Puffer poisoning cases

The poisonous properties of the puffer fish have been known for centuries, and were described as early as ad 220 in China. A Chinese treatise written in ad 600 by Chaun Yanfang (Studies on the Origin of Diseases) described the liver, ovaries, and roe as the most poisonous. Despite the risks, puffer fish is stiU eaten as a delicacy in Japan, where it is known as fugu. Fish that contain the toxin are also accidentally eaten sometimes. Consequently poisoning cases do occur. Between 1974 and 1983 there were 646 cases and 179 fatalities. It has been estimated that as many as 200 cases a year may occur, with a mortality rate of up to 50 per cent. A trained chef should know which parts of the fish to avoid. 

Tsunenari S, Uchknura Y, Kanda M. Puffer poisoning in Japan—a case report. J Forensic Sci 25 240-245, 1980. 

Recently, several poisoning cases due to ingestion of, in addition to those of puffers, big and small gastropods have caused in Japan, Taiwan, and China. Especially small gastropods in China have caused many poisoning for a long time, resulting in many deaths and caused serious problems in public health. 

In Taiwan and China, many food poisoning cases due to ingestion of wild puffer have occurred (Hwang, 2003a,b), while consumers here do not often eat puffer. According to data ofTTX poisoning in Taiwan (Table IV), TTX... 

Puffer poisoning occurs when people always intentionally consume toxic specimen or its tissues. In many cases, the consumers cannot differentiate the toxic puffer species, the strong toxic parts of puffer, and other TTX-bearing animals (toxic gobies, gastropods, crabs, horseshoe crabs, and so on). Hence, TTX-associated poisoning incidents do not minimize or prevent. 

On the other hand, to ensure the safety of consumers in some other Asian countries where the puffer consumption has been increasing, a comprehensive toxicological study should be carried out to identify the toxic and nontoxic puffer fish. On the basis of the results, consumer awareness should be created through several media in order to reduce the poisoning cases. In Japan, as described before, the death number decreases to less than one order although food poisoning cases occur every year. 

No reliable incidence data exist for tetrodotoxin poisoning. The most extensive data on tetrodo-toxin poisoning comes from Japan where 6386 cases of puffer fish poisoning were reported during the 78-year-period 1886-1963 (59.4% were fatal) [134, 135]. If the average population during this time is assumed to have been approximately 60,000,000, this implies a minimum incidence of... 

Locally acquired tetrodotoxin poisoning has been reported in Mexico [162], and the United States, where cases have occurred in Florida due to the consumption of locally caught puffer fish, which were assumed to be contaminated with tetrodotoxin [163,164]. 

Ravaonindrina N, Andriamaso TH, Rasolofonirina N. Puffer fish poisoning in Madagascar four case reports. Arch Inst Pasteur Madagascar 67 61-64, 2001. 

Lyn PC. Puffer fish poisoning four case reports. Med J Malaysia 40 31-34, 1985. 

Kan SK, David P, Chan MK. Nine fatal cases of puffer fish poisoning in Sabah, Malaysia. Med J Malaysia 42 199-200, 1987. 

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