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INFECTIONS OF LEISURE. At the Shore. (insert picture of a beach). Puffer Fish Poisoning. Rare in U.S., common in Japan which is known as fugu-fugu Tetrodotoxin , heat stable, non-protein Causes total paralysis including respiratory paralysis 60% dies within the first 24 hours.

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At the shore l.jpg
At the Shore

  • (insert picture of a beach)


Puffer fish poisoning l.jpg
Puffer Fish Poisoning

  • Rare in U.S., common in Japan which is known as fugu-fugu

  • Tetrodotoxin, heat stable, non-protein

    • Causes total paralysis including respiratory paralysis

    • 60% dies within the first 24 hours.


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Ciguatera Food Poisoning

  • The most commonly reported food borne illness in U.S.

  • Most common toxins include ciguatoxin and maitotoxin

    • Lipid soluble

    • Colorless

    • Odorless

    • Heat stable


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Incubation period from 2 – 30 hours

Symptoms

  • Filipinos & Chinese are more severely affected, Hawaiians the least

  • Gastrointestinal

    • Diarrhea

    • Nausea & vomiting

    • Abdominal pain


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  • Symptoms

    • Neurological

      • Vertigo

      • Weakness

      • Motor paralysis

      • Blurred vision

      • Coma

      • Temperature reversal


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Diagnosis on clinical grounds

  • electrolyte imbalance

  • Elevated serum ammonia

  • Treatment is primarily symptomatic

    • Remove toxin through emesis or gastric lavage with activated charcoal

    • Intravenous mannitol

    • Acetamenophen for myalgia


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    • Prevention

      • Avoid ingesting fish weighing more than 5 pounds

      • Beware of fish caught during red tides


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    Scombroid-Fish Poisoning

    • Definition:

      • Acute clinical syndrome characterized by histamine toxicity due to ingestion of spoiled fish.

      • Half of the outbreaks reported to CDC were due fish served in restaurants & cafeterias.

    BONITO

    ALBACORE


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    YELLOW FIN TUNA

    MACKEREL


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    • Histidinehistamine due to spoilage

      • Marine bacteria cause spoilage, e.g., M. morganii, K. pneumoniae, E. coli, clostridia, achromobacter, plesiomonas, enterobacter, serratia, & hafnia – common bacteria on fish surface

      • Histamine is heat stable and freezing stable


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    • Diagnosis on clinical grounds sharp, peppery, & bitter tasting fish.

    • Treatment is supportive and symptomatic

      • Epinephrine

      • Oxygen

      • Corticosteroids

      • Aminophylline

      • IV cemetidine


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    Vibrio sharp, peppery, & bitter tasting fish.vulnificus

    • Found in the pacific and Atlantic coasts

    • Most invasive and rapidly lethal human pathogen

    • Major Syndromes

      • Primary septicemia after ingestion of raw oysters by individuals with liver disease

      • Most vulnerable are individuals who have liver disease, especially alcoholic cirrhosis


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    VIBRIO VULNIFICUS sharp, peppery, & bitter tasting fish.

    • The most invasive and rapidly lethal human pathogen

    • Septicemia after of raw oysters

      • Portal of entry is gastrointestinal tract

      • Incubation period 16 hours

      • DIC & septic shock

    • 2nd major syndrome is wound infections

      • Occurs in first 36 hours on trunk & extremities

      • Majority of cases from alcohol abuse


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    Treatment sharp, peppery, & bitter tasting fish.

    • Prompt institution of ciprofloxacin, combination of ceptazidime & doxycycline


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    MYCOBACTERIUM MARINUM sharp, peppery, & bitter tasting fish.

    • Pathogen of salt and freshwater fish

    • Isolated from swimming pools or aquariums, dead or diseased fish.

    • Causes cutaneous lesions, osteomyelitis, arthritis, sclero-keratitis


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    Freshwater: Lakes & Hot Tubs sharp, peppery, & bitter tasting fish.

    • Pseudomonas Dermatitis/Folliculitis

      • Swimming pools and spas

      • Synthetic sponges


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    • Swimmer’s ear sharp, peppery, & bitter tasting fish.

      • Painful & pruritic auditory canal

      • Recurrent in swimmers

      • Mild infections respond to 2% acetic acid or eardrops containing topical steroids.


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    Aeromonas in Fish brackish water.


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