101. Puffer fish poisoning in Bangladesh: clinical and toxicological results from large outbreaks in 2008
- Author
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Ariful Basher, Fazle Rabbi Chowdhury, Osamu Arakawa, M.A. Islam, Mari Yotsu-Yamashita, M.A. Razzak, Quazi Tarikul Islam, Ulrich Kuch, M.I. Bari, M.A. Faiz, Dietrich Mebs, A.B.M. Sayeduzzaman, and Ham Nazmul Ahasan
- Subjects
Adult ,Male ,Abdominal pain ,Adolescent ,Nausea ,Respiratory arrest ,Physiology ,Poison control ,Enzyme-Linked Immunosorbent Assay ,Tetrodotoxin ,Urine ,Disease Outbreaks ,Foodborne Diseases ,Young Adult ,Poverty Areas ,medicine ,Paralysis ,Animals ,Humans ,Child ,Bangladesh ,Tetraodontiformes ,business.industry ,Public Health, Environmental and Occupational Health ,Outbreak ,General Medicine ,Middle Aged ,Infectious Diseases ,Child, Preschool ,Anesthesia ,Vomiting ,Female ,Parasitology ,medicine.symptom ,Respiratory Insufficiency ,business ,Chromatography, Liquid ,Fishes, Poisonous - Abstract
Poisoning after eating puffer fish containing highly lethal tetrodotoxin (TTX) is widespread in Asia. In 2008, naive inland populations in Bangladesh were exposed to cheap puffer fish sold on markets. In three outbreaks, 141 patients with history of puffer fish consumption were hospitalized. Symptoms of poisoning included perioral paraesthesia, tingling over the entire body, nausea and vomiting, dizziness, headache, abdominal pain and muscular paralysis of the limbs. Seventeen patients (12%) died from rapidly developing respiratory arrest. Blood and urine samples from 38 patients were analyzed using a TTX-specific enzyme-linked immunoassay (ELISA). Medium to high TTX levels were detected (1.7-13.7 ng/ml) in the blood of 27 patients. TTX was below detection level (< 1.6 ng/ml) in 11 blood samples but the toxin was detected in urine. Ten patients had blood levels above 9 ng/ml and developed paralysis; seven of these died. The remaining patients recovered with supportive treatment. High concentrations of TTX and its analogues 4-epiTTX and 4,9-anhydroTTX were also found in cooked puffer fish by post-column liquid chromatography-fluorescence detection. To prevent future instances of puffer fish poisoning of this magnitude, measures should be implemented to increase awareness, to control markets and to establish toxicological testing. To improve the management of this and other poisoning in Bangladesh, facilities for life-saving assisted ventilation and related training of healthcare personnel are urgently needed at all levels of the health system.
- Published
- 2011
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