The onset of symptoms of pufferfish poisoning may occur within 10 minutes of ingestion of toxic fish or be delayed for ≥4 hours. The toxin does not alter the taste or appearance of the fish, and it is not destroyed or inactivated by cooking, canning, freezing, or smoking. Levels of toxin are usually highest in the ovaries, liver, intestine, and skin. Venom from the salivary glands of the blue ringed octopus contains tetrodotoxin and bites may be fatal. In addition to pufferfish, porcupine fish, and ocean sunfish, tetrodotoxin has been found in other marine animals, such as starfishes, flatworms, various crabs, and mollusks. It acts by binding to sodium channels and blocking axonal nerve transmission, and results in ascending paralysis and respiratory failure. Tetrodotoxin is a heat-stable, water-soluble, nonprotein toxin that is 50 times more potent than strychnine. In 1996, three cases of fugu poisoning occurred in San Diego in chefs who ate prepackaged, ready-to-eat fugu illegally imported from Japan. 29 Nowadays, all cooks and restaurants handling fugu must be licensed, and most cases of pufferfish poisoning occur in inexperienced fishermen who prepare their own food. For example, in the 10-year period from 1967 to 1976 there were 1105 cases and 372 deaths (34% mortality), and from 1983 to 1992 there were only 449 cases and 49 deaths (11% mortality). Increased awareness of fugu poisoning and strict regulation and training of licensed fugu chefs has resulted in far fewer cases and lower mortality in recent years. Over the 78-year period from 1886 to 1963, there were 6386 cases of fugu poisoning in Japan, with an approximately 59% mortality. The fugu experience is characterized by tingling of the lips and tongue, a sensation of generalized warmth and flushing, and a feeling of euphoria and exhilaration. The fugu is filleted, thinly sliced, and then arranged in traditional patterns such as a crane. Most cases of pufferfish poisoning occur in Japan, where pufferfish or fugu is eaten as a very expensive and prized delicacy. It is likely that tetrodotoxin is synthesized by bacteria such as Actinomyces, Alteromonas, Aeromonas, Pseudomonas, and Vibrio spp. #Fugu fish death skin#2 The toxin is usually concentrated in the ovaries, liver, intestines, and skin of the fish. Potentially toxic fish are distributed widely throughout the world and include pufferfish, porcupine fish, and ocean sunfish. Pufferfish or fugu poisoning occurs after ingestion of fish containing tetrodotoxin, a potent neurotoxin. One of the earliest recorded outbreaks of pufferfish poisoning in travelers may have involved Captain Cook and members of his crew, who became ill after eating pufferfish liver while sailing in the South Pacific during their second voyage around the world in 1774 ( Box 49.3). Pufferfish poisoning has been recognized since ancient Egyptian times. Vernon Ansdell, in Travel Medicine (Fourth Edition), 2019 Pufferfish (Fugu) Poisoning Table 2 summarizes detection of various TTX levels in Asian patients between 19. TTX poisoning by horseshoe crab is evident in Thailand. Other than puffer fish, edible marine gastropod-associated poisoning is also a concern in China and Taiwan. The fishes have been found to be most dangerous if eaten just before or during their reproductive season due to a positive relationship between gonadal activity and toxicity. Recent cases of morbidity and mortality in Bangladesh due to consumption of puffer fish have also been described. Episodic cases have been documented in the US. TTX intoxication is also frequently reported from some cities in China. Cases of death are also found in Hong Kong, Singapore, and Australia. Approximately 50 people die of puffer fish poisoning in Japan every year. During 1974–83, the incidence of puffer fish intoxication was estimated to be approximately 200 cases annually, with almost 50% mortality. The bacteria were isolated from the skin of a puffer fish Takifugu poecilonotus in 1987, and production of TTX and its derivatives was subsequently confirmed in the laboratory. have been considered as putative TTX producers in puffer fish and other TTX-harboring marine animals. According to recent evidences, Pseudomonas spp. This poisoning has mostly been associated with the consumption of puffer fish from waters of the Indo-Pacific ocean regions. Puffer fish poisoning has been reported to a great extent in many parts of the world, particularly in coastal areas.
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