• Journal of The Korean Society of Clinical Toxicology
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• v.17 no.1
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• pp.1-6
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• 2019

Scombroid fish poisoning (SFP) is a form of histamine food poisoning caused by the ingestion of improperly stored fish. The term "scombroid" derives from the family name of the fish family first implicated, such as tuna and mackerel. On the other hand, non-scombroid fish species, such as sardine and herring, can also cause histamine poisoning. The histamine is converted from histidine by a bacterial enzyme in the causative fish. Because the symptoms of SFP can easily be confused with food allergies, it is believed to have been significantly under-reported. In 2016, an outbreak of SFP occurred among primary school students who had eaten yellowtail steak in Korea. The most common findings consisted of a rapid onset of flushing of the face and trunk, erythematous and urticarial rash, diarrhea, and headache occurring soon after consuming the spoiled fish. Usually, the course is self-limiting and antihistamines can be used successfully to relieve symptoms, but several life-threatening SFP cases have been reported. Clinical toxicologists should be familiar with SFP and have competency to make a differential diagnosis between fish allergy and histamine poisoning. SFP is a histamine-induced reaction caused by the ingestion of histamine-contaminated fish, whereas a fish allergy is an IgE-mediated reaction. This review discusses the epidemiology, pathophysiology, diagnosis, treatment, and preventive measures of SFP.

• Journal of Food Hygiene and Safety
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• v.18 no.3
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• pp.133-138
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• 2003

The data on outbreaks of puffer fish poisoning during 1991 to 2002 in Korea were gathered from press reports, and characterized information collected. During the period, a total of 32 outbreaks of puffer fish poisoning was reported. These outbreaks caused 111 persons to become poisoning, among the cases 30 persons were fatal. The mean case fatality rate was 27.0%, and most of deaths (93.3%) were the male of above 29 years old. Patient number of below 4 persons per a poisoning accident occupied 75.0% of total outbreaks; 65.8% of total cases; and 66.7% of total deaths) was occurred in the months, November through January. Most of puffer fish poisoning (75.0% of total outbreaks; 68.5% of total cases; and 73.3% of total deaths) were found along the south coastal area of Korea, including Busan, Gyeongsangnam-do, Jeollanam-do and Jeju-do. Over than 80% of puffer fish poisoning outbreaks occurred at fishing boat and home where privately made food was cause, and outbreaks in restaurants accounted for 15.6%. Most commonly implicated foods were Guk, boiled soup with puffer fish meat and spices.

• Journal of The Korean Society of Clinical Toxicology
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• v.9 no.2
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• pp.95-100
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• 2011

Purpose: Ingestion of puffer fish can be poisonous due to the presence of potent neurotoxins such as tetrodotoxin (TTX) found in its tissues. There are few clinical reports related to TTX. We performed this study to evaluate the clinical characteristics of TTX poisoning. Methods: We conducted a retrospective study of the 41 patients diagnosed with TTX poisoning who visited the Seoul Asan medical center from July 2004 and December 2010. A review of patients' electronic medical records and patient telephone interviews were conducted. Diagnosis of TTX poisoning was confirmed by observing the casual link between puffer fish consumption and the development of typical TTX intoxication symptoms. Results: The mean age of the patients included in the study was 46.6 years. The highest incidence of intoxication was observed in patients in their 50s (10 patients). Seasonal distribution of intoxication events included 10 in spring, 7 in summer, 10 in fall, and 14 in winter. In most cases, symptoms occurred within 1 hour of ingestion. A wide range of symptoms were associated with puffer fish ingestion affecting multiple body systems including neuromuscular (27 patients), gastrointestinal (19 patients), and cardiopulmonary/vascular (19 patients). All patients were treated with symptomatic and supportive therapy and recovered completely, without sequelae, within 48 hours. In three cases, ventilator support was required. Conclusion: TTX poisoning is not seasonally related, and patients admitted to the emergency room were observed with a wide range of symptoms. Where TTX poisoning is diagnosed, supportive therapy should be performed. Early intubation and ventilation is important, especially is cases of respiratory failure.

• Journal of The Korean Society of Clinical Toxicology
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• v.19 no.1
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• pp.55-58
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• 2021

Ciguatera is the commonest syndrome of marine poisoning that is caused by the ingestion of ciguatoxins that accumulate in certain tropical and subtropical finfish. It is endemic throughout the subtropical and tropical regions of the Indo-Pacific and Caribbean and has been rarely reported in Korea. With the expansion of travel, tourism, and the import of fish from the tropics, ciguatera poisoning now affects a diverse population. We report a case of ciguatera in a 70-year-old woman, presenting with general paralysis and coma, which developed after consuming codfish and mackerel in Korea.

• ALGAE
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• v.30 no.1
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• pp.49-58
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• 2015

In September 2007, reports of respiratory irritation and fish kills were received by the Florida Fish and Wildlife Conservation Commission (FWC) from the Jacksonville, Florida area. Water samples collected in this area indicated a bloom of Karenia brevis, the dinoflagellate that produces brevetoxin, which can cause neurotoxic shellfish poisoning. For the next four months, K. brevis was found along approximately 400 km of coastal and Intracoastal waterways from Jacksonville to Jupiter Inlet. This event represents the longest and most extensive red tide the east coast of Florida has experienced and the first time Karenia species other than K. brevis have been reported in this area. This extensive red tide influenced commercial and recreational shellfish harvesting activities along Florida's east coast. Fourteen shellfish harvesting areas (SHAs) were monitored weekly during this event and 10 SHAs were closed for an average of 53 days due to this red tide. The length of SHA closure was dependent on the shellfish species present. Interagency cooperation in monitoring this K. brevis bloom was successful in mitigating any human health impacts. Kernel density estimation was used to create geographic extent maps to help extrapolate discreet sample data points into $5km^2$ radius values for better visualization of the bloom.

• ALGAE
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• v.26 no.4
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• pp.317-325
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• 2011

Five benthic species of the genus Gambierdiscus (Dinophyceae) were observed for the first time in the coastal waters of Pakistan, Northern Indian Ocean. The morphology of the epiphytic, ciguatera-related toxic species G. toxicus, G. belizeanus, G. polynesiensis, G. australes and G. cf. yasumotoi are presented here, described by the Kofoid system of thecal plates Po, 3', 7", 6c, 8s, 5"', 1p, 2"" with differences in cell shape, cell size, plates, pores around the apical pore plate by using light and scanning electron microscopy. The occurrence of these potentially toxic dinoflagellate species in Pakistani coastal areas of Manora Channel and Balochistan during high temperatures of 28-$32^{\circ}C$ is cause of concern for human health impacts from ciguatera fish poisoning.

• Journal of Pharmacopuncture
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• v.3 no.2
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• pp.1-25
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• 2000

We were trying to study the validity of Puffer fish's poison(Tetrodotoxin- TTX) to make a traditional Korean Medical treatment. The following conclusions were made after literary studies. 1. The first record of the puffer fish dates back 2000 years ago in the Chinese text Book of Mountain and Sea and other texts from the similar period. 2. Puffer fish's poison IS known as tetrodotoxin which is an amino perhydroquinazoline compound. It has a chemical formula of $C_{11}H_{17}N_3O_8$ in the hemiacetal structure and has the molecular weight of 319. 3. Tetrodotoxin (TTX) plays a role as potent neurotransmitter blocker by blocking the $Na^+$ -gate channel which hinders the influx of $Na^+$ ion into the cell. 4. Symptoms of the puffer fish poisoning ranges from blunted sense in the lips and tongue, occasional vomiting in the first degree to sudden descending of the blood pressure, apnea, and other critical conditions in the fourth degree. Intoxication of the puffer fish poison progresses at a rapid pace as death may occur after an hour and half up to eight hours in maximum. Typical death occurs after four to six hours. 5. Ways to treat the puffer fish poisoning include gastric irrigation, induce vomiting, purgation, intravenous fluid injection, and correcting electrolytic imbalance and acidosis. In cases of dyspnea, apply oxygen inhalation and conduct artificial respiration. 6. Tetrodotoxin (TTX) may be applied in treating brain disorders, ocular pain, excess pain in the large intestine and ileum, and relieving tension of the skeletal museles, neuralgia, rheumatism, arthritis, and etc. 7. In terms of Oriental medicine, the puffer fish poison has characteristics of sweet, warm, and poisonous. It's known efficacies are to tonify weakness, dispel damp, benefit the lower back, relieve hemorrhoid, kills parasites, remove edema, and so forth. And the puffer fish eggs processed with ginger are said to be effective against tuberculosis and lung cancer, thus, it's validity must be investigated and further research should be followed.

• Journal of The Korean Society of Clinical Toxicology
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• v.12 no.2
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• pp.46-53
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• 2014

Purpose: We conducted this study in order to determine clinical features and prognostic factors in adults with acute tetrodotoxin (TTX) poisoning caused by ingestion of puffer fish. Methods: In this retrospective study, 107 patients were diagnosed with TTX poisoning. The subjects were divided into two groups according to duration of treatment; Group I, patients were discharged within 48 hours (n=76, 71.0%), Group II patients were discharged after more than 48 hours (n=31, 29.0%). Group II was subsequently divided into two subgroups [IIa (n=12, 11.2%), IIb (n=19, 17.8%)] according to the need for mechanical ventilation support. Results: In multivariable logistic regression analysis, the predictors of the need for treatment over 48 hours were dizziness (odds ratio [OR], 4.72; 95% confidence intervals [CI], 1.59-12.83), time interval between onset of symptom and ingestion (OR, 0.56; 95% CI, 0.16-0.97), $PaCO_2$<35 mmHg (OR, 8.37; 95% CI, 2.37-23.59). In addition, predictors of the need for mechanical ventilation were a time interval between onset of symptoms and ingestion (OR, 0.54; 95% CI, 0.11-0.96) and $PaCO_2$<35 mmHg (OR, 5.65; 95% CI, 1.96-18.66). Conclusion: Overall, dizziness, time interval between onset of symptoms and ingestion, ${\Delta}DBP$ and $PaCO_2$<35 mmHg predict the need for treatment over 48 hours, time interval between onset of symptoms and ingestion and $PaCO_2$<35 mmHg predict the need for mechanical ventilation support after acute TTX poisoning.

• Journal of Food Hygiene and Safety
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• v.19 no.2
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• pp.74-83
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• 2004

Raw-fish food contains a lot of moisture and is a high-protein food. It is a first-stage processed food taking a lot of manual work. Therefore, it is classified as a PHF food, very liable to cause a bacterial food-poisoning. But its manufacturers are usually small-sized and a systematic sanitation management is difficult to expect. But the manufacturer participating in this study produces chilled fresh raw-fish food. Fish are sliced into two fillets, which are packaged under vacuum, kept and distributed in refrigerators, and sold within a day. It is a newly-developed kind of raw-fish food, and a more improved kind of raw-fish food making possible a systematic sanitation management. The HACCP (Hazard Analysis and Critical Control Point) is a systematic and continuous process-control method which is very efficient for controling food sanitation and reducing the expenses. A new HACCP model has been developed to be applied to a large-sized chilled fresh raw-fish food manufacturer. To ascertain its efficiency, the baterial examination was done to its workplace and products. The significance test was done on its data by "SPSS 12.0 for Window" and "Mann-Whitney U Test". The numbers of bacteria on its final products were significantly different in flatfish and porgy. The number of bacteria tended to decrease in each time-differential sampling (P＜.00l). The final food products showed no food-poisoning bacteria in all the time-differential tests and in all the samplings, which proves that the CCP of the HACCP system is under control. After the SSOP program was applied, no pathogenic bacteria were found in the work-place, and the kinds and numbers of bacteria decreased. The numbers of general bacteria and colon bacilli also showed a significant difference from those before the SSOP program in the filleting board (P＜.05), in the skinning board (P＜.0l), in the neck-removing knife (P＜.05), and in the filleting knife (P＜.01). The working equipments, periodically disinfected, also showed a significant difference in sanitary conditions (in the dehydrator, P＜.05). The number of bacteria found on the food-touching surface was within the standard (below 500/l00 cm$^2$) After the SSOP program was applied, the general bacteria and colon bacilli were not found. The quality of water used in the food processing was also within the standard. The numbers of bacteria falling from the air in the work-place were negligible in all the samplings (＜30CFU/l000ι). The staphylococci and fungi were not found.

• Journal of Preventive Medicine and Public Health
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• v.5 no.1
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• pp.111-114
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• 1972

There was an outbreak of food poisoning on the 17 October, 1970 among the primary school children who came from a rural area, Yeongi-gun, Choongcheongnam-do to Seoul City on an educational trip. Of the 199 children participating in the trip, 149 cases of food poisoning developed a 74.9% attack rate. The acute onset of symptoms, of abdominal pain, diarrhea, vomiting and headache which occurred 1-5 hours after eating their lunch suggests that the outbreak was due to staphylococcal food poisoning. The common source of food was identified as the lunch packed in a chip-box which were eaten on October 17 during the trip. Most probable kind of food of the lunch as the cause was the favoured fish paste. The lunch were prepared at restaurant A in Seoul City. One of the personnel of the restaurant had a unhealed cut wound on the third finger tip of the left hand, from which it was considered that the food was contaminated with Staphylococcus during preparation. The chance of multiplication of Staphylococcus to produce enterotoxin in the food might be existed during flavouring the food with some degree of heat, and also during about 10 hours elapsed before serving the food after preparation.