7 Fish and seafood toxins

7 Fish and seafood toxins - FISH AND SEAFOOD INTOXICATIONS...

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Unformatted text preview: FISH AND SEAFOOD INTOXICATIONS Dr. Ryser FSC 342 U.S. FISH AND SEAFOOD CONSUMPTION 1995 estimates Cooked fish: 1 case / 106 servings Raw / lightly cooked shellfish: 1 case / 103 servings 2003 estimate 4.3 billion pounds of fish and seafood consumed Annual Fish and Seafood Consumption FISH AND SEAFOOD INTOXICATIONS Causes of Fish and Seafood Illness Bacterial: Vibrio spp. (common) Viral: norovirus and Hepatitis A Seafood toxins: marine algae and bacteria SHELLFISH POISONING FISH AND SEAFOOD INTOXICATIONS Marine algal toxins Paralytic shellfish poisoning Diarrhetic shellfish poisoning Neurologic shellfish poisoning Amnesic shellfish poisoning Ciguatera poisoning Bacterial Scombroid Puffer fish poisoning Marine algae: Red Tides Survive in sediment up to 6 years :bloom” in summer in response to favorable temperature, pH, salinity, light and available nutrients Expansion and spread of seasonal algal blooms since 1980 Waste production Global warming (El nino) Marine Algal Toxins: Red Tides Shellfish ingest up to 3 g of algae (dry weight) in 24 h and become toxic to humans (shellfish unaffected) Toxin accumulates in digestive glands These clams are paralyzed by the effects of the red tides Marine Algal Toxins: Red Tides ~2% (60 – 80 species) of > 4000 marine algae produce toxins Classified as dinoflagellates Alexandrium spp. Gymnodidium spp. Dinophysis spp. Prorocentrum spp. Types of Dinoflagellates Paralytic Shellfish Poisoning (PSP) Incidence ~1600 cases worldwide worldwide (including ~300 fatalities) Sporadic outbreaks in United States and many European countries Vehicles Mussels, clams, scallops, oysters, crab, lobster, puffer fish __________________________ PSP: Clinical Illness Amount of toxin required 144 - 1660 μg/person (intoxication) 300 - 12,400 μg/person (lethal) Onset: 15 min- 10 hours (med ~ 2 h) Symptoms – similar to botulism Numbness in mouth and extremities Headache and dizziness “ Floating sensation” Paralysis and resperitory distress PSP: Treatment Emetic or gastric lavage Without antitoxin death frequency occurs within 2-24 h PSP – Nova Scotia PARALYTIC SHELLFISH POISONING: NOVA SCOTIA July 3/98 Health Canada Health Protection Branch - Laboratory Centre for Disease Control Nova Scotia has identified 2 clusters of paralytic shellfish poisoning (PSP). The first cluster involved a couple who had eaten mussels they had harvested themselves from the Bedford Basin. The federal Department of Fisheries and Oceans (DFO) subsequently collected mussels from the same location and confirmed high levels of PSP toxin.The second cluster involved a family who had eaten mussels purchased from a truck vendor.The vendor has not yet been traced. An investigation is on-going with the involvement of DFO, the Canadian Food Inspection Agency (CFIA) and the Nova Scotia Department of Agriculture. Source: Nova Scotia Department of Health and Fitness PSP: Outbreaks CDC 2004 2003 2002 2000 Diarrhetic Shellfish Poisoning (DSP) Incidence First reported in The Netherlands (1961) followed by Japan (late 1970s) 1976 - 1990: ~ 10,000 cases reported worldwide with incidence decreasing due to increased surveillance and legislation Predominant in Japan and Europe Vehicles Mussels, oysters DSP: Clinical Illness Clinical Illness Amount of toxin required: > 40 ug in adults Onset: 30 min- 3 h Symptoms Diarrhea, nausea, vomiting, ab pain Treatment and outcome Self-limiting with occasional fluid replacement Rarely hospitalized Neurotoxic Shellfish Poisoning (NSP) Prevalence U.S. – East coast up to North Carolina, Gulf coast, Texas Elsewhere: Caribbean, Spain, New Zealand NSP: Clinical Illness Relatively low toxicity Onset time: 1-3 hours Symptoms Numbness and tingling in mouth spreading to extremities Vomiting and diarrhea Reversal of hot and cold sensations Treatment and Outcome Spontangeous recovery w/in 2-3 days Amnesic Shellfish Poisoning (ASP) Incidence: First identified in Canada: 107 cases traced to blue mussels Confined to Canada and the united States Vehicles: Mussels, oysters, and clams ASP: Clinical Illness Toxicity: > 20 ug / g Onset: 3- 24 hours Symptoms Gastroenteritis (within 24 h) Various neurological disturbances and seizures __________________________________ ___________________________________ Ciguatera Poisoning History Recognized in ancient Egypt: 2,700 – 2,400 B.C. 1492 - case in Caribbean during voyage of Columbus Source: fish Ciguatera Poisoning Most common among fish-borne poisoning >50,000 cases annually worldwide Estimated 2-3% of cases reported Most common in Hawaii, Virgin Islands, Puerto Rico, and Florida one-third of all fin fish-borne illness Florida: ~5 cases/100,000 Hawaii: 1996 – 2000 126 outbreaks / 214 cases Incidence: ~3.0 – 8.7 cases/100,000 Ciguatera Poisoning Vehicles At least 400 species of tropical reef-feeding fish living between latitudes 35° North and 35° South Caribbean, Pacific and Indian Ocean Most common: large fishgrouper, sea bass, snapper, barracudas, eels, parrot fish and mullet Ciguatera Poisoning Ciguatera Poisoning Clinical Illness Toxic human dose: 0.6 ng/kg Onset time: 2-30 h Symptoms (similar to NSP) Nausea, vomiting, watery diarrhea, Tingling /numbness in mouth, hands and feet Dull aches and sharp shooting pains Ciguatera Poisoning Outcome Generally self-limitng w/ recovery generally within 1-3 weeks Severe cases: shock, respiratory failure and coma Chronic sequelae: fatigue, neurological effects may persist for months or years ___________________________________ During January 2005--June 2006, CDC conducted a study of ciguatera fish poisoning among recreational fishers who fished from Texas Gulf Coast oil rigs. Two cases of ciguatera fish poisoning were identified in attendees of a 1998 dinner party in Houston, Texas, where snapper and barracuda fillets, both caught from an oil-rig platform off the Texas Gulf Coast, were served. Within 4 hours of the meal, a woman aged 50 years had onset of generalized pruritus and severe gastrointestinal symptoms, including diarrhea, abdominal pain, nausea, and vomiting. The symptoms persisted into the following day; 24 hours after eating the contaminated fish, she began experiencing arm and leg weakness. Two days after the meal, she began to feel tingling in her arms and legs and around her mouth and had hot-cold temperature sensation reversal. Her illness persisted for several days (exact number of days is unknown). She visited her primary-care physician but did not receive any medication. She reported no long-term effects. A man aged 56 years, a friend of the female patient, attended the same dinner party and became ill within 12 hours of eating the fish. He experienced muscle aches and stiffness, burning on urination, a metallic taste in his mouth, and hot-cold temperature sensation reversal. The patient also reported that his penis was extremely sensitive, which caused occasional ejaculations; although this phenomenon is a neurologic symptom, it is not characteristic of Ciguatera Poisoning: Outbreaks FISH AND SEAFOOD INTOXICATIONS Current Concerns Contamination not generally detected organoleptically Monitoring programs - HACCP Rapid toxin detection methods Awareness by public and clinicians for rapid diagnosis and proper treatment BACTERIAL INTOXICATIONS INVOLVING FISH Scombroid Puffer Food Poisoning Fish Poisoning SCOMBROID FISH POISONING Bacterial Species Responsible Morganella morganii Hafnia alvei Klebsiella pneumoniae Proteus spp. Vibrio spp. some Lactobacillus spp. (cheese) SCOMBROID FISH POISONING History and Incidence: Symptoms recorded in the early 1800s Early 1950's - first confirmed cases of scombroid fish poisoning in Japan SCOMBROID FISH POISONING: Common in Japan, US and England CDC: Scombroid fish poisoning is one of the primary foodborne diseases of chemical etiology in the US Records scarce: most cases unreported SCOMBROID FISH POISONING Vehicles Scambroid fish(Family Scombroidae): tuna, mackerel, and others Non-scombroid fish: Sardines, anchovies, herring and salmon Non-fish products: cheese SCOMBROID FISH POISONING Susceptiblity anyone Increased risk Elderly Cardiac, respiratory and asthma patients SCOMBROID POISONING: Symptoms Onset: ~ 5 minutes Rash (face, neck and upper chest) Diarrhea Flushing, sweating and headache Vomiting Dizziness, palpitations, burning of the mouth, metallic taste Majority mild, self-limiting and recover within a few hours ______________________________________ SCOMBROID POISONING OUBREAKS: 2004 SCOMBROID FISH POISONING - PENNSYLVANIA, 1998 May 12, 2000 MMWR. In December 1998, the Chester County Health Department (CCHD) in Pennsylvania received reports of four cases of scombroid fish poisoning among patrons at a local restaurant. This report summarizes the investigation of these cases by CCHD, the Pennsylvania Department of Agriculture (PDAg), and the Pennsylvania Department of Health (PDOH). Findings from this investigation suggest that initial processes that are not regulated by the Food and Drug Administration (FDA) (i.e., from hooking the fish to unloading the fish on the dock) may permit scombrotoxin formation. On December 3, 1998, four adults became ill after eating tuna-spinach salad at the restaurant. Symptoms of illness included a burning sensation in the mouth, a metallic taste, facial flushing, nausea, diarrhea, sweating, and headache; symptoms occurred approximately 5 minutes to 2 hours after eating the salad. One patient was taken to the local emergency department and treated with diphenhydramine, cimetidine, and epinephrine. The other three patients were not examined by physicians and their symptoms resolved within a few hours. A presumptive diagnosis of scombroid fish poisoning was made based on clinical and epidemiologic features of the illness. A sample of the remaining fish obtained from the restaurant was sent to PDOH for testing. The fish was positive for coliform and Escherichia coli, and tests were positive for histamine levels greater than 50 ppm (fresh fish normally contain histamine levels of less than 10 ppm using an enzyme-linked immunoabsorbent assay. SCOMBROID TOXIN Hisatime Produced at >4 deg. C by the bacteria, conversion of free histidine in fish and some aged cheese (eg Swiss) to histamine vis histidine decarboxylase Toxic dose: > = 100 mg in fish Heat stable: survives canning Generally undetectable organoleptically PUFFER FISH POISONING Long history in Japan Recognized for more than 2000 years unknown origin Only delicacy forbidden to Emperor of Japan for his safety FIRST DOCUMENTED CASES OF PUFFER FISH POISONING – About 1778 The first recorded cases of tetrodotoxin poisoning were from the logs of Captain James Cook. He recorded his crew eating some local tropic fish (pufferfish), then feeding the remains to the pigs kept on board. The crew experienced numbness and shortness of breath, while the pigs were all found dead the next morning. In hindsight, it is clear that the crew received a mild dose of tetrodotoxin, while the pigs ate the pufferfish body parts that contain most of the toxin, thus killing them. PUFFER FISH A japanease delicacy 10,000 tons consumed annually Up to $200 per serving ~ 200 cases per year mostly from home preparation Fatality rate: 50% Lethal dose: as low as 1.4 oz of fish PUFFER FISH POISONING Vehicle Puffer fish (“Fugu”) Range Primarily the Indo-Pacific Ocean Other cases and deaths have occurred from puffer fish from the Atlantic ocea, gulf of mexico, and west coast PUFFER FISH POISONING: Incidence Rare in the US Less than 20 cases in United States since 1975 1996 California: 3 cases, no deaths PUFFER FISH POISONING: Clinical Illness Onset: 10 minutes to 4 hours Numbness of lips and tounge Sensation of lightness or floating Tingling sensation spreading from the mouth Nausea, vomiting, diarrhea Muscle and respitory paraylsis ________________________ PUFFER FISH POISONING: Treatment Artificial respirator Fluid replacement No antitoxin avaliable PUFFER FISH POISONING Tetrodotoxin produced by certain bacteria Vibrio palagia Alteromonas tetraclonis Shewanella alga PUFFER FISH POISONING: The Toxin Tetrodotoxin – a potent neurotoxin Lethal dose: 1 mg Heat soluable Water soluble Accumulates in fish viscera- gonads, liver and intestine Man dies of poisoning after dining on deadly 'fugu' puffer fish May 5, 2005 Mainichi Daily News IKI, Nagasaki -- Police were cited as saying that a 78-year-old man died here, apparently from poisoning caused by eating a puffer fish that an acquaintance gave him. Iki Police Station officials said a fisherman Baba knew gave him a type of puffer fish called tora fugu in Japanese, and at about noon on Wednesday, he prepared it and put it in a bowl of miso soup. However, after eating it, Baba's hands, feet and tongue went numb, and he was taken to hospital at about 3 p.m. that day. He died at around 6:30 a.m. the following morning. PUFFER FISH POISONING: Prevention No not eat puffer fish Avoid improperly prepared puff. fish Special license needed for preparation Puffer fish may not be imported except under specific authorization of the FDA ...
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  • Fall '11
  • Ryser
  • Seafood, paralytic shellfish poisoning, Diarrheal shellfish poisoning, Fish Poisoning, scombroid fish poisoning

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