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Health Ministry urges caution after fatal pufferfish poisoning

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One kind of potentially fatal pufferfish. Photo by Chhut Chheana / USAID Wonders of the Mekong

Health Ministry urges caution after fatal pufferfish poisoning

The Ministry of Health has reiterated its call for extreme caution when eating three kinds of potentially fatal pufferfish, as cases of poisoning continue to occur despite frequent warnings.

In a press release, the ministry said that since 2017, there have been seven cases of poisoning resulting from consumption of pufferfish in four provinces – Banteay Meanchey, Koh Kong, Kratie and Siem Reap.

The ministry’s warning came after Banteay Meanchey province saw its third fatal case of pufferfish poisoning on Tuesday when a family became sick after the mother cooked fish that had been discarded by a local fisherman.

The woman, who was warned not to eat the fish by the fisherman, died two days later, while five young family members were hospitalised.

The ministry said in the seven recent cases of pufferfish poisoning, five people died and 40 more became unwell.

The statement said there are 10 species of pufferfish, of which three are poisonous – Tetraodon cochinchinensis, Monotrete leiurus and Tetraodon fluviatillis.

The ministry said the three species contain a highly poisonous substance. If the poison reaches the central nervous system, it causes death.

The fish have the highest concentration of poison during their biannual reproduction seasons between February and March and July and September.

Sperm and eggs are the most dangerous parts of the fish to eat, followed by the liver, intestine, skin and flesh.

The ministry said people normally start to feel unwell 20 minutes to two hours after eating these kinds of pufferfish.

Symptoms include itchiness of the lips and mouth, followed by headaches, dizziness, itchiness of the genitalia, difficulty speaking, loss of balance, muscle weakness, paralysis of the ends of the hands and legs, nausea, diarrhoea, loss of energy and inability to move the jaw.

In serious cases, victims have difficulty breathing, eventually leading to death.

The ministry said vomiting can help evacuate the poison and it advised seeking urgent medical attention at the nearest health centre or hospital.

It stressed that puffer fish poison cannot be eliminated by cooking or freezing it.

The Post was unable to reach Minister of Health Mam Bun Heng or ministry spokesman Ly Sovann for comment.

Banteay Meanchey provincial Department of Health director Keo Sopheaktra said that after the most recent case of pufferfish poisoning in his province, the ministry had urged all relevant officials to broadly disseminate the information to villagers and throughout the province.

“We will disseminate [this information] from the upper levels to the lower levels – meaning from provinces to towns, districts, villages and remote areas – through the network of the Ministry of Health and relevant authorities,” he said.

Sum Chankea, Banteay Meanchey provincial coordinator for rights group Adhoc, said that although in the past there had been broad publicity from the authorities on the radio, in newspapers and on television, some villagers did not follow instructions.

They continued to eat the pufferfish, he said, because they consider it particularly delicious. Chankea said pufferfish are especially appealing to alcohol drinkers.

“When villagers value it like that, it is difficult to prevent them. They would only be afraid if someone put a skull sign on it . . . If you ask them to choose between a pufferfish and their life, then they will understand,” Chankea said.

The pufferfish is considered the second most poisonous vertebrate on Earth – after the golden poison frog of Colombia. The poison in one pufferfish is enough to kill 30 humans, and there is no known antidote. Despite this, people continue to eat the fish and it is served in high-end restaurants throughout the world.

Called fugu in Japan, pufferfish meat is a highly prized dish that is prepared by specially trained, licensed chefs. Even so, according to government figures, 30 to 50 people in Japan are hospitalised every year due to fugu poisoning, of which five people die.

It seems the pufferfish’s appeal is not just in its exquisite taste. Small doses of neurotoxins from the poison, which is 1,200 times deadlier than cyanide, can create a feeling of euphoria.

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