce rapid and violent death. The flesh of many
pufferfish may not usually be dangerously toxic. Tetrodotoxin has
also been isolated from widely differing animal species, including
metabolic source of tetrodotoxin is uncertain. Reports of the
production of tetrodotoxin/anhydrotetrodotoxin by several bacterial
species, including strains of the family
point toward a bacterial origin of this family of toxins. These are
relatively common marine bacteria that are often associated with
marine animals. If confirmed, these findings may have some
significance in toxicoses that have been more directly related to
these bacterial species.
The diagnosis of tetrodon poisoning is based on the observed
symptomology and recent dietary history.
Poisonings from tetrodotoxin have been almost exclusively
associated with the consumption of pufferfish from waters of the
Indo-Pacific ocean regions. Several reported cases of poisonings,
including fatalities, involved pufferfish from the Atlantic Ocean,
Gulf of Mexico, and Gulf of California. There have been no
confirmed cases of poisoning from the Atlantic pufferfish,
. However, in one study, extracts from
fish of this species were highly toxic in mice. The trumpet shell
has been implicated in food poisonings, and
evidence suggests that it contains a tetrodotoxin derivative. There
have been several reported poisonings from mislabeled pufferfish
and at least one report of a fatal episode when an individual
swallowed a California newt.
The first symptom of intoxication is a slight numbness of the
lips and tongue, appearing between 20 minutes to three hours after
eating poisonous pufferfish. The next symptom is increasing
paraesthesia in the face and extremities, which may be followed by
sensations of lightness or floating. Headache, epigastric pain,
nausea, diarrhea, and/or vomiting may occur. Occasionally, some
reeling or difficulty in walking may occur. The second stage of the
intoxication is increasing paralysis. Many victims are unable to
move; even sitting may be difficult. There is increasing
respiratory distress. Speech is affected, and the victim usually
exhibits dyspnea, cyanosis, and hypotension. Paralysis increases
and convulsions, mental impairment, and cardiac arrhythmia may
occur. The victim, although completely paralyzed, may be conscious
and in some cases completely lucid until shortly before death.
Death usually occurs within 4 to 6 hours, with a known range of
about 20 minutes to 8 hours.
All humans are susceptible to tetrodotoxin poisoning. This
toxicosis may be avoided by not consuming pufferfish or other
animal species containing tetrodotoxin. Most other animal species
known to contain tetrodotoxin are not usually consumed by humans.
Poisoning from tetrodotoxin is of major public health concern
primarily in Japan, where "fugu" is a traditional delicacy. It is
prepared and sold in special restaurants where trained and licensed
individuals carefully remove the viscera to reduce the danger of
poisoning. Importation of pufferfish into the United States is not
generally permitted, although special exceptions may be granted.
There is potential for misidentification and/or mislabeling,
particularly of prepared, frozen fish products.
Food and Drug
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a
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