First U.S. Fugu Poisoning

After the dinner patrons had departed and the restaurant was closed on a recent Monday night, three chefs sat down to share a gift from a friend who had recently traveled to Japan. Their prize was an exotic fish dish marinated in sake, soy sauce and sesame seeds.

The youngest of the three noticed a strange, unfamiliar tingling in his mouth and lips within minutes after eating a coin-sized piece.

In rapid succession, the 23-year-old became dizzy and fatigued; he developed a powerful headache.

Then he experienced throat contractions that made speaking difficult.

Chest pains followed, as did shaking, nausea and vomiting.

Shortly thereafter, his legs buckled and he collapsed.

Paramedics called to the Japanese restaurant in San Diego recognized his symptoms as a classic food poisoning case. The diagnosis was made easier because the two other chefs were also felled after eating the marinated fish. Besides suffering all the above symptoms, one victim reporting having “feelings of doom.”

The three were revived at a nearby emergency room after their stomachs were pumped. They were placed on intravenous fluids and administered a liquid form of activated charcoal, which absorbs toxins. Hospitalized overnight, they were released the next day.

The men, whose names were not released because of medical confidentiality laws, were lucky: They survived severe food poisoning from a notorious source--fugu.

The fugu, or puffer, from Japan is among a family of fish considered the most poisonous of all marine life. Yet the flesh is a Japanese delicacy that brings as much as $400 per serving. The attraction is as much thrill-seeking--a gastronomic Russian roulette--as it is a desire to consume the strange and the wonderful.

The absurdly high price is charged because fugu can be eaten safely only if prepared by chefs certified in Japan to handle the fish. Extreme care and skill must be used to remove the liver, gonads, intestines and skin, which harbor tetrodotoxin, a neurotoxin so powerful that there is a 60% fatality rate among people who ingest it.

Such culinary skill and knowledge was obviously lacking in the San Diego episode last month. In fact, the fugu was smuggled into this country, according to an investigation of the poisoning by the Centers for Disease Control and Prevention in Atlanta and San Diego County’s Department of Environmental Health. The findings were reported in the most recent issue of the CDC’s Morbidity and Mortality Weekly Report.

“These are the first cases [of fugu poisoning] in United States,” said Dr. Mark Smolinski, an epidemiologist with the CDC’s Epidemic Intelligence Service.

Investigators believe the three men survived because of the small amount of toxin ingested and the rapid treatment in the emergency room.

The U.S. Food and Drug Administration does allow import of fugu, but only for special occasions and only when it is served in Japanese restaurants by certified fugu chefs. The Japanese Ministry of Health and Welfare ensures that any fugu exported to this country is properly processed and certified safe for consumption. Even so, there is some question about the effectiveness of the Japanese government’s oversight because an average of 50 people die of fugu poisoning each year in Japan.

The identification of the product’s manufacturer was forwarded to Japanese health officials for their follow-up investigation. U.S. officials are awaiting the outcome.

The agreement with the Japanese government has struck food safety advocates as ironic because the FDA has a difficult time ensuring the wholesomeness of traditional seafood species in this country and is ill-equipped to deal with fish like fugu that harbor a potentially deadly neurotoxin.

Fugu is a member of the Tetraodontidae order, which includes the ocean sunfish and porcupine fish. These species inhabit the shallow waters of the temperate and tropical zones off of Japan, China, Mexico, the Philippines and Taiwan. All five countries export fugu. Other fish, including California newt and the eastern salamander, also possess lethal quantities of tetrodotoxin.