Ingestion of pufferfish containing saxitoxin can result in neurologic symptoms within a few hours. Transportation of the fish can result in cases remote from the place of capture, making diagnosis more difficult.
Toxin: saxitoxin (similar to that causing paralytic shellfish poisoning, PSP, above), Both saxitoxin and tetrodotoxin inhibit the fast sodium channels but at separate sites.
Patient history: typically a recreational fisherman
Clinical findings:
(1) tingling and numbness of mouth, tongue, lips, face, arms and/or legs
(2) nausea and vomiting
(3) muscle weakness
(4) ataxia or other cerebellar signs
(5) drowsiness
(6) incoherent speech
Onset within 0.5 to 8 hours after ingesting pufferfish
Severity of illness was not related to the amount of pufferfish eaten, and not everyone who eats the pufferfish becomes ill.
Duration of illness: 10 hours to 45 days (median 24 hours, average 6.6 days), with all patients recovering
Locations:
(1) Florida (Titusville), with cases from transported fish in New Jersey and Virginia
(2) Phillipines
(3) Far East
