Suleiman M, Muhammad J, Jelip J, William T, Chua T H
Southeast Asian J Trop Med Public Health. 2017 Jan;48(1):197-203.
The horseshoe crab (Carcinoscorpius rotundicauda) is consumed by those residing near the coastal areas of Kota Marudu District in Malaysia, as it is considered a delicacy. During June to August, 2011 thirty cases of tetrodotoxin poisoning were reported from Kota Marudu District following ingestion of horseshoe crabs caught in Kota Marudu Bay. The purpose of this study is to describe this case series in order to determine risk factors to prevent further outbreaks. There were six confirmed and 24 probable cases of tetrodotoxin poisoning identified in the study area during the study period as diagnosed by clinical presentation and laboratory findings. Symptoms included dizziness (80%), circumoral and lingual numbness (80%), hand and feet numbness (63.3%), nausea and vomiting (30%) and weakness and difficulty in breathing (26.6%). Three cases (10%) died while 27 cases recovered. Forty-seven percent of the cases had onset of symptoms within 30 minutes of ingestion and 14% 31-60 minutes after ingestion of horseshoe crab meat. Urine samples were collected from the cases, while horseshoe crabs, cockles and sea water from the epidemic area were also taken for analysis. Tetrodotoxin was detected in the urine of six cases; the highest concentrations recorded were among the three cases who died. High tetrodotoxin concentrations were found in the hepatic cecum and eggs of the tested horseshoe crabs. Dinoflagellates were not detected in the sea water or cockle samples. Intensive health education was initiated quickly to stop other members of the Marudu Bay community from consuming the horseshoe crabs. This is the first documented epidemic of tetrodotoxin poisoning in Sabah.
马来西亚哥打马鲁都地区沿海居民食用马蹄蟹（圆尾鲎），认为其是一种美味佳肴。2011年6月至8月期间，哥打马鲁都地区报告了30例因食用在哥打马鲁都湾捕获的马蹄蟹而导致的河豚毒素中毒病例。本研究的目的是描述这一系列病例，以确定预防进一步疫情爆发的风险因素。在研究期间，根据临床表现和实验室检查结果，在研究区域内确定了6例确诊和24例疑似河豚毒素中毒病例。症状包括头晕（80%）、口周和舌部麻木（80%）、手足麻木（63.3%）、恶心和呕吐（30%）以及虚弱和呼吸困难（26.6%）。3例（10%）死亡，27例康复。47%的病例在摄入马蹄蟹肉后30分钟内出现症状，14%在摄入后31 - 60分钟出现症状。收集了病例的尿液样本，同时还采集了疫区的马蹄蟹、蛤和海水进行分析。在6例病例的尿液中检测到了河豚毒素；记录到的最高浓度出现在3例死亡病例中。在检测的马蹄蟹的肝盲囊和卵中发现了高浓度的河豚毒素。在海水或蛤样本中未检测到甲藻。迅速开展了强化健康教育，以阻止哥打马鲁都湾社区的其他成员食用马蹄蟹。这是沙巴有记录的首例河豚毒素中毒疫情。
