Puffer fish poisoning in Bangladesh: clinical and toxicological results from large outbreaks in 2008

Q. T. Islam, M. A. Razzak, M. A. Islam, M. I. Bari, A. Basher, F. R. Chowdhury, A. B.M. Sayeduzzaman, H. A.M.N. Ahasan, M. A. Faiz, O. Arakawa, M. Yotsu-Yamashita, U. Kuch, D. Mebs

    Research output: Contribution to journalArticlepeer-review

    66 Citations (Scopus)

    Abstract

    Poisoning after eating puffer fish containing highly lethal tetrodotoxin (TTX) is widespread in Asia. In 2008, naïve 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.

    Original languageEnglish
    Pages (from-to)74-80
    Number of pages7
    JournalTransactions of the Royal Society of Tropical Medicine and Hygiene
    Volume105
    Issue number2
    DOIs
    Publication statusPublished - 2011 Feb

    Keywords

    • Bangladesh
    • ELISA
    • Poisoning
    • Puffer fish
    • TTX
    • Tetrodotoxin

    ASJC Scopus subject areas

    • Parasitology
    • Public Health, Environmental and Occupational Health
    • Infectious Diseases

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