An unusual clinical syndrome following ingestion of fish

Summary

• 1. A clinical syndrome resembling that previously described as “fish poisoning” was observed in thirteen soldiers stationed in Puerto Rico and two civilians who were working in the mess hall where the troops ate.

• 2. The chief complaints were nausea, weakness, numbness of the legs, diarrhea, paresthesias, metallic taste, cutaneous itching and muscular aches and pains. The paresthesias consisted of burning and tingling of the tongue, mouth and lips, aggravated when drinking anything cold; in addition, there was a feeling of “pin pricks” in the fingers and toes. Symptoms occurred several hours after eating the fish. Recovery was slow and was complete in three weeks in the average case.

• 3. Treatment was symptomatic and consisted of analgesics for pain, thiamine chloride, calcium gluconate, tincture of belladonna and bismuth and paregoric in the more severe diarrheas.

• 4. The causative agent, most likely a toxin calls for further investigation. This toxin occurs in certain species of fish caught in the waters adjacent to Puerto Rico and the Virgin Islands, is more common at the time of spawning and is not destroyed by heat or refrigeration.

• 5. This is the first outbreak of its kind among army personnel, although sporadic cases have occurred among the native population.

• 6. It is hoped that as many cases as possible be reported so that a truer incidence of this type of fish poisoning will be appreciated.

• 7. It is advised that pending further investigation, the species of fish which have been involved in the outbreaks of fish poisoning be declared unsafe for human consumption during certain seasons of the year when caught in waters around Puerto Rico and the Virgin Islands.