Puffer fish poisoning in Bangladesh: clinical and toxicological results from large outbreaks in 2008.

Poisoning after eating puffer fish containing highly lethal tetrodotoxin (TTX) is widespread in Asia. In 2008, naïve inland populations in Bangladesh were exposed to cheap puffer fish sold on markets. In three outbreaks, 141 patients with history of puffer fish consumption were hospitalized. Symptoms of poisoning included perioral paraesthesia, tingling over the entire body, nausea and vomiting, dizziness, headache, abdominal pain and muscular paralysis of the limbs. Seventeen patients (12%) died from rapidly developing respiratory arrest. Blood and urine samples from 38 patients were analyzed using a TTX-specific enzyme-linked immunoassay (ELISA). Medium to high TTX levels were detected (1.7-13.7 ng/ml) in the blood of 27 patients. TTX was below detection level (< 1.6 ng/ml) in 11 blood samples but the toxin was detected in urine. Ten patients had blood levels above 9 ng/ml and developed paralysis; seven of these died. The remaining patients recovered with supportive treatment. High concentrations of TTX and its analogues 4-epiTTX and 4,9-anhydroTTX were also found in cooked puffer fish by post-column liquid chromatography-fluorescence detection. To prevent future instances of puffer fish poisoning of this magnitude, measures should be implemented to increase awareness, to control markets and to establish toxicological testing. To improve the management of this and other poisoning in Bangladesh, facilities for life-saving assisted ventilation and related training of healthcare personnel are urgently needed at all levels of the health system.

Occurrence of tetrodotoxin and paralytic shellfish poisons in a gastropod implicated in food poisoning in southern Taiwan.

The toxicity of the gastropod Nassarius papillosus implicated in a food paralytic poisoning incident in Liuchiu Island, Taiwan, in October 2005 is reported. The symptoms of a victim (67 years old) were featured by general paresthesia, paralysis of phalanges and extremities, paralysis, coma, and aphasia. The remaining specimens of shell were assayed for toxicity. The range of specimen toxicity was found to be 63-474 mouse units (MU) per specimen for N. papillosus by a tetrodotoxin (TTX) bioassay. The mean (SD) toxicity of the digestive gland and other portions were 296 +/- 120 and 382 +/- 156 MU in N. papillosus. The toxin was partially purified from the acidic methanol extract of the gastropod by using a C18 solid-phase extraction column. The eluate was then filtered through a 3000 MW cut-off ultrafree microcentrifuge filter. It was shown that the toxin purified from gastropods analysed by high-performance liquid chromatography and liquid chromatography/mass spectrometry contained TTX 42-60 microg g(-1) (about 90%), whereas along with minor paralytic shellfish poisons (PSP) it was 3-6 microg g(-1) (about 10%).

Localization of tetrodotoxin in the skin of a brackishwater puffer Tetraodon steindachneri on the basis of immunohistological study.

A monoclonal antibody-based immunoassay for localization of tetrodotoxin (TTX) in the skin of a brackishwater puffer Tetraodon steindachneri is described in this paper. TTX was recognized in the undifferentiated basal cells and succiform cells in the skin under light microscope. Malpighian cells of the skin did not exhibit any TTX antigen. Neither gland nor enclosed gland-like apparatus possessing TTX was apparent in the skin.

Toxicity and toxin profiles of the newt, Cynops pyrrhogaster from western Japan.

A total of 382 specimens of a Japanese newt, Cynops pyrrhogaster, were collected from western Japan during 1996 to 1999, and assayed for their individual, geographical, sexual, seasonal variations, and anatomical distribution of toxicity by mouse. Most of the specimens tested showed toxicity scores ranging from 5 to 370 MU/g, where no seasonal, but large individual, sexual, and regional variations of toxicity were clearly recognized. Among the parts, skin and muscle showed higher toxicity scores (56 MU/g) than liver, stomach, intestine and gonad, whose toxicity ranged from less than 2 to 33 MU/g. The C. pyrrhogaster toxin was purified by several steps of column chromatography and was shown to consist of tetrodotoxin (TTX) and 6-epiTTX as main components, and 4-epiTTX, 4,9-anhydro-6-epiTTX, and 4,9-anhydroTTX as minor ones by means of HPLC and 1H-NMR analyses.

Chelonodon patoca, a highly toxic marine puffer in Japan.

Toxicity of a Japanese marine puffer Chelonodon patoca ("okinawafugu") was examined by mouse assay from 1996 to 1999. Frequency of the toxic specimens was found to be 100% with high toxicity scores. Among the tissues tested, toxicity in the skin ranged from 60 to 6,700 MU/g, in the ovary from 25 to 670 MU/g, in the testis from 45 to 550 MU/g, in the muscle from 2 to 390 MU/g, and in the liver from 5 to 380 MU/g. The liver, which is known as one of the most toxic organs in Japanese marine puffer in general, showed lower toxicity in the present study. Thus, the anatomical distribution of toxicity was unique in C. patoca, in comparison with that of other Japanese puffers. C. patoca toxin was characterized as tetrodotoxin (TTX), 4-epiTTX and anhydroTTX by HPLC.

Occurrence of tetrodotoxin in the skin of a rhacophoridid frog Polypedates sp. from Bangladesh.

Twenty-three specimens of a tree-frog Polypedates sp. were collected from two locations (Mymensingh and Barisal) of Bangladesh in 1999, and assayed for their toxicity scores and toxin principle. Among the tissues, only the skin of the Mymensingh specimens was found to be toxic in mouse test, with the toxicity scores of 31-923MU/g. The toxin isolated from the skin was analyzed by high-performance liquid chromatography, electrospray ionization-time of flight mass spectrometry and proton nuclear magnetic resonance, and characterized as tetrodotoxin, a toxin principle.

Delayed haemolytic activity by the freshwater puffer Tetraodon sp. toxin.

In order to elucidate the toxin composition of the freshwater puffer in Bangladesh, about 230 specimens of Tetraodon sp. were collected from 1997 to 1999 and extracted. After partitioning the toxins between an aqueous layer and a 1-butanol layer, the toxin in the aqueous layer was characterized as paralytic shellfish poison (PSP) (data not shown), while the toxin in the 1-butanol layer was identified as palytoxin (PTX) or PTX-like substance based on the delayed haemolytic activity which was inhibited by an anti-PTX antibody and ouabain (g-strophanthin). This is the first report on the occurrence of PTX or PTX-like substance(s) in puffer fish.

An epidemic survey on freshwater puffer poisoning in Bangladesh.

An epidemic investigation was carried out on freshwater puffer poisoning incidents in Bangladesh from April 1988 to May 1996. A lot of information on 10 poisoning cases involving 55 victims was collected through newspapers, interviewing the victims and their families, concerned hospital sources or questionnaires to them. Symptoms of the victims were partly similar to those caused by paralytic shellfish poison (PSP) or tetrodotoxin (TTX). Among them, however, muscle pain, discharge of black urine, and longer recovery time are clearly different. Further, serum creatine phosphokinase (CPK) values were found to be higher (230-450 and 298-430 IU/l) than normal values in two cases. From these different symptoms and high CPK values, it can be predicted/assumed that present freshwater puffer toxin is implicated in not only PSP, but also other toxin(s).

Occurrence of a methyl derivative of saxitoxin in Bangladeshi freshwater puffers.

A new component of paralytic shellfish poison was isolated from a Bangladeshi freshwater puffer Tetraodon cutcutia. Its structure was deduced to be carbamoyl-N-methylsaxitoxin based on electrospray ionization mass spectrometry, [1H] NMR, and conversion experiments.

Occurrence of paralytic shellfish poisons in Thai freshwater puffers.

Screening tests were carried out on the toxicity of freshwater puffers Tetraodon leiurus complex and Tetraodon suvatii collected from Udonthani province, north-eastern Thailand. Toxicity was highest in the liver and varied according to the location and season of fish catch. Fish which were reared in tap water for 3 months reduced the toxicity substantially. Partial purification was achieved by an ultrafiltration technique. Toxin components were consequently identified by high-performance liquid chromatography. It was found that toxins separated from the eggs, liver, skin and muscle of these puffers were composed of saxitoxin, neosaxitoxin and decarbamoylsaxitoxin.

Occurrence of paralytic shellfish poison in Bangladeshi freshwater puffers.

Two species of freshwater puffer fish, Tetraodon cutcutia and Chelonodon patoca, collected from several locations in Bangladesh, showed lethal potency in mice ranging from 2.0 to 40.0 MU/g tissue as paralytic shellfish poison. In both species, toxicity of the skin was generally higher than the other tissues examined (muscle, liver and ovary). Water-soluble toxins from T. cutcutia were partially purified by activated charcoal treatment followed by column chromatographies using Bio-Gel P-2 and Bio-Rex 70. Analyses by cellulose acetate membrane electrophoresis and high-performance liquid chromatography with fluorometric detection demonstrated that the toxins were composed of saxitoxin, decarbamoylsaxitoxin, gonyautoxins 2 and 3, decarbamoylgonyautoxins 2 and 3, and three unidentified components which are possibly related to paralytic shellfish poison.

Two new isomers of domoic acid from a red alga, Chondria armata.

Isodomoic acids G and H, two new isomers of the neurotoxin domoic acid, along with isodomoic acids A, B, E and F, were isolated from a red alga, Chondria armata, collected at the southern tip of Kyushu Island. The structures of two of these were deduced to be (E, E) and (Z, E) isomers of 2-carboxy-4-(5-carboxy-l-methyl-2-hexenylidene)-3-pyrro- lidineacetic acid, based on electrospray ionization mass and [1H]nuclear magnetic resonance spectral analyses including [1H-1H]correlation spectroscopy and nuclear Overhauser effect correlation spectroscopy.

[A study on disclosure by HIV positives by use of simulation using case vignettes].

AIDS patients/HIV positives have been increasing in Japan, but a large proportion of university students, who have high risk sexual behavior, are not aware of the danger of HIV infection. Because of little disclosure by AIDS patients/HIV positives in Japan, the students have a poor chance of knowing of their risk in sexual behavior situations. Discrimination or prejudice toward AIDS patients/HIV positives has suppressed disclosure. However, as the real risk changes of disclosure is unknown, a simulation study, using case vignettes, was carried out to measure risks. A total of 1,128 university students (487 male and 641 female) were asked to read one of six vignettes describing HIV positives, that consisted of three infection routes (one by blood preparation and two by sexual intercourse) with disclosure or without disclosure. After reading a vignette, they answered questions about the images of HIV positives and their attitudes to him or her. As a result of reading these vignettes, friendly images were enhanced and the disagreeable images were decreased, but students' attitudes were unchanged. Significant differences were recognized in attitudes concerning responsibility for the infection and sympathy toward HIV positives, depending on the infection routes (blood preparation or sexual intercourse). Female students had a tendency to be more favorable to HIV positives than the male students. This simulation study showed the difficulty of changing students' attitudes regardless of the image of HIV positives, and demonstrated the need for effective action toward reducing discrimination or prejudice.

Potentiation of GABA-induced Cl- current by a series of n-alcohols disappears at a cutoff point of a longer-chain n-alcohol in rat dorsal root ganglion neurons.

We studied the effects of n-alcohols on gamma-aminobutyric acid (GABA)-induced Cl- current of rat dorsal root ganglion neurons in primary culture by a whole-cell, patch-clamp technique. n-Alcohols (C1-C11) at the concentrations inducing anesthesia in whole animals enhanced the current evoked by GABA application to the neurons. Their potencies for current enhancement increased with their carbon chain length, leveled off for higher alcohols and completely disappeared at C12. The potency of the alcohols for current enhancement correlated well with their anesthetic potencies.

A new saxitoxin analogue from a xanthid crab Atergatis floridus.

A novel paralytic toxin was isolated from toxic specimens of a xanthid crab Atergatis floridus inhabiting the Pacific coast of Shikoku Island. Its structure was deduced to be 11-saxitoxinethanoic acid (SEA) based on high-performance liquid chromatography, electrospray ionization mass spectrometry, and 1H and 13C-NMR spectrometries. This acid was assumed to exist as an equilibrium mixture of three tautomers, the main tautomer being the hydrate form 11 beta-epimer. SEA showed a specific toxicity of 830 mouse units per mumole on i.p. injection into mice.

[Effects of 5-HT1A receptor agonist and 5-HT1B receptor agonist on single and paired rats' behavior].

Serotonin (5-hydroxytryptamine, 5-HT) receptors as well as dopamine receptors are important in connection with schizophrenia. In this study we evaluated the effects of the 5-HT1A receptor agonist (8-hydroxy-2-(di-n-propylamino)tetralin, 8-OH-DPAT) and 5-HT1B receptor agonist (1-(3-trifluoromethylphenyl)piperazine, TFMPP) on the single and paired rats' movement distance in an open-field. Generally animals are gregarious in their natural setting, so the presence of another companion might alter the effects of the drugs. Therefore we devised a video analysis system to pick up the two rats' movements individually through two CCD video cameras and objectively recorded two rats' movement for 30 minutes. Experimental rats were injected with 8-OH-DPAT (0.05, 0.25, 1.25, 6.25 mg/kg, s.c.) or TFMPP (0.12, 0.5, 2.0, 8.0 mg/kg, i.p.) and the control rats were injected with saline. In the single cases experiments, the rats were put alone into the open field after the injection. In the paired cases experiments, they were put into the open field with a companion rat after the injection. In the 8-OH-DPAT experiment, the movement distance of single cases showed dose dependent increase tendency and that of the 1.25 mg/kg group and the 6.25 mg/kg group showed significant increase, but that of paired cases did not show that tendency, on the contrary, the movement distance of 0.05 mg/kg group showed significant decrease. In the TFMPP experiment, the movement distance of 2.0 mg/kg groups showed significant increases in the single and the paired cases. These findings suggest that both 5-HT1A receptors and 5-HT1B receptors affect the rats' movement distance.(ABSTRACT TRUNCATED AT 250 WORDS)

Properties of hemagglutinins newly separated from toxic phytoplankton.

Unique substances of the hemagglutinating activity were separated from unialgal cultures of the toxic phytoflagellates, Chattonella marina and Gymnodinium sp. Molecular masses of the substances were estimated to be 14,000 in Chattonella and 15,000 in Gymnodinium. These two substances contained phosphorus, hexose (galactose) and glycerol in the following molar ratios; 1.00:1.18:1.24 (Chattonella) and 1.00:1.07:1.10 (Gymnodinium). Hemagglutinating titres using rabbit red blood cells were inferred to be 25,000 in both preparations. In the presence of Chattonella hemagglutinin (0.10-0.50 microM), the growth of C. marina in Provasoli's ES media was little affected during 24 h of incubation, whereas a marked suppression took place in growth in Gymnodinium sp. (50% inhibition, 0.12 microM) or the diatom Nitzschia closterium (0.17 microM). On the other hand, Gymnodinium hemagglutinin inhibited the growth of the three species of phytoplankton. A 50% inhibition occurred at 0.12 microM in C. marina, at 0.22 microM in N. closterium or at 0.50 microM in Gymnodinium sp.

GABA receptor-channel complex as a target site of mercury, copper, zinc, and lanthanides.

1. The GABAA receptor-chloride channel complex has been shown to be modulated by a variety of chemicals. Scores of chemicals with diverse and unrelated structures augment the GABA-induced chloride current, while some other chemicals suppress the current. Certain heavy metals and a variety of polyvalent cations increase or decrease the current in a potent and efficacious manner. 2. We have studied the mechanisms whereby mercury, copper, zinc, and lanthanides modulated the GABA system by whole-cell and single-channel patch clamp techniques as applied to the rat dorsal root ganglion neurons in primary culture. 3. Mercuric chloride augmented the GABA-induced current to 115% of control at 0.1 microM and to 270% of control at 100 microM. It also generated a slowly developing inward current carried by a variety of ions. In contrast, methylmercury suppressed the GABA-induced current. The potent stimulation of the GABA system by mercuric chloride is deemed important in mercury intoxication. 4. Copper and zinc suppressed the GABA-induced current with an EC50 of 16 and 19 microM, respectively. They bound to a common site on the external surface of the GABA receptor-channel complex. 5. Lanthanum augmented the GABA-induced current with an EC50 of 230 microM by increasing the affinity of the receptor for GABA. It bound to a site on or near the external surface of the GABA receptor-channel complex which is different from the sites for GABA, barbiturates, benzodiazepines, picrotoxin, and copper/zinc. 6. Six other lanthanides with larger atomic numbers also exerted the same stimulatory effect with their efficacies increasing with the atomic number. 7. Single-channel analyses have revealed that the augmentation of whole-cell current by terbium, a lanthanide, is due to three actions: an increase in the overall mean open time, a decrease in the overall mean closed time, and an increase in the overall mean burst time.