title: Lessepsian migration and tetrodotoxin poisoning due to Lagocephalus sceleratus in the eastern Mediterranean.
abstract: BACKGROUND
  The Suez Canal permits migration of fish from the Indo-Pacific Ocean to the Mediterranean Sea. This phenomenon (Lessepsian migration) has enabled poisonous fish species to colonize the Mediterranean Sea.
  
  
  OBJECTIVE
  To report clinical tetrodotoxin poisoning after consumption of the Lessepsian immigrant fish Lagocephalus sceleratus caught on the Israeli coast of the eastern Mediterranean.
  
  
  METHODS
  Thirteen patients aged 26-70years were admitted after consuming L. sceleratus. Signs of toxicity appeared within 1h. The main manifestations included vomiting, diarrhea, headache, paraesthesias, slurred speech, muscle weakness, dyspnea, hypertension, tachycardia, respiratory arrest, seizures and coma. Treatment was supportive, including mechanical ventilation (two patients). Patients recovered within 4days. All fish were identified as L. sceleratus, a species known to contain tetrodotoxin.
  
  
  CONCLUSIONS
  The diagnosis of tetrodotoxin poisoning was suggested by typical clinical manifestations together with temporal proximity to consumption of tetrodotoxin-containing fish. To the best of our knowledge, this is the first case series of tetrodotoxin poisoning reported from the eastern Mediterranean and due to L. sceleratus. Man made disruption of the ecological balance has resulted in the spread of tetrodotoxin-containing fish from the Indo-Pacific region to the Mediterranean Sea. Increased awareness is required to identify tetrodotoxin poisoning in an atypical fauna.
authors.affiliation: Israel Poison Information Center, Rambam Health Care Campus, The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, PO Box 9602, Haifa 31096, Israel. d_bentur@rambam.health.gov.il
authors.forename: Yedidia
authors.initials: Y
authors.lastname: Bentur
authors.forename: Jalal
authors.initials: J
authors.lastname: Ashkar
authors.forename: Yael
authors.initials: Y
authors.lastname: Lurie
authors.forename: Yishai
authors.initials: Y
authors.lastname: Levy
authors.forename: Zaher S
authors.initials: ZS
authors.lastname: Azzam
authors.forename: Moni
authors.initials: M
authors.lastname: Litmanovich
authors.forename: Marina
authors.initials: M
authors.lastname: Golik
authors.forename: Bella
authors.initials: B
authors.lastname: Gurevych
authors.forename: Daniel
authors.initials: D
authors.lastname: Golani
authors.forename: Arie
authors.initials: A
authors.lastname: Eisenman
mesh_terms: D000328:Adult; D000368:Aged; D025041:Animal Migration; D000818:Animals; D004417:Dyspnea; D005260:Female; D005400:Fishes, Poisonous / Q000502:physiology; D005517:Foodborne Diseases / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D007557:Israel; D008297:Male; D008522:Mediterranean Sea; D008875:Middle Aged; D010292:Paresthesia; D023721:Tetraodontiformes / Q000502:physiology; D013779:Tetrodotoxin / Q000506:poisoning*
chemical_list: D013779:Tetrodotoxin