318
FINDLAY E. RUSSELL
cases of ichthyotoxism reported during recent years and the numerous
findings of toxic fish by biologists and public health workers indicate
that ichthyosarcotoxism is an important medical entity within a broad
circumglobal area. The clinical significance of the entity has been the
subject of numerous reports (von Fraenkel and Krick, 1945 ; Lee and
Pang, 1945 ; Cohen et al., 1946 ; Halstead and Lively, 1954 ; Halstead,
1958 ; Banner et al., 1963a).
The first symptoms and signs of ciguatera poisoning are usually
evident within 4 h following ingestion of the offending fish. The
presenting symptoms are nausea and parasthesia (described as numbness or tingling) about the mouth, tongue and throat, or sometimes
over the face and distal parts of the fingers and toes. Weakness,
abdominal pain, vomiting, diarrhea and chills are often experienced.
If the poisoning is severe the victim may also complain of severe
malaise, muscular weakness and incoordination, chills and fever,
restlessness, insomnia and dyspnea. Increased sweating and hypotension are sometimes observed during the acute illness. Other symptoms and signs sometimes seen during the agonal period are headache,
dizziness, dilation of the pupils, strabismus, ptosis and severe pain in
the back and thighs. The superficial and deep reflexes are usually
hypoactive or absent. The victim often experiences parasthesia which
is almost classical in type: hot objects feel cold and cold objects feel
hot.
In fatal poisonings the above findings progressively worsen, severe
muscular weakness and muscular incoordination develop and walking
becomes difficult. Pruritus, often limited to the palms of the hands and
soles of the feet becomes intense, breathing becomes labored and cyanosis may develop. Convulsions have been reported. There is no evidence to indicate that a case of ciguatera poisoning imparts immunity.
A second poisoning in a patient previously stricken within 6 months,
or perhaps even a year, is more likely to be more serious than the same
poisoning in a patient not previously exposed to the toxin.
The symptoms and signs of ciguatera poisoning appear to be very
similar to those of paralytic shellfish poisoning, and it is possible that
the components of the two toxins are related.
2. Tetraodon
Tetraodon, puffer or fugu poisoning may occur following the
ingestion of certain puffers, ocean sunfishes or porcupinefishes. The
puffers, or puffer-like fishes, appear to be the only fishes universally
regarded as poisonous. They are known in various parts of the
world as globefishes, blowfishes, balloonfishes, swellfishes, toadfishes,
FINDLAY E. RUSSELL
cases of ichthyotoxism reported during recent years and the numerous
findings of toxic fish by biologists and public health workers indicate
that ichthyosarcotoxism is an important medical entity within a broad
circumglobal area. The clinical significance of the entity has been the
subject of numerous reports (von Fraenkel and Krick, 1945 ; Lee and
Pang, 1945 ; Cohen et al., 1946 ; Halstead and Lively, 1954 ; Halstead,
1958 ; Banner et al., 1963a).
The first symptoms and signs of ciguatera poisoning are usually
evident within 4 h following ingestion of the offending fish. The
presenting symptoms are nausea and parasthesia (described as numbness or tingling) about the mouth, tongue and throat, or sometimes
over the face and distal parts of the fingers and toes. Weakness,
abdominal pain, vomiting, diarrhea and chills are often experienced.
If the poisoning is severe the victim may also complain of severe
malaise, muscular weakness and incoordination, chills and fever,
restlessness, insomnia and dyspnea. Increased sweating and hypotension are sometimes observed during the acute illness. Other symptoms and signs sometimes seen during the agonal period are headache,
dizziness, dilation of the pupils, strabismus, ptosis and severe pain in
the back and thighs. The superficial and deep reflexes are usually
hypoactive or absent. The victim often experiences parasthesia which
is almost classical in type: hot objects feel cold and cold objects feel
hot.
In fatal poisonings the above findings progressively worsen, severe
muscular weakness and muscular incoordination develop and walking
becomes difficult. Pruritus, often limited to the palms of the hands and
soles of the feet becomes intense, breathing becomes labored and cyanosis may develop. Convulsions have been reported. There is no evidence to indicate that a case of ciguatera poisoning imparts immunity.
A second poisoning in a patient previously stricken within 6 months,
or perhaps even a year, is more likely to be more serious than the same
poisoning in a patient not previously exposed to the toxin.
The symptoms and signs of ciguatera poisoning appear to be very
similar to those of paralytic shellfish poisoning, and it is possible that
the components of the two toxins are related.
2. Tetraodon
Tetraodon, puffer or fugu poisoning may occur following the
ingestion of certain puffers, ocean sunfishes or porcupinefishes. The
puffers, or puffer-like fishes, appear to be the only fishes universally
regarded as poisonous. They are known in various parts of the
world as globefishes, blowfishes, balloonfishes, swellfishes, toadfishes,