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Archive Number 20100601.1820
Published Date 01-JUN-2010
Subject PRO/MBDS> Food poisoning, puffer fish - Cambodia: fatality, Kampong Cham, RFI
FOOD POISONING, PUFFER FISH - CAMBODIA: FATALITY, KAMPONG CHAM,
REQUEST FOR INFORMATION
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Mon 31 May 2010
Source: The Phnom Penh Post [edited]
<http://www.phnompenhpost.com/index.php/2010053139379/National-news/man-dies-from-eating-puffer-fish.html>
One person died, and 23 were hospitalized after eating poisonous fish
in Kampong Cham province's Batheay district late last week (week of
24 May 2010), officials said.
Lor Chanly, Batheay district governor, said a 38-year-old man died on
Thursday [27 May 2010] after he and 23 other residents from 2
villages in Mepring commune were poisoned by pufferfish caught in a
nearby lake.
Touch Huot, superintendent of Batheay district referral hospital,
where the villagers were treated, said Sunday [30 May 2010] that most
of the patients -- who had all suffered chest pains, stomachaches and
diarrhea -- had recovered.
"Only 2 of the 23 hospitalized have not left the hospital yet, and
they will be allowed to leave today [31 May 2010] because they are
getting better," he said.
Lor Chanly said it was the 1st time anyone had been poisoned by
pufferfish in the district and that he would warn people about the
dangers of the fish.
"I will take urgent action to inform my villagers about this and tell
them not to eat the fish anymore," he said.
The poisoned villagers received free treatment at the referral
hospital because they are all poor, Lor Chanly said.
"Normally, patients who are hospitalized for 3 days or more have to
pay between 40 000 and 60 000 riels [USD 10-15]," he said.
A 41-year-old resident of Kandal province's Kandal Stung district
died earlier this month [May 2010] after eating poisonous fish, but
it is unknown what kind of fish it was.
[Byline: Tep Nimol]
--
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>
[Although 2 fatalities associated with consumption of poisonous
fishes are reported in the above newswire, one death in Kampong Cham
province is attributable to consumption of puffer fish, and other 23
cases are hospitalized as well.
Puffer fish is also known as blowfish. Almost all puffer fish contain
tetrodotoxin (TTX), a substance that makes them foul tasting and
often lethal to fish. To humans, tetrodotoxin is deadly, up to 1200
times more poisonous than cyanide. There is enough toxin in one
puffer fish to kill 30 adult humans. There are more than 120 species
of puffer fish worldwide. Most are found in tropical and subtropical
ocean waters, but some species live in brackish and even fresh water
(see <http://animals.nationalgeographic.com/animals/fish/pufferfish.html>).
Small puffer fish inhabiting brackish water or freshwater in
Southeast Asia are also toxic. Toxicity of the skin is usually higher
than that of the viscera in these puffer fish. The toxin of brackish
water species was identified as TTX but in the freshwater species,
saxitoxins (STXs), toxins that belong to the paralytic shellfish
poison (PSP) family, were detected as the main toxic principles.
In Thailand and Cambodia, however, food poisoning incidents due to
the freshwater puffer fish have occasionally occurred, with some
fatalities. PSP is a group of neurotoxins produced by certain species
of dinoflagellates, and the main component, STX, has an almost
equivalent molecular size and action mechanism to TTX. Therefore, the
symptoms of freshwater puffer fish poisoning are very similar to
those of marine puffer fish poisoning, i.e., TTX poisoning (1).
Saxitoxin (STX) is heat- and acid-stable, and does not alter the odor
or taste of food. This toxin cannot be destroyed by cooking or
freezing. It is rapidly absorbed through the human gastrointestinal
tract and excreted in urine. This portion of the molecule is believed
to block the opening of the voltage-sensitive Na+ channel, preventing
the rapid entrance of sodium into the cell at depolarization. The
outcome of blockage at this site is motor paralysis. Ingestion of PSP
produces neurologic symptoms that are sensory, cerebellar, and motor.
The most common symptoms are tingling and burning of the mouth and
tongue, numbness, drowsiness, and incoherent speech. These symptoms
occur 30 minutes to 2 hours after ingestion of the fish, depending on
the amount of toxin ingested. In severe cases, ataxia, muscle
weakness, respiratory paralysis, and death can occur. Saxitoxin and
tetrodotoxin together and saxitoxin alone in freshwater puffer fish
have been reported in water near Thailand and Bangladesh (2).
Tetrodotoxin (TTX) is a powerful neurotoxin that can cause death in
approximately 50 percent to 60 percent of persons who ingest it. The
liver, gonads, intestine and skin of puffer fish contain the highest
concentrations of TTX. Tetrodotoxin is heat-stable and blocks sodium
conductance and neuronal transmission in skeletal muscles.
Paresthesia begins 10-45 minutes after ingestion, usually as tingling
of the tongue and inner surface of the mouth.
Other common symptoms include vomiting, lightheadedness, dizziness,
feelings of doom and weakness. Patients with severe poisoning may
fall into a coma, and death may occur within 4 to 6 hours of
ingestion. Typically, death is due to respiratory muscle paralysis.
Other manifestations include salivation, muscle twitching,
diaphoresis, pleuritic chest pain, dysphagia, aphonia and
convulsions. Diagnosis is based on clinical symptoms and a history of
ingestion. Treatment is supportive, and there is no specific antidote (3,4,5).
More information from reliable source on type of toxin associated
with one death and 23 cases hospitalized after consumption of puffer
fish in Batheay district, Kampong Cham province, Cambodia would be
highly appreciated by PRO/MBDS.
References
----------
1. Arakawa O, et al. Toxins of puffer fish that cause human
intoxications. Coastal Environmental and Ecosystem Issues of the East
China Sea, 2010; 227 - 44 (full article available at
<http://www.terrapub.co.jp/onlineproceedings/fs/nu/pdf/nu2010227.pdf>).
2. CDC. Neurologic illness associated with eating Florida pufferfish,
2002. MMWR, 2002;51:321-3.
3. Chowdhury FR, et al. Puffer fish (tetrodotoxin) poisoning: an
analysis and outcome of six cases. Trop Doct, Oct 2007; 37: 263-4
(full article available at <http://td.rsmjournals.com/cgi/reprint/37/4/263>).
4. Ahasan HA, et al. Paralytic complications of puffer fish
(tetrodotoxin) poisoning. Singapore Med J, Feb 2004; 45(2): 73-4
(full article available at <http://www.ncbi.nlm.nih.gov/pubmed/14985845>).
5. Kanchanapongkul J. Puffer fish poisoning: clinical features and
management experience in 25 cases. J Med Assoc Thai, Mar 2001; 84(3):
385-9 (abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/11460940>).
For a map of Cambodia with provinces, see
<http://www.discoveryindochina.com/cam/map_provinces.html>. For the
interactive HealthMap/ProMED-mail map with links to other recent
PRO/MBDS and ProMED-mail postings on Cambodia and neighboring
countries, see <http://healthmap.org/r/01qf>. - Mods.SCM/YMA]