Tetrodotoxin Reaches Europe: First Case

November 15, 2010, 7:19 pm


Seafood Intoxication by Tetrodotoxin: First Case in Europe. Fernandez-Ortega JF et al. J Emerg Med November 2010;39:612-617.


This important case report describes a 49-year-old man who developed generalized paralysis and respiratory failure  after consuming a trumpet shellfish (Charonia lampas sauliae) that had been caught off the southern coast or Portugal.  Tests done on the remains of the gastropod and on the patient’s blood and urine were negative for saxitoxin — the cause of paralytic shellfish poisoning (PSP) — but positive for tetrodotoxin (TTX). The authors note that this is the first case of tetrodotoxin poisoning reported to be caused by a fish or shellfish caught in European waters, and hypothesize that global warming may be responsible for the spread of microalgae that produce the toxin.

Clinically, this case had a classic presentation for TTX poisoning.  Within minutes of eating the gastropod the patient experienced perioral numbness, then more generalized paresthesias along with abdominal pain, nausea, and vomiting.  Muscle weakness quickly progressed to muscle paralysis and respiratory insufficiency.  He was supported with intubation and mechanical ventilation.  Motor activity started to return 25 hours after ingestion, and recovered completely within 72 hours.  Other diagnoses that were considered before the results of the TTX tests were available included PSP, clostridium botulinum, Guillain-Barre syndrome, and a cerebral vascular accident.

Several years ago in Chicago, there were two cases of TTX poisoning stemming from imported puffer fish that was erroneously labelled as “monkfish”.

Related posts:

Poisonous tetrodotoxin-containing sea slugs invade Auckland!

What the fugu — the secret of poison sushi

To read my 2007 Emergency Medicine News report describing a dinner of puffer fish prepared three ways, click here.

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