Puffer Fish Poisoning: Bangladesh Perspective

  • Fazle Rabbi Chowdhury
  • H.A.M. Nazmul Ahasan
Living reference work entry


As a coastal country, puffer fish (tetrodotoxin) poisoning is quite common in Bangladesh, which sporadically involved many of the rive rain districts and so far brought considerable number of death. Puffer fish is also known as fugu (in Japan), toadfish, globefish, blowfish, balloonfish, etc. around the world. There are nearly 100 different species and 38 of them are found in Japan. Tetrodotoxin (TTX), a potent neurotoxin, was first isolated and named in 1909 in Japan. The fish belongs to the order Tetraodontidae which also includes ocean sunfish and porcupine fish. TTX is also found in the venom on the blue-ringed octopus available around Australia. So far there were eight outbreaks of TTX poisoning that happened in Bangladesh from 1988 to 2008 involving 247 people as victims with a death toll of 46 (18.6 %). Twenty (20) species of puffer fish are available in Bangladesh, of which two are freshwater puffer (Tetraodon patoca and Tetraodon cutcutia) and the rest are marine puffer (mainly Takifugu oblongus). Tetraodon patoca is commonly found in the southern part and Tetraodon cutcutia in the northwest, northeast, and northern part of the country. Out of the eight outbreaks, two were caused by freshwater species, five by marine species, and one by unidentified species. Most common clinical features of TTX poisoning include perioral numbness; tongue, face, and extremity paresthesia; salivation; nausea; vomiting; diarrhea; abdominal pain; vertigo; dizziness; etc. Unfortunately there is no specific antidote for TTX poisoning, and respiratory muscle paralysis is the main cause of death. Building awareness is the main way of preventing this type of poisoning.


Action Potential Generation Coastal District Puff Fish Aluminum Phosphide Poisoning Incident 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ahasan HAMN, Mamun AA, Karim SR, Bakar MA, Gazi EA, Bala CS. Paralytic complications of puffer fish (Tetrodotoxin) poisoning. Singapore Med J. 2004;45(2):73–4.PubMedGoogle Scholar
  2. Ahasan HAMN, Mamun AA, Rasul CH. Puffer fish poisoning (Tetrodotoxin) in Bangladesh: clinical profile and role of anti-cholinesterase drugs. Trop Doct. 2005;35:235–6.PubMedCrossRefGoogle Scholar
  3. Ahmed S. Puffer fish tragedy in Bangladesh: an incident of Takifugu oblongus poisoning in Degholia, Khulna. Afr J Mar Sci. 2006;28(2):457–8.CrossRefGoogle Scholar
  4. Amin MR, Awwal A, Sattar MA, Hasan R, Islam R, Jalil MA, et al. Pilot survey on cases of poisoning and its outcome on different category of hospitals in Bangladesh. J Med. 2009;10 Suppl 1:15–7.Google Scholar
  5. Arakawa O, Hwang D, Taniyama S, Takatani T. Toxins of puffer fish that cause human intoxication. In: Coastal environmental and ecosystem issues of the East China Sea. 2010. Nagasaki, p. 227–44.Google Scholar
  6. Centers for Disease Control and Prevention (CDC). Tetrodotoxin poisoning associated with eating puffer fish transported from Japan – California, 1996. MMWR Morb Mortal Wkly Rep. 1996;45:389–91.Google Scholar
  7. Chamandi SC, Kallab K, Mattar H, Nader E. Human poisoning after ingestion of puffer fish caught from Mediterranean Sea. Middle East J Anesth. 2009;20(2):285–8.Google Scholar
  8. Chew SK, Goh CH, Wang KW, Mah PK, Tan BY. Puffer fish (Tetrodotoxin) poisoning: clinical report and role of anti-cholinesterase drugs in therapy. Singapore Med J. 1983;24:168–71.PubMedGoogle Scholar
  9. Chowdhury FR, Mamun AA. A fishy tale. Stud BMJ. 2004;12:349.Google Scholar
  10. Chowdhury FR, Ahasan HAMN, Mamun AA, Rashid AKM, Mahboob AA. Puffer fish (Tetrodotoxin) poisoning: an analysis and outcome of six cases. Trop Doct. 2007a;37(4):263–4.PubMedCrossRefGoogle Scholar
  11. Chowdhury FR, Ahasan HAMN, Rashid AKM, Mamun AA, Khaliduzzaman SM. Puffer fish (Tetrodotoxin) poisoning: a clinical analysis, role of neostigmine and short-term outcome of 53 cases. Singapore Med J. 2007b;48(9):830–3.PubMedGoogle Scholar
  12. Chowdhury FR, Rahman A, Mohammed FR, Chowdhury A, Ahasan HAMN, Bakar MA. Acute poisoning in southern part of Bangladesh – the case load is decreasing. Bangladesh Med Res Counc Bull. 2011;37:61–5.PubMedCrossRefGoogle Scholar
  13. Dewick P. Saxitoxin and tetrodotoxin. Med Nat Prod. 2001;2:396–8.Google Scholar
  14. Diener M, Christian B, Ahmed MS, Luckas B. Determination of Tetrodotoxin and its analogs in the puffer fish Takifugu oblongus from Bangladesh by hydrophilic interaction chromatography and mass-spectrometric detection. Anal Bioanal Chem. 2007;389:1997–2002.PubMedCrossRefGoogle Scholar
  15. Faiz MA. Baseline survey on cases of poisoning and its outcome, reported on behalf of poison information centre. Dhaka: Dhaka medical college; 2007. p. 1–31.Google Scholar
  16. Fernandez-Ortega JF, Santos JMM, Herrera-Gutierrez ME, Fernandez-Sanchez V, Loureo PR, Rancano AA, et al. Seafood intoxication by Tetrodotoxin: first case in Europe. J Emerg Med. 2010;39(5):612–7.PubMedCrossRefGoogle Scholar
  17. Fish and Fish products (Inspection and Quality control) rule 1997 as published in Bangladesh Gazette on December 10, 1997 by the Ministry of Fisheries and Live stock. Government of the people’s republic of Bangladesh. 1997. p. 8693–732.Google Scholar
  18. Galib SM. Puffer fishes: a common and an old threat in Bangladesh (Internet). 2011 (updated 9 July 2011; cited 2011 Aug 30).
  19. Hagen NA, du Souich P, Lapointe B, Ong-Lam M, Dubuc B, Walde D, Canadian Tetrodotoxin Study Group, et al. Tetrodotoxin for moderate to severe cancer pain: a randomized, double blind, parallel design multicenter study. J Pain Symptom Manage. 2008;35:420–9.PubMedCrossRefGoogle Scholar
  20. Haque MA, Islam QT, Ekram ARMS. Puffer fish poisoning. TAJ. 2008;21(2):199–202.Google Scholar
  21. Hasan S, Rahman MM, Hossain T, Mosaddik A, Khatun S, Absar N. Purification, characterization and toxic profile of two toxins isolated from puffer fish Tetraodon patoca, available in Bangladesh. Pak J Biol Sci. 2007;10(5):773–7.PubMedCrossRefGoogle Scholar
  22. Hoque MMA, Chowdhury S. Protection and safe guard in law of Bangladesh against puffer fish intoxication. J Dhaka Med Coll. 2008;17(1):42–5.Google Scholar
  23. How CK, Chern CH, Huang YC, Wang LM, Lee CH. Tetrodotoxin poisoning. Am J Emerg Med. 2003;21(1):51–4.PubMedCrossRefGoogle Scholar
  24. Humaira N, Rahman M, Luby SP, Rahman M, Haider MS, Faruque LI, et al. Multiple outbreaks of puffer fish intoxication in Bangladesh, 2008. Am J Trop Med Hyg. 2010;83(2):440–4.CrossRefGoogle Scholar
  25. ICDDRB. Outbreak of Tetrodotoxin poisoning following consumption of puffer fish in Bangladesh. ICDDRB Health Sci Bull. 2008;6(3):6–11.Google Scholar
  26. Islam QT, Razzaq MA, Islam MA, Bari MI, Basher A, Chowdhury FR, et al. Puffer fish poisoning in Bangladesh: clinical and toxicological results from large outbreaks in 2008. Trans R Soc Trop Med Hyg. 2011;42(2):72–8.Google Scholar
  27. Kohane DS, Lu NT, Crosa GA, Kuang Y, Berde C. High concentrations of adrenergic antagonists prolong sciatic nerve blockade by tetrodotoxin. Acta Anaesthesiol Scand. 2001;45:899–905.PubMedCrossRefGoogle Scholar
  28. Kotaki Y, Shimizu Y. 1-Hydroxy-5, 11- dideoxytetrodotoxin, the first N- hydroxy and ringdeoxy derivative of tetrodotoxin found in the newt Taricha granulosa. J Am Chem Soc. 1993;115:827–30.CrossRefGoogle Scholar
  29. Lan MY, Lai SL, Chen SS, Hwang DF. Tetrodotoxin intoxication in a uraemic patient (letter). J Neurol Neurosurg Psychiatry. 1999;67:127–8.PubMedCentralPubMedCrossRefGoogle Scholar
  30. Lehane L. Paralytic shellfish poisoning: a potential public health problem. Med J Aust. 2001;175:29–31.PubMedGoogle Scholar
  31. Mahmud Y, Yamamori K, Noguchi T. Occurrence of TTX in a brackish water puffer “midorifugu” Tetraodon nigroviridis, collected from Thailand. J Food Hyg Soc Jpn. 1999a;40:363–7.CrossRefGoogle Scholar
  32. Mahmud Y, Yamamori K, Noguchi T. Toxicity and Tetrodotoxin as the toxic principle of a brackish water puffer Tetraodon steindachneri, collected from Thailand. J Food Hyg Soc Jpn. 1999b;40:391–5.CrossRefGoogle Scholar
  33. Mahmud Y, Tanu MB, Noguchi T. First occurrence of a food poisoning incident due to ingestion of Takifugu oblongus, along with a toxicological report on three marine puffer species in Bangladesh. J Food Hyg Soc Jpn. 1999c;40(6):473–80.CrossRefGoogle Scholar
  34. Mahmud Y, Arakawa O, Noguchi T. An epidemic survey on freshwater puffer poisoning in Bangladesh. J Nat Toxins. 2000;9:319–26.PubMedGoogle Scholar
  35. Marcil J, Walczak JS, Guindon J, Ngoc AH, Lu S, Beaulieu P. Anti-nociceptive effects of tetrodotoxin (TTX) in rodents. Br J Anaesth. 2006;96:761–8.PubMedCrossRefGoogle Scholar
  36. Matsui T, Hamada S, Konosu S. Difference in accumulation of puffer fish toxin and crystalline tetrodotoxin in the puffer fish, Fugu rubripes rubripes. Bull Jpn Soc Sci Fish. 1981;47:535.CrossRefGoogle Scholar
  37. Miyazawa K, Noguchi T. Distribution and origin of Tetrodotoxin. J Toxicol Toxin Rev. 2001;20:11–33.CrossRefGoogle Scholar
  38. Mosher HS, Fuhrman FA, Buchwald HD, Fischer HG. Tarichatoxin–tetrodotoxin: a potent neurotoxin. Science. 1964;144:1100–10.PubMedCrossRefGoogle Scholar
  39. Ngy L, Taniyama S, Shibano K, Yu C, Takatani T, Arakawa O. Distribution of tetrodotoxin in puffer fish collected from coastal waters of Sihanouk ville. Cambodia J Food Hyg Soc Jpn. 2008a;49(5):361–5.CrossRefGoogle Scholar
  40. Ngy L, Tada K, Yu CF, Takatani T, Arakawa O. Occurrence of paralytic shellfish toxins in Cambodian Mekong puffer fish Tetraodon turgidus: selective toxin accumulation in the skin. Toxicon. 2008b;51:280–8.PubMedCrossRefGoogle Scholar
  41. Ngy L, Yu C, Taniyama S, Takatani T, Arakawa O. Co-occurrence of tetrodotoxin and saxitoxin in Cambodian marine puffer fish Takifugu oblongus. Afr J Mar Sci. 2009;31(3):349–54.CrossRefGoogle Scholar
  42. Rahman R, Faiz MA, Selim S, Rahman B, Basher A, Jones A, et al. Annual incidence of snake bite in rural Bangladesh. PLoS Negl Trop Dis. 2010;4(10):e860.PubMedCentralPubMedCrossRefGoogle Scholar
  43. Saoudi M, Abdelmouleh A, El Feki A. Tetrodotoxin: a potent marine toxin. Toxin Rev. 2010;29(2):60–70.CrossRefGoogle Scholar
  44. Silva CCP, Zannin M, Rodrigues DS, Santos CR, Correa IA, Junior VH. Clinical and epidemiological study of 27 poisonings caused by ingesting puffer fish (Tetraodontidae) in the states of Santa Catarina and Bahir, Brazil. Rev Inst Med Trop S Paulo. 2010;52(1):51–5.PubMedCrossRefGoogle Scholar
  45. Taniyamma S, Mahmud Y, Tanua MB, Takatania T, Arakawab O, Noguchib T. Delayed haemolytic activity by the freshwater puffer Tetraodon sp. toxin. Toxicon. 2001;39:725–7.CrossRefGoogle Scholar
  46. Williams BL. Behavioral and chemical ecology of marine organisms with respect to tetrodotoxin. Mar Drugs. 2010;8:381–98.PubMedCentralPubMedCrossRefGoogle Scholar
  47. Yang CC, Liao SC, Deng JF. Tetrodotoxin poisoning in Taiwan: an analysis of poison center data. Vet Hum Toxicol. 1996;38(4):282–6.PubMedGoogle Scholar
  48. Yotsu-Yamashita M. Chemistry of puffer fish toxin. J Toxicol Toxin Rev. 2001;20:51–66.CrossRefGoogle Scholar
  49. Zaman L, Arakawa O, Shimosu A, Shida Y, Onoue Y. Occurrence of a methyl derivative of saxitoxin in Bangladeshi freshwater puffers. Toxicon. 1998;36(4):627–30.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  1. 1.Department of MedicineSylhet M.A.G.Osmani Medical CollegeSylhetBangladesh
  2. 2.Department of MedicineDhaka Medical CollegeDhakaBangladesh

Personalised recommendations