• 대한임상독성학회지
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• 제17권1호
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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.

• 한국식품위생안전성학회지
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• 제18권3호
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• pp.133-138
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• 2003

우리나라에서 1991년부터 2002년 사이의 복어독 중독 발생상황에 대하여 신문에 보도된 내용을 검색하여 정리하고 특성을 분석하였다. 조사기간 중 우리나라에서는 총 32건의 복어독 중독사고가 발생하여, 111명이 중독되었고 그 중 30명이 사망하여 27.0%의 치사율을 나타내었으며, 연도에 따라 중독건수, 환자수 및 사망자수의 변동이 심하였다. 사망자는 29세 이상의 남성이 대부분을 차지하였다. 식중독 발생건별 환자수를 보면 4인 이하의 소규모 중독사건이 전체 발생건수의 75.0%인 24건을 차지하였고, 식중독 통계 집계기준인 5인 이상의 집단 식중독은 8건에 지나지 않았다. 우리나라에서 복어독 중독 발생건수의 59.4%(19/32)가 11월부터 익년 1월 사이에 발생하였고, 이 시기의 환자수 및 사망자수 또한 각각 65.8%(73/111), 66.7%(20/30)로 나타나 복어중독은 겨울철에 집중되었다. 지역적으로는 발생 건수의 75.0%(24/32)가 부산, 경남, 전남, 제주 등 남해안 지역에서 집중적으로 발생하였다. 섭취장소별로는 총 32건 중 18건(56.3%)이 선박에서 발생하였고, 가정에서 8건(25.0%)이 발생하였으며, 음식점에서 발생한 것은 5건(15.6%)이었다. 복어독 중독의 가장 중요한 원인 음식물은 국(탕 포함)으로 발생건수의 68.8%(22/32), 환자수의 64.0%(71/111), 사망자의 66.7%(20/30)를 차지하였고, 그 외 찜, 회, 내장탕, 알 등도 원인이 된 경우가 있었다.

• 대한임상독성학회지
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• 제9권2호
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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.

• 대한임상독성학회지
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• 제19권1호
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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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• 제30권1호
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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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• 제26권4호
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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.

• 대한약침학회지
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• 제3권2호
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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.

• 대한임상독성학회지
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• 제12권2호
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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.

• 한국식품위생안전성학회지
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• 제19권2호
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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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• 제5권1호
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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.