Juvenile Hong Kong Pufferfishes can be curious. Hello there!
I have picked Takifugu alboplumbeus to feature in this first ‘marine life’ post, because although it is a common species which is not only restricted to Hong Kong, it somehow has come to be commonly known as the Hong Kong Pufferfish. And also, well, would you just look at that little face.
The characteristic of pufferfishes is their ability to inflate their body, increasing their size dramatically. The fish triggers this defence mechanism by drawing water into a chamber near the stomach. Pufferfishes have beak-like teeth and small spines covering much of the body, though you wouldn’t think it from looking at these guys. Also, pufferfishes can be highly toxic if eaten; the notorious Japanese delicacy of ‘fugu’ which requires specialist preparation is in fact a pufferfish. Pufferfishes are omnivorous, feeding on worms, crustaceans, molluscs and algae amongst other things.
Hongkongers love their seafood – a quick glance at the local restaurants scene will more than proove that point. Per capita HK has one of the highest seafood consumption rates in the world. For many locals, expats and tourists a trip to Sok Kwu Wan on Lamma for a seafood meal would not be complete without a big steamed grouper (also called garoupa). But aside from concerns about over-fishing and sustainability, eating these fish can be a health risk, too. That is because these large reef fish are more likely than others to give you ‘Ciguatera fish-poisoning‘. Ciguatera (‘see-gwa-terra’) is a food born toxin harbored by large reef fish. Originally the toxin (CTX) comes from a microscopic organism called Gambierdiscus. Gambierdiscus is a dinoflagellate – a single-called organism with a thin shell and two beating hair-like whips called ‘flagella’ that move it through the water.
Gambierdiscus sticks to coral, seaweed and algae in tropical and sub-tropical regions (like HK) and is eaten by smaller fish feeding on the coral and algae. These fish in turn are eaten by predator fish and so the toxin moves up the food chain, finally accumulating in its greatest concentration in the large reef fish.
Tissues like the roe (fish eggs), head, skin and insides are particularly good at concentrating CTX. CTX is odourless and tasteless and very heat-resistant – so conventional cooking will not destroy or inactivate the toxin.
So how bad is CTX poisoning?
Ciguatera causes a combination of gastrointestinal, neurological and cardiovascular symptoms. The gastrointestinal symptoms include nausea, vomiting, abdominal pain and diarrhoea. That might not be that bad, right? But the cardiovascular symptoms are more serious: a slowing of your pulse to under 60 beats per minute (sinus bradycardia) and low-blood pressure (hypotension) which can be life-threatening but can also be treated. The common neurological symptoms include a sensation of tingling, tickling, pricking, or burning of a person’s skin, numbness of lips, tongue and the four limbs, reversal of hot-cold sensation, muscle pain, muscle weakness, joint pains, itching and fatigue and these symptoms can last for weeks or even months.
CTX in Hong Kong
Because ciguatera is a matter of food safety the HK government requires by law that the reporting of all diagnosed or suspected cases and as a result there are some good statistics on ciguatera in Hong Kong. From 1988 to 2008 there were between 3 and 117 outbreaks annually causing between 19 and 425 people to fall ill. Groupers were responsible for almost 60% of those cases, with snappers causing another 32%. The rest of the cases were caused by moray eels, triggerfish, parrot fish and other reef fish. Past records of ciguatera fish poisoning cases in Hong Kong show that the following fish are more likely to contain ciguatoxins: Moray Eels, Potato Groupers, Speckled Blue Groupers, Tiger Groupers, High Fin Groupers, Hump Head Wrasses, Areolated Coral Groupers, Black Saddled Coral Groupers, Lyretails, Black Fin Red Snappers, Flowery Groupers and Leopard Coral Groupers.
The most recent suspected case was in September 2014 when a 38-year old man became ill. Before that 19 people aged between 23 and 71 became ill after a shared seafood meal on Lamma in June 2013.
Ciguatoxin is very difficult to detect in fish samples so quality control measures are very difficult to implement and suspected cases are often not confirmed because either a sample of the eaten fish is not available anymore or chemical test are not able to detect the ciguatoxin well enough.
How to avoid CTX poisoning
To avoid this nasty CTX poisoning your best bet is to avoid large reef fish especially groupers. Any reef fish over 2 kg in weight is especially risky. And if you do chose to eat such fish stay away from the high-risk body parts of head (sorry, no more sought-after cheek meat), insides, skin and roe (eggs).
The HK government’s guidelines for the prevention of CTX poisoning are:
Buy coral reef fish from reputable and licensed seafood shops. Do not buy the fish if in doubt.
Consume less coral reef fish, especially marine fish over three catties (1.5 kg).
Only eat small amounts of coral reef fish at any one meal and avoid having a “whole fish feast” in which all the dishes come from the same big coral reef fish.
Avoid eating the head, viscera, skin, and roe of coral reef fish which usually have higher concentration of toxin.
When eating coral reef fish, avoid alcohol, peanuts or beans as they may aggravate ciguatera poisoning.
If you are suffering from ciguatoxin poisoning you should refrain from coral reef fish. The intoxication will sensitize patients and they will suffer from ciguatoxin poisoning even if they are exposed to a lower concentration of toxin.
Seek medical treatment immediately when symptoms of ciguatera fish poisoning appear. The unfinished fish should be brought to FEHD (Food & Environmental Hygiene Department) for testing.
Ciguatoxins are actually a group of about 20 chemically related toxins. The most potent of these is Pacific-CTX-1 (PCTX-1) which is found in the Pacific Ocean.
Ciguatera fish-poisoning was described as early as 600 BC by the Chinese and Captain James Cook’s log details effects felt by his crew on a voyage to Tahiti in 1774.
The clinical description of the syndrome came from Portuguese biologist Don Antonio Parra and were published in Havana in 1787. Parra said, “some [fishes] cannot be eaten because they are `ciguatos’ and some others are suspicioned because they carry with them the poison..I can speak from personal experience, because on 15 March 1786, twenty-two of us ate a Cubera, and we all developed those symptoms to a greater or lesser extent. All were prostrated, but each one was suffering various types of discomfort, although the most common type of difficulty was the extreme exhaustion accompanied by more or less pain. I observed that I had extreme difficulty in breathing, which caused great pain and a feeling of suffocation. My tongue became rough and I developed a sour taste in my mouth.”
The Hong Kong Centre for Health Protection (CHP) of the Department of Health is investigating a suspected ciguatera poisoning case affecting a 38-year-old man. The patient, with good past health, developed symptoms of ciguatera poisoning including facial and tongue numbness, skin itchiness over the forehead and the neck, abdominal pain and diarrhoea about two to three hours after eating a marine fish at home on September 24.
He attended the Accident and Emergency Department of Pamela Youde Nethersole Eastern Hospital on September 25 and was subsequently admitted. He is now in stable condition. The CHP’s investigations are ongoing.
Ciguatera fish poisoning is not uncommon in tropical areas. More than 400 species of fish have been implicated in this food borne illness that’s relatively common in several areas of the world. This toxin is the result of the accumulation of marine algae and the toxins they produce passing up the food chain. These marine algae hang on to dead coral and seaweed. They are then eaten by herbivore fish which are subsequently eaten by predatory reef fish which concentrates the toxin in its tissue.
The toxin accumulates in the fish body, in particular in internal organs, through eating small fish that consumed toxic algae in coral reef seas. A larger fish is therefore more likely to carry higher amounts of the toxin. However, it is not easy to tell from the appearance of the fish whether it contains the toxin. The reef fishes are more likely to get contaminated during storms and other turbulence.
People affected may show symptoms of numbness of the mouth and the limbs, vomiting, diarrhoea, pain in the joints and muscles. An unusual characteristic that is common in ciguatera is temperature reversal. This may be seen from 2 to 5 days after eating the fish. Hot objects seem cold and cold objects can give a shock-like sensation. There have been serious injuries because a person was unable to recognize extremely hot sensations. Other odd symptoms are food may taste metallic and teeth may seem painful or loose.Most people affected by ciguatoxin would recover without long-term health effects, but if excessive toxins are consumed, the circulatory and nervous systems can be affected.
Symptoms may come back after ingesting certain foods and drinks; alcohol, caffeine, nuts and fish.
There are no laboratory tests to diagnose this disease and it’s based on clinical symptoms and a history ofeating an offending fish.
Ciguatera fish poisoning is the most common form of neurotoxin poisoning associated with the consumption of fish in Hong Kong. From 2000 to 12 June 2013, the Centre for Food Safety had received 284 referrals of CFP from the Department of Health (see Figure). A total of 867 persons were affected.
Number of ciguatoxins cases from 2000 to 2013 (Up to 12 June 2013)
The reporting of CFP occurred year round. However, it was observed that over 60% of total cases were reported in March to July of the year. The number of person affected also provided similar observation.
Different kinds of coral reef fish caught in the wild were known to be associated with CFP. Black fin red snapper, Tiger grouper, Lyretail, Leopard coral grouper, Areolated coral grouper and Moray eel were the top six common types of fish linked to CFP, accounting for over 50% of CFP cases. Farmed fish which was usually fed by formulated pellet or trash fish was not likely the source of toxins.
Fish commonly involved in CFP from 2000 to 12 June 2013.
The toxin cannot be destroyed by cooking. To prevent ciguatera fish poisoning, you should observe the following measures:
* Eat less coral reef fish;
* Eat small amounts of coral reef fish at any one meal and avoid having a whole fish feast in which all the dishes come from the same big coral reef fish;
* Avoid eating the head, skin, intestines and roe of coral reef fish, which usually have a higher concentration of toxins;
* When eating coral reef fish, avoid consuming alcohol, peanuts or beans as they may aggravate ciguatoxin poisoning;
* Seek medical treatment immediately should symptoms of ciguatoxin fish poisoning appear; and
* Coral reef fish should be purchased from reputable and licensed seafood shops. Do not buy the fish when the source is doubtful.
Once a swampy backwater of fewer than 20 million people, the Pearl River Delta—the southern swath of mainland China above Hong Kong—now has three times that population. Tens of millions more humans in the Pearl River Delta means many more toilets a-flush, pumping a steady gush of human waste into the South China Sea.
Read the full story at Quartz