Abstract
Background: Tetrodotoxin is considered the most lethal toxin in the marine environment.
Prior cases of intoxication previously described correspond to consumption of tetrodotoxin
in tropical or subtropical regions of Asia or the Pacific Islands. Objectives: We
present the first European case of tetrodotoxin intoxication in a patient who ingested
part of a trumpet shellfish (Charonia sauliae) from the Atlantic Ocean in Southern Europe. Case Report: Our patient suffered general
paralysis, including the respiratory muscles, a few minutes after the consumption
of a few grams of C. sauliae. Intubation and mechanical ventilation were necessary for 52 h after the intoxication.
The corresponding electrophysiologic studies showed complete non-excitability, with
no recordable sensory or motor nerve conduction. We detected the presence of tetrodotoxin
in the mollusk and the patient's blood and urine by means of high-performance liquid
chromatography-mass spectrometry analysis technique. A previous bioassay showed extremely
high quantities of the toxin in the mollusk. Conclusions: This case alerts us to the
possibility of a very harmful biotoxin in European coastal waters. This now should
be included in the differential diagnosis of similar cases in Europe, and we must
be vigilant for its possible presence in Europe.
Keywords
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References
- Toxins: bacterial and marine toxins.Clin Chem Lab Med. 2006; 26: 397-419
- Origin and transfer of toxins involved in ciguatera.Comp Biochem Physiol C. 1993; 106: 615-628
- Dangerous marine animals: that bite-sting-shock-are non-edible.Cornell Maritime Press, Cambridge, MD1959
- Tetrodotoxication with nassauris glans: a possibility of tetrodotoxin spreading in marine products near Pratas Island.Am J Trop Med Hyg. 2005; 73: 985-990
- Tetrodotoxin: occurrence in Atelopid frogs of Costa Rica.Science. 1975; 189: 151-152
- Tarichatoxin-tetrodotoxin: a potent neurotoxin.Science. 1964; 144: 1100-1110
- Experimental induction of ciguatera toxicity in fish through diet.Nature. 1963; 197: 1026-1027
- Occurrence of tetrodotoxin on a trumpet shellfish “boshubora” Charonia sauliae.Nippon Suisan Gakkai Shi. 1981; 47: 934-941
- Vibrio alginolyticus, a TTX-producing bacterium isolated from the starfish Astropecten polyacanthus.Nippon Suisan Gakkai Shi. 1987; 53: 617-621
- Report of collaborative studies of the bioassays for paralytic shellfish poison.J Assoc Off Anal Chem. 1959; 42: 263-271
- Determination of decarbamoyl saxitoxin and its analogues in shellfish by prechromatographic oxidation and liquid chromatography with fluorescence detection.J AOAC Int. 1996; 79: 1111-1115
- Determination of tetrodotoxin in human urine and blood using C18 cartridge column, ultrafiltration and LC-MS.J Chromatogr B Analyt Technol Biomed Life Sci. 2006; 832: 75-80
- Paralytic complications of puffer fish (tetrodotoxin) poisoning.Singapore Med J. 2004; 45: 73-74
- Never eat an ugly fish: three cases of tetrodotoxin poisoning from Western Australia.Emerg Med. 1997; 9: 136-142
- Puffer fish poisoning: clinical features and management experience in 25 cases.J Med Assoc Thai. 2001; 84: 385-389
- Tetrodotoxin poisoning from ingestion of a porcupine fish (Diodon hystrix) in Papua New Guinea: nerve conduction studies.Am J Trop Med Hyg. 1997; 56: 30-32
- Tetrodotoxin poisoning associated with eating puffer fish transported from Japan—California, 1996.MMWR Morb Mortal Wkly Rep. 1996; 45: 389-391
- Paralytic shellfish poisoning: a potential public health problem.Med J Aust. 2001; 175: 343-344
- Medical toxicology: diagnosis and treatment of human poisoning.Elsevier Science Publishing Company, Inc, New York1988
- Puffer fish poisoning: a potentially life-threatening condition.Med J Aust. 2002; 177: 650-653
- Puffer fish poisoning.Med J Aust. 1973; 1: 73-74
- Molecular mechanisms of neurotoxin action on voltage-gated sodium channels.Biochimie. 2000; 82: 883-892
- Tetrodotoxin, saxitoxin and their significance in the study of excitation phenomena.Pharmacol Rev. 1966; 18: 997-1049
- Use of high performance liquid chromatography to measure tetrodotoxin in serum and urine of poisoned patients.Toxicon. 2004; 44: 549-553
- Analysis of marine toxins—techniques, method validation, calibration standards and screening methods.in: Botana L.M. Seafood and freshwater toxins: pharmacology, physiology, and detection. 2nd edn. CRC Press, New York2008: 21-50
- Food poisoning.Emerg Med Clin North Am. 2007; 25: 357-373
Article info
Publication history
Published online: February 09, 2009
Accepted:
September 1,
2008
Received in revised form:
August 14,
2008
Received:
June 15,
2008
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
