88 Autonomic neuropathy symptoms, including hyperhydrosis, excessive salivation, hypotension, bradycardia, and temperature dysregulation, are common. 87, 88 Limb weakness develops soon after and may result in flaccid quadriparesis. Acral and perioral paresthesias and sensory loss develop within minutes to hours of ingestion. Tetrodotoxin poisoning causes a rapidly progressive sensorimotor polyneuropathy that may affect bulbar and respiratory muscles. 87, 88 The toxin is best recognized in tales of fatal poisonings following ingestion of improperly prepared fugu, an expensive Japanese delicacy of raw puffer fish that should only be eaten when prepared by a specially licensed chef. Tetrodotoxin is an exceptionally potent sodium channel blocker that is found in high concentrations in the skin and viscera of tetraodontiform fish, including puffer fish (Fugu poecilonotus) and porcupine fish (Diodon hystrix), as well as in blue-ringed octopus (Hapalochlaena maculosa) and certain amphibians ( Figure 14-3). Katz, in Clinical Neurotoxicology, 2009 Tetrodotoxin-related Neuropathy Generally, they are left alone by predators. The normal visual defense mechanism for slow-swimming and clumsy pufferfishes is their ability to inflate to several times their normal size by swallowing air when threatened, and tetrodotoxin may be an inadvertent weapon. The bacteria have a host as a safe place to live, eat, and reproduce whereas the host uses the toxin for predation or defense or both. There appears to be a symbiotic association between tetrodotoxin-producing bacteria and higher organisms, which offers distinct advantages to both partners. It has been suggested that the puffer fish accrue tetrodotoxin as a biological defense agent. Therefore, the tetrodotoxin of puffer fish is not endogenous (produced by the puffer fish itself), but exogenous (taken from outside and accumulated) via the food chain. Reproduced from Noguchi T and Arakawa O (2008) Tetrodotoxin – Distribution and accumulation in aquatic organisms, and cases of human intoxication. Flow diagram of mechanism of tetrodotoxin accumulation. The number of species found to contain tetrodotoxin continues to grow ( Figure 3).įigure 5. Terrestrial organisms include the Harlequin frogs ( Atelopus spp.), Costa Rican frog ( Atelopus chiriquiensis), three species of California newt ( Taricha spp.), and members of the Salamandridae (salamanders). and the Japanese trumpet shell Boshubora), and marine algae ( Jania spp.). Other marine organisms have been found to store tetrodotoxin and include the Australian blue-ringed octopus ( Hapaloclaena maculosa, which uses tetrodotoxin as a toxin for capturing prey), parrot fish, triggerfish, goby, angelfish, boxfish ( Ostracion spp.), tobies, porcupine fish, molas or ocean sunfish, globefish, seastars, starfish ( Astropecten scoparius), xanthid crabs ( Eriphia spp.), a horseshoe crab ( Carcinoscorpius rotundicauda), two Philippine crabs ( Zosimus aeneus and Atergatis floridus), a number of marine snails, flatworms, sea squirts, several nemerteans (ribbonworms), and several species of Chaetognatha (arrow worms), which use tetrodotoxin as a venom for prey, molluscs ( Nassarius spp. Tetrodotoxin now has been found in a wide genre of species.
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