Crazy Fish Stories: Sometimes an ounce of prevention really is worth a pound of cure

“Illinois Poison Center, How may I help you?”  Nurses, pharmacists and physicians in our call center repeat this more than 200 times a day.IPC calls can vary from a mom with “I am not sure if this is an emergency, but . . .” to a nurse or physician with “I have a 23-year-old male who ingested an unknown amount of antifreeze and is comatose with a pH of 6.8” (for the non-medical folks, that is really bad). Common calls to the IPC involves accidental and intentional overdoses of analgesics such as ibuprofen (e.g. Motrin and Advil) or acetaminophen (e.g. Tylenol), cleaning products, personal care products, as well as prescription and over-the-counter medications.

Unfortunately, sometimes the products we are notified about can harm others who come in contact with them, in addition to those who are already showing symptoms.

Public health is distinct from health care in that public health focuses on the prevention of disease within populations, while health care focuses on the treatment of disease in individuals.  (2002 National Health Policy Forum)

There have been a couple of “fishy stories” over the years that fit this definition.  The IPC was called for help with the diagnosis and treatment of poisoned patients who had consumed toxin-containing fish, but public health was needed to prevent additional injuries in the community.

Fish Story 1:

In 2007, the IPC was called about a family that had eaten fish bought at a local market. They were having strange neurological symptoms and weakness.  The family said they had purchased puffer fish – which is illegal in the U.S. – and made a soup out of it. Due to a concern for puffer fish poisoning (e.g. tetrodotoxin), a report was made to the local public health department.  The local health department notified the state public health department which in turn called in the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA).

Fish and soup samples tested by public health showed high levels of tetrodotoxin and DNA testing confirmed the agent was puffer fish.  The FDA performed an investigation and found that 228 boxes of fish had been imported to the U.S. labeled as monkfish when they actually contained puffer fish.  YIKES!  Over 5,000 pounds of potentially deadly puffer fish were recalled because of this public health investigation.  An ounce of prevention was surely worth a pound of cure in this case.

Puffer fish (from:

Monkfish (from:

Fish Story 2a and 2b:

In 2004 and again in 2014, the IPC was called about patients experiencing debilitating muscle pain with laboratory evidence of severe muscle cell breakdown.  One thing in common: all the patients had consumed buffalo fish, a carp-like fish native to the Illinois and Mississippi Rivers. Muscle inflammation and breakdown is a common symptom of Haff disease, associated with a toxin found in buffalo fish, salmon, crayfish and carp.  The toxin has not yet been identified and the reason why it occurs has not yet been completely solved.

The first cases reported in Illinois were in 2004 and involved fish sold in a southern Illinois store near the Missouri border.  Once the diagnosis was made, the public health department was notified and the buffalo fish in the store was confiscated to prevent further cases.

The second set of cases, 10 years later, involved two Chicagoland-area stores and resulted in 4 people injured. The public health investigation showed that both stores shared the same distributor, and the buffalo fish was removed from all markets and the distributor. Collaboration and quick action prevented further injury to Illinoisans from the sale of toxin-containing fish.

(Buffalo Fish –

These fish stories are just a few of numerous emerging threats identified and tracked by poison centers.  From food to laundry pods to synthetic cannabinoids to chemical terrorism, the potential for a mass casualty poisoning event in our communities and state is ever-present.  The nation’s poison centers will always be ready to help the public, health care providers and public health to ensure the safety of those who we serve.



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