Poisoning after ingestion of pufferfish in Brazil: report of 11 cases
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LETTER TO THE EDITOR
Open Access
Poisoning after ingestion of pufferfish in Brazil: report of 11 cases Eneida Márcia de Souza Simões1, Thelma Marly Abreu Mendes1, Angelino Adão1 and Vidal Haddad Junior2*
Abstract In this brief communication the authors report eleven cases of human poisoning caused by ingestion of pufferfish meat. Three patients (two children and one adult) were seriously affected. The circumstances that precipitated the poisoning are discussed as well as the clinical aspects observed. No deaths were registered and the patients did not present sequelae after the episode. Keywords: Pufferfish, Marine poisonings, Poisonous animals, Poisonous fish, Tetrodotoxin
Dear Editor of JVATiTD, Pufferfish or blowfish (baîaku, in ancient Tupian language) are marine bony fish commonly found in tropical areas. They are capable of inflating their body by swallowing air or water, assuming a rounded shape that makes difficult the predation by other animals. Additionally, pufferfish may store toxins synthesized by bacteria that cause severe poisoning when its viscera, skin or muscles are ingested [1-5]. The majority of victims of pufferfish poisoning are fishermen and their families that usually consume their meat [1-5]. In Japan, the approximate number of poisonings per year is 50 with a high death rate [1-5]. In that country, there is a typical dish that employs raw pufferfish meat (fugu). In Brazil, the most important genera are Lagocephalus and Sphoeroides. The former accumulates less toxins and is not commonly associated with poisoning, while the latter is related to most accidents in the country [1-5]. The most common pufferfish toxin is the tetrodotoxin, a neurotoxin with violent paralyzing effect, which blocks sodium channels. The symptoms usually begin within six hours with perioral paresthesia, weakness of facial muscles and extremities, abdominal pain, drooling, nausea, vomiting, and diarrhea. Patients may have motor dysfunction with muscular weakness, hypoventilation, * Correspondence: [email protected] 2 Department of Dermatology, Botucatu Medical School, São Paulo State University (UNESP – Univ Estadual Paulista), Caixa Postal 557, Botucatu, SP CEP 19618-000, Brasil Full list of author information is available at the end of the article
and dysarthria. The ascending paralysis occurs within 4 to 24 hours, with paralysis of the extremities followed by paralysis in respiratory muscles. Late cardiac and central nervous system dysfunction may be observed. Patients with severe poisoning may develop important muscular paralysis, have fixed and non-reactive pupils, apnea, and absence of encephalic trunk reflexes, but they remain aware. Victims who survive the acute phase of intoxication (the first 24 hours), usually recover without long term consequences, but full recuperation may take days. There is no antidote, and the treatment is based on responding to manifested signs and symptoms [1-5]. In this communication, we report the poisoning of 11 members of a family from Duque de Caxias city (Rio de Janeiro
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