Puffer fish poisoning

Puffer fish poisoning is caused by tetrodotoxin. It occurs within several hours of eating. Tetrodotoxin is present in the livers, gonads, intestines, and skin of pufferfish. In Japan, the pufferfish delicacy is prepared by special chefs. The toxin is not destroyed by freezing or cooking.

CASES/YEAR
1 (US); 250 (Global)
AGENT TYPE
Toxins
OTHER NAMES
Tetrodotoxin, acute effect;
ACUITY
Acute-Severe
INCUBATION
Within several hours of eating; [CCDM, p. 226] Within 60 minutes in fatal cases; [Cecil, p. 693]
INITIAL SYMPTOMS
Grade 1: Perioral numbness, paresthesias & nausea; Grade 2: facial & tongue numbness, mild paresis, incoordination & slurred speech; Grade 3: respiratory paralysis & dilated fixed pupils; [Cecil, p. 693]
PRECAUTIONS
COMMENTS
Puffer fish poisoning (tetrodotoxin) causes paresthesias, dizziness, gastrointestinal distress, ataxia, and may rapidly progress to respiratory paralysis. [CCDM, p. 226] Tetrodotoxin is present in the livers, gonads, intestines, and skin of pufferfish (blowfish, balloonfish, and toadfish), porcupinefish, and sunfish (Mola species). In Japan, the pufferfish delicacy is prepared by special chefs. [Cecil, 24th Ed, p. 699] The toxin is not destroyed by freezing or cooking. [Merck Manual, p. 3064]
DIAGNOSTIC
Clinical; Detection of tetrodotoxin in fish;
SCOPE
Most cases are in Japan. [CCDM]
SIGNS & SYMPTOMS
  • >fatigue, weakness
  • E dysphagia
  • G diarrhea
  • G nausea, vomiting
  • N muscle weakness
  • N paresthesia
  • R dyspnea
  • *bleeding tendency
  • *paralysis
ANTIMICROBIC

No

VACCINE

No

ENTRY
Ingestion
SOURCE
Animal Tissue, Eating Infected or Toxin-Containing Fish
RESERVOIR
Fish and Shellfish
RISK FACTORS
  • Ingest toxins in food or water
  • Victim--air release of toxins
  • Victim--water/food release
TREATMENT
No specific antidote; Cardiopulmonary support is the focus of treatment. The toxin degrades within a few hours. [Cecil, p. 693]
DRUG LINK
REFERENCES FOR CASES/YEAR
1. (US) Estimated 1 case/year;
2. (Global) About 50 deaths are reported every year in Japan; Poisoning cases have been reported in Mexico; 10 deaths were reported in Europe from 1974-1979 (sale no longer permitted); [Whittle2000: PMID 10885118] Cases may also occur in California, Africa, South America, and Australia. "In some studies, mortality has approached 50%." [Goldfrank's Toxicological Emergencies, 9th Ed. P. 671] Guesstimate: 200 in Japan and 50 elsewhere including 1 in US;