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Public Health Response to Puffer Fish (Tetrodotoxin) Poisoning from Mislabeled Product

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Abstract:

Tetrodotoxin is a neurotoxin that occurs in select species of the family Tetraodontidae (puffer fish). It causes paralysis and potentially death if ingested in sufficient quantities. In 2007, two individuals developed symptoms consistent with tetrodotoxin poisoning after ingesting home-cooked puffer fish purchased in Chicago. Both the Chicago retailer and the California supplier denied having sold or imported puffer fish but claimed the product was monkfish. However, genetic analysis and visual inspection determined that the ingested fish and others from the implicated lot retrieved from the supplier belonged to the family Tetraodontidae. Tetrodotoxin was detected at high levels in both remnants of the ingested meal and fish retrieved from the implicated lot. The investigation led to a voluntary recall of monkfish distributed by the supplier in three states and placement of the supplier on the U.S. Food and Drug Administration's Import Alert for species misbranding. This case of tetrodotoxin poisoning highlights the need for continued stringent regulation of puffer fish importation by the U.S. Food and Drug Administration, education of the public regarding the dangers of puffer fish consumption, and raising awareness among medical providers of the diagnosis and management of foodborne toxin ingestions and the need for reporting to public health agencies.

Document Type: Research Article

Affiliations: 1: Chicago Department of Public Health, Chicago, Illinois 60612, USA; Centers for Disease Control and Prevention, Chicago Quarantine Station, AMC O'Hare, POB 66012, Chicago, IL 60666, USA 2: U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition, College Park, Maryland 20740, USA; HFS-707, U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition, 5100 Paint Branch Parkway, College Park, MD 20740, USA 3: Biodiversity Institute of Ontario, University of Guelph, Guelph, Ontario, Canada N1G 2W1 4: U.S. Food and Drug Administration Center for Veterinary Medicine, Laurel, Maryland 20855, USA 5: U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition, College Park, Maryland 20740, USA 6: Illinois Poison Center, Chicago, Illinois 60606, USA; University of Chicago Hospitals, Chicago, IL 60637, USA 7: Illinois Poison Center, Chicago, Illinois 60606, USA 8: Chicago Department of Public Health, Chicago, Illinois 60612, USA 9: Swedish Covenant Hospital, Chicago, Illinois 60625, USA 10: Illinois Department of Public Health, Springfield, Illinois 62761, USA 11: Illinois Department of Public Health, Chicago, Illinois 60612, USA

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