Multiple Outbreaks of Puffer Fish Intoxication in Bangladesh, 2008

Abstract

During April and June 2008, we investigated three outbreaks of marine puffer fish intoxication in three districts of Bangladesh (Narshingdi, Natore, and Dhaka). We also explored trade of marine puffer fish in Cox's Bazaar, a coastal area of the country. We identified 95 people who had consumed puffer fish; 63 (66%) developed toxicity characterized by tingling sensation in the body, perioral numbness, dizziness, and weakness, 14 of them died. All three outbreaks were caused by consumption of large (0.2–1.5 kg) marine puffer fish, sold in communities where people were unfamiliar with the marine variety of the fish and its toxicity. Coastal fishermen reported that some local businessmen distributed the fresh fish to non-coastal parts of the country, where people were unfamiliar with the larger variety, to make a quick profit. Lack of knowledge about marine puffer toxicity contributed to the outbreaks. Health communication campaigns will enhance people's knowledge and may prevent future outbreaks.

Seasonal Toxicity Assessment of Oblong Blowfish (Takifugu oblongus) from Tamil Nadu Coast, India

“…Yet another study by Khora in 1991, reported that skin of the pufferfishes were most toxic. Lee et al, in 2003 reported that TTX is accumulated in the pufferfishes through their food chain and indeed the toxicity varies depending on this factor too. Khora in 1994 reported that pufferfishes raised in captivity are non toxic.…”

“…Pufferfishes produce a potent neurotoxin named Tetrodotoxin (TTX) which is a sodium channel blocker in cell membranes. Reports indicated that TTX is much similar to saxitoxin (STX), which causes paralytic shellfish poisoning (How et al, 2003).…”

“…T. oblongus was a disaster to Bangladesh in the years 1998 and 2002 causing several deaths due to its toxin (Mahmud et al, 1999;Ahmed., 2006;Homaira et al, 2010). This study was undertaken to analyse the toxicity of the pufferfish Takifugu oblongus collected from the coast line of Tamil Nadu using Swiss albino mice.…”

Social Ecological Analysis of an Outbreak of Pufferfish Egg Poisoning in a Coastal Area of Bangladesh

“…1,4,5,8,[15][16][17] Only one study explored the use of pufferfish in the coastal region and the inhabitants' understanding about puffer toxicity and epidemiologic information. 12 Because the number of outbreaks being reported increased in 2008, it was important to explore if there had been recent changes in availability of pufferfish and its use.…”

“…9 Seven outbreaks of marine pufferfish poisoning have been reported in national newspapers, scientific articles, and unpublished work throughout Bangladesh during 1998-June 2008, which affected 156 persons and caused 40 deaths (case-fatality rate = 26%). 3,4,[12][13][14] However, most investigations have been limited to quantitative epidemiologic outbreak analysis, which primarily focused on the immediate risk factors associated with illness, and to signs and symptoms of case-patients and their management; a few studies highlighted the toxicologic characteristics of pufferfish. 1,4,5,8,[15][16][17] Only one study explored the use of pufferfish in the coastal region and the inhabitants' understanding about puffer toxicity and epidemiologic information.…”