Tetrodotoxin poisoning

Selective blockade of fast sodium channels in nerves and muscle membranes 

Bowel movements - diarrhea Cranial nerves - palsy Dizziness (true vertigo) 

Extremities - pain, shooting (paresthesias) Extremities - sensations, abnormal (dysesthesias) Head - pain (headache) 

Mentation - floating sensation Mouth - numb Muscles, gen - paralysis Muscles - pain (myalgia) 

Skin - sensation, reversed hot-cold Speech - inarticulate (dysarthria) 

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Tetrodotoxin poisoning has been recogniz for more than two thousand years. Japanese historical records show that the consumption of certain species of pufferOsh (Tetraodon spp.) resulted in paralytic intoxication (8), This problem continues in modern times in various i ian countries, especially Japan, where pufferfish are still regarded as a delicacy. Clinical symptoms of TTX intoxication include numbness, paralysis, and in some instances death. In fact, the "zombie state described in the Voodoo religion has been attributed to TTX in potions derived from pufferOsh (9). 

Yang, C., et al.. An outbreak of tetrodotoxin poisoning following gastropod mollusc consumption. Hum. Exp. Toxicol., 14, 446, 1995. 

Hwang DF, Noguchi T. (2007) Tetrodotoxin poisoning. Adv Food Nutr Res 52 141-236. 

CDC (1996) Tetrodotoxin poisoning associated with eating puffer fish transported from Japan-Cali-fornia. Morbidity and Mortality Weekly Report 45 389-391. 

Staphylococcus food poisoning, 215-217 Sulfur mustard poisoning, 403-406 Tetrodotoxin poisoning, 414-417 Thallium poisoning, 418-421 Trichinellosis, 222-226 Trichothecene poisoning, 422-425 Typhoid fever, 232-236 Typhus - epidemic, 237-241 Typhus - murine, 242-245 Typhus - scrub, 246-249 Viral gastroenteritis, 254-256 West Nile fever, 261-265 Yellow fever, 270-273 Yersiniosis, 274-277... 

As has already been cited, causes of tetrodotoxin poisoning and subsequent fatalities have been reported for centuries. Up to a point... 

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... 

Other Southeast Asian countries have also reported cases of tetrodotoxin poisoning. A report from the Poison Control Center in Taiwan, with a 1989 population of approximately... 

The mortality rate is dependent on, among other things, timely access to intensive care facilities. In some series, it has approached 60% [133,145]. When death results, it usually occurs within 6 h, and sometimes as rapidly as 17 min, following toxin ingestion. Persons who have not died within 24 h generally recover completely. Similar to PSP, symptoms of tetrodotoxin poisoning usually resolve within 1-2 days and residual impairment has not been reported. The mortality rate from the retrospective analysis of 42 outbreaks of tetrodotoxin-associated paralytic snail poisoning in Asia was 5.2% and 16% had respiratory arrest [140]. 

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]. 

No risk factors for tetrodotoxin poisoning are known. It is likely that intoxication and its severity are dose dependent [137], Age has not been shown to increase the risk of illness in Taiwan, illness occurred in persons from 9 months to 71 years of age [137]. The toxin is heat stable so that cooking is not protective. Tetrodotoxin concentrates in the viscera and roe of some animals, such as puffer fish [148], Presumably,... 

Yang CC, Liao SC, Deng JR Tetrodotoxin poisoning in Taiwan an analysis of poison center data. Vet Human Toxicol 38 282-286, 1996. 

Kanchanapongkul J, Krittayapoositpot P. An epidemic of tetrodotoxin poisoning following ingestion of the horseshoe crab Carcinoscorpius rotundicauda. Southeast Asian J Trop Med Public Health 26 364-367, 1995. 

Yang CC, Deng JF, Tsai WJ, Lin TJ, Han KC. An outbreak of tetrodotoxin poisoning following gastropod moUusk consumption. Hum Exp Toxicol 14 446-450, 1995. 

Deng JF, Tsai WJ, Chung HM, Tominack RL. Hypertension as an unusual feature in an outbreak of tetrodotoxin poisoning. J Toxicol Clin Toxicol 29 71-79, 1991. 

Chew SK, Goh CH, Wang KW, Mah PK, Tan BY. Puffer fish (tetrodotoxin) poisoning clinical report and role of anti-cholinesterase drugs in therapy. Singapore Med J 24 6 >-lll, 1983. 

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