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Frightful Fish Tale: Doctors Warn of Poison Pufferfish

Image: A pufferfish lies on a chopping board at a Japanese restaurant

A pufferfish, known as fugu in Japan, lies on a chopping board to remove toxic internal organs at a Japanese restaurant "Torafugu-tei" in Tokyo. Every year in Japan people end up in hospital after eating pufferfish, and sometimes they die. YOSHIKAZU TSUNO / AFP - Getty Images, file

The brother and sister showed up in the emergency room with odd symptoms – numb teeth, weakness and, most frightening, troubled breathing. They’d eaten banned, deadly poisonous pufferfish.

There wasn’t much the busy Minneapolis emergency room team could do, but they kept an eye on the two, who helpfully brought in samples of the toxic fish they’d eaten. Once it was clear they were not going to die, both left, against medical advice, and disappeared.

The fish they ate was an extremely poisonous species of pufferfish – related to an Asian delicacy widely known as fugu. The 30-year-old man and his 33-year-old sister told doctors they’d bought the dried fish in New York and brought it back to Minneapolis as a treat.

“The patient stated that he had purchased dried fish described as globefish from a street vendor in New York City and transported the fish to Minnesota himself,” doctors, led by the U.S. Food and Drug Administration’s Dr. Jonathan Deeds, wrote in their report.

"My teeth can't feel themselves."

They had eaten the fish six hours earlier, and half an hour after tasting it, their mouths, hands and feet went numb, they became very tired and had trouble breathing. “He also complained that ‘my teeth can’t feel themselves,’” the team, including the emergency room doctors, wrote in a report released by the Centers for Disease Control and Prevention.

It was classic tetrodotoxin poisoning. “Tetrodotoxin is a deadly, potent poison; the minimum lethal dose in an adult human is estimated to be 2–3 mg,” Deeds and colleagues wrote.

“Tetrodotoxin is a heat-stable and acid-stable, nonprotein, alkaloid toxin found in many species of the fish family Tetraodontidae (puffer fish) as well as in certain gobies, amphibians, invertebrates, and the blue-ringed octopus.” Cooking or freezing doesn’t remove the poison; nor does marination.

Venomous sea creatures threaten beachgoers

People who eat enough die a frightening death from respiratory failure. Part of the allure of fugu is the little tingling that aficionados get when they eat it, as well as a small thrill of the danger. Properly prepared, the fish isn’t dangerous, but it requires special training.

And some species are not safe to eat no matter how skillfully prepared.

Tests on the fish showed it wasn’t the fugu that is served by skilled sushi chefs, but another species known as Lagocephalus lunaris. It was loaded with deadly toxin. Fugu species carry the toxin only in certain organs –- so a trained expert can remove the dangerous parts -- but some species have it throughout the body and this is one of them.

“Because these fish were reportedly purchased in the United States, they pose a substantial U.S. public health hazard given the potency of the toxin and the high levels of toxin found in the fish,” Deeds and colleagues wrote.

“In its native region, it has been confused with similar looking, nontoxic species, resulting in numerous illnesses. This is the same species that was illegally imported and responsible for illnesses in California, Illinois, and New Jersey in 2007.”

"Because these fish were reportedly purchased in the United States, they pose a substantial U.S. public health hazard."

Public health officials wanted to track down the source of the dangerous fish, but the two patients had disappeared. “Visits to the two patients’ home were made by both public health officials and law enforcement; however, current residents of the home stated that they had no knowledge of the patients’ whereabouts. There was no labeling on the fish packaging, and all attempts to determine the source of the fish were unsuccessful.”

It’s so dangerous the FDA has very specific warnings.

“The FDA is advising consumers only to eat puffer fish (also known as fugu, bok, blowfish, globefish, swellfish, balloonfish, or sea squab) from two known safe sources. The safe sources are 1) imported puffer fish that have been processed and prepared by specially trained and certified fish cutters in the city of Shimonoseki, Japan, and 2) puffer fish caught in the mid-Atlantic coastal waters of the United States, typically between Virginia and New York. Puffer fish from all other sources potentially contain deadly toxins and therefore are not considered safe,” FDA says in a note to consumers.

“However, puffer fish caught off the east coast of Florida should not be eaten because the entire fish is potentially toxic.”

FDA bans personal import of puffer fish and tells restaurants there’s only one acceptable source – a New York importer called Wako International.