Puffer fish (Tetrodotoxin) poisoning: an analysis and outcome of six cases

Abstract

On 24 July 2005, six members of a single family were admitted to the Medicine and Pediatrics Department of Khulna Medical College Hospital, Khulna, Bangladesh, with a history of ingestion of puffer fish. All patients developed toxic manifestations. The cases were clinically analysed with successful outcomes.

Multiple Outbreaks of Puffer Fish Intoxication in Bangladesh, 2008

“…1 Tetrodotoxin, the puffer fish's toxin, is present in the liver, gall bladder, intestine, gonads, eggs, and skin of the fish in sufficient amounts to cause intoxication among people who eat the fish. [1][2][3][4] The body musculature is less poisonous. 1 In humans, this neurotoxin blocks the sodium channel in the excitable cell membrane and causes deadening of the tongue and lips, dizziness, and vomiting followed by numbness and prickling over the body, rapid heart rate, decreased blood pressure, and muscle paralysis.…”

“…1 In humans, this neurotoxin blocks the sodium channel in the excitable cell membrane and causes deadening of the tongue and lips, dizziness, and vomiting followed by numbness and prickling over the body, rapid heart rate, decreased blood pressure, and muscle paralysis. 1,3,5,6 Death results from respiratory arrest because of paralysis of the respiratory muscles. 6 Tetrodotoxin poisoning has no specific antidote, but immediate supportive treatment and judicious administration of neostigmine, along with atropine, can minimize fatalities.…”

“…9,11 There are published reports of sporadic episodes of puffer fish toxicity in Bangladesh, primarily from districts in the coastal region. 3,12 These reports have focused on the clinical and toxicological analysis of puffer poisoning, with little information on local availability of the fish or the communities' knowledge and understanding of toxicity of the fish. 1,3,7,12,13 During April and June 2008, a collaborative team from the Institute of Epidemiology, Disease Control and Research (IEDCR) and International Center for Diarrheal Disease Research, Bangladesh (ICDDR, B) investigated three different outbreaks of puffer fish poisoning in Narshingdi, Dhaka, and Natore Districts.…”

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

“…In this low-income setting, when persons find free or less expensive fish in the market, they take advantage of the opportunity. 4,13,16 The social ecological theory explores how a societies' struggle for livelihoods can produce certain disease patterns. 23 We explored this outbreak at multiple levels of the society by identifying factors from the individual, family, community, and national levels that enabled the outbreak to occur.…”

“…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. 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.…”