First Confirmed Case Of Puffer Fish Poisoning In India, Everything You Need To Know

What Is Puffer Fish?

Puffer fish ranges from one inch to more than two feet and is scaleless with rough, spiky skin and long tapered bodies. They have fat, round and bulging heads. All of them have four teeth that are fused to form a beak-like shape.

Puffer fish is also known as blowfish because to escape, they quickly ingest a huge amount of water in their elastic stomach and turn into balls which are many times bigger than their normal size. Also, some of their species have spines that help them from gulping by predators. Some puffer fish have wild colours in their bodies to show their toxicity while some blend their colours with the environment.

More than 120 species of puffer fish are found worldwide mostly in tropical and subtropical ocean waters, while some live in fresh and brackish water also. [3]

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Why Is Puffer Fish Poisonous?

A study says that puffer fish contains tetrodotoxin (TTX), a potent neurotoxin that can cause human intoxications and fatalities to a large extent. The toxin is responsible for causing death by circulatory failure, muscular paralysis and respiratory depression.

Studies say that the origin of TTX cannot be identified, but in puffer fish, it is known to be produced by endosymbiotic bacteria that pass down the food chain. [4]

The toxicity due to TTX is high in Asian countries such as Japan, where the fish is eaten as a delicacy. However, in Japan, the limit of preparation of ‘fugu' or puffer fish and its consumption is strictly controlled by law, followed by preparation by only chefs who are qualified.

Another study says that TTX blocks sodium channels that may cause heart failure and death in many cases. It has a direct effect on motor, peripheral, autonomic and sensory nerves and may cause a drop in blood pressure, depressing respiration and blockage in peripheral autonomic nerves. [5]

Tetrodotoxin comes under the list of most toxic substances known and is 1200 times more lethal than cyanide and 50 times more dangerous than strychnine or curare, with no known antidote. [6]

Analgesic Effects Of Tetrodotoxin

Though TTX is a neurotoxin and highly lethal for humans, it has certain analgesic effects on cancer pain, inflammation pain, acute pain, neuralgia and other pain types linked to burning, trauma, arthritis and contusion.

The TTX works as analgesia as it blocks the sodium channels and thus, decreases the nerve impulse and excitations of the nervous system, especially at the injury sites and eases pain.

TTX, as a drug, is given via subcutaneous or intramuscular injections to avoid stomach problems as it is unstable in gastric acid. Also, the dose is given in controlled amounts after recommendation by a medical expert. [7]

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Symptoms Of Puffer Fish Poisoning

A study says that whenever a person experiences food poisoning along with certain neurological signs, their history of seafood or fish consumption is evaluated first.

Upon consumption, the symptoms usually begin in between 15-30 minutes and include: [8]

• Mild paraesthesia or Tingling in the mouth or extremities
• Nausea
• Dizziness
• Hypotension or low blood pressure
• Vertigo
• Aphasia
• Vomiting
• Muscle weakness
• Loss of consciousness
• Paralysis
• Respiratory failure causing death

Some Advisory On Puffer Fish By The FDA

• The ovaries and testes, liver, skin and intestines of puffer fish usually contain the toxin. Therefore, it should be cleaned and cooked in a special manner after removal of toxic organs. [9]
• The TTX in the fish cannot be destroyed by freezing or cooking, and in fact, freezing and thawing of this fish prior to removal of toxins can cause spread of the toxin into the flesh.
• Personal importation of puffer fish in many countries is strictly prohibited due to the health hazard related to it.
• For restaurants selling or serving puffer fish has to follow state and local rules and regulations to do so, along with FDA recommendations.

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Treatment Of Puffer Fish Poisoning

To date, there is no effective antidote for tetrodotoxin poisoning by puffer fish. In many cases, the death due to TTX has been recorded within 17 minutes of consumption.

Therefore, the person needs to be immediately rushed to the hospital for possible treatment of the symptoms.

In the case of respiratory failure, they should be provided immediate mechanical ventilation. Gastric emptying via vomiting is also suggested to allow the poison to come out of the body.

The use of activated charcoal helps bind the toxin in the body. [10]

Monoclonal neutralising antibody injection is also effective and is known for 100% survival rates in mice. No reports have yet been reported in humans. [11]

Drugs with yet-to-be-proved benefits include cholinesterase inhibitors, gastric lavage with sodium bicarbonate, naloxone, cysteine, steroid and antihistamines.

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To Conclude

Puffer fish in India is endemic to Kerala and Southwest India. In some licensed restaurants in India, especially Mumbai, fugu or puffer fish dishes are served by highly trained chefs who are experts in cleaning and cooking the fish without toxicity.

The fish has a unique flavour, which is why, some people prefer consuming it, in spite of knowing about dangers related to it.

However, self-cleaning and cooking of the fish is not suggested.