The pufferfish, considered a delicacy in multiple countries, contains tetrodotoxin which causes sodium channel blockade and can lead to muscle paralysis, respiratory failure, and death.
Pufferfish are members of the Tetraodontidae family, with almost 200 species known. Most pufferfish contain tetrodotoxin, a dangerous marine toxin up to 1200 times more toxic to humans than cyanide . Tetrodotoxin is heat-stable, odorless, and tasteless .
It exerts its dangerous effects by binding to voltage-gated sodium channels in the nerve and muscle tissue, blocking the flow of sodium ions across this channel and preventing generation and propagation of the action potential. This results in paralysis which can lead to respiratory failure and death . Intoxication from ingestion of affected species was previously isolated to countries known to historically have higher pufferfish consumption (Japan, China, Korea, Taiwan). Pufferfish, also known as fugu, is served as a delicacy and perioral numbness is a well-known effect . There is increasing frequency of human poisonings from ingestion of tetrodotoxin-containing pufferfish in less traditional areas, including multiple countries in the Mediterranean as well as the US, Australia, New Zealand, and Spain [5-7]. It is thought that the “spread” of toxicity from pufferfish across the world may be secondary to increasing global water temperatures .
What is the clinical presentation of tetrodotoxin poisoning following pufferfish ingestion? [4, 5]
Onset: Most cases will present within 5-30 minutes of ingestion; however, onset of symptoms as late as 20 hours after ingestion is reported.
Gastrointestinal effects: Nausea or vomiting, hyperemesis, abdominal pain, gastrointestinal motility disorders, hematemesis, and diarrhea
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