An 83-year-old elderly woman in Malaysia died after cooking and eating a pufferfish that she had bought from Facebook; her husband also ate the fish and is in the ICU.

According to an advisory by the Singapore Food Agency, pufferfishes contain a toxin that’s highly poisonous, without just 0.002 grams of it potent enough to kill an adult human being.

The elderly couple who ate the pufferfish suffered breathing difficulties shortly after and were rushed to the hospital, where the elderly woman died and her husband is now in a coma.

According to Sin Chew Daily, the elderly had placed an order for the pufferfish on Facebook and received it on the morning of 25 March.

The couple’s son said that his late mother Lin Xiu Wan then proceeded to fry two of the fish for lunch with her husband, 84-year-old Huang Chuan Xin, who had eaten about 2/3 of one of the fish at about 2 pm, according to China Press.

Madam Lin then started feeling numbness in her hands, feet and lips about one and a half hours later, as she started shivering and having breathing difficulties.

Mr Huang then started displaying the same symptoms about an hour later.

Their son returned home and noticed that his parents were not feeling well, and he then rushed them to a nearby hospital for help.

His mother was immediately warded in the Intensive Care Unit (ICU) but succumbed to the poison and died at 7 pm.

His father suffered a lung infection and is still in the ICU, in stable condition but now in a coma, and doctors have told the family that the toxins have spread to other parts of his body and things are not looking good for him.

The incident was later reported to the Malaysian Ministry of Health, who tested the puffer fish and said that Madam Lin’s death was “food poisoning with neurological manifestation resulting in respiratory failure and irregular heart rate, possibly due to toxin ingestion”.

Her family has since collected her body for the funeral.

The son said that his parents didn’t know that the pufferfish was poisonous and it was their first time eating it, and he added that he never expected such a thing to happen after just one meal.

The pufferfish was later traced back to a fisherman from Mersing, who sold the fish to a Batu Pahat distributor for processing.

The online seller was then found to have sold about 15kg of the pufferfish to 5 customers in three towns on Saturday but thankfully the customers have not eaten the fish yet.

The pufferfishes have since been seized by the authorities.

Singapore Food Agency’s guidelines on pufferfish

Introduction

Pufferfish, also known as ‘fugu’, is a popular delicacy in Japan.

But did you know, pufferfish is an infamously poisonous fish that contains a lethal toxin known as tetrodotoxin (TTX), where as little as 0.002 g is enough to kill an adult human. 

In Singapore, there are restaurants with pufferfish on the menu, though there are restrictions in place for food safety. In this article, we will learn more about pufferfish poisoning and how to protect ourselves from it.

What’s is TTX?

TTX is completely colourless and odourless. Cooking also does not destroy this dangerous toxin. When the toxin enters the body, it binds to the nerves, stopping them from working and the person become paralysed, unable to breathe and can suffocate to death. This can happen rapidly within 10 minutes to a few hours depending on the dosage. There is also no antidote.

Anyone who have consumed pufferfish and feel symptoms like tingling, numbness, and any form of paralysis, should seek medical attention immediately. 

Why are Pufferfish Poisonous?

Pufferfish are not born poisonous. Pufferfish have evolved to accumulate TTX in their bodies, as a defence mechanism against getting eaten by bigger fish. The bacteria that produce the toxin are eaten by plankton, which are in turn eaten by snails and worms. Pufferfish then eat these snails and worms, gradually absorbing and accumulating the TTX in their bodies. Most of the toxin accumulates in the liver and ovaries, though this depends on the species of the pufferfish. 

This means that farmed pufferfish which have never eaten any prey containing TTX are not poisonous. Therefore, the farming of pufferfish in enclosed areas and fed only TTX-free pellets, is becoming increasingly popular.

Ensuring safety of pufferfish in Singapore

In Singapore, SFA permits the import of pufferfish under strict conditions. Currently, only Japan is approved to export pufferfish to Singapore. The pufferfish must have been prepared in SFA-accredited establishments by expert pufferfish chefs which have been certified and licensed by the government of Japan. These chefs have undergone training and examinations to ensure they have the required skills and knowledge to prepare pufferfish safely.

As Singapore, unlike Japan, does not have a pufferfish preparation license system, SFA requires imported pufferfish to be pre-prepared by the licensed chefs. For wild pufferfish which are of a higher risk, only the prepared muscle fillet is allowed for import. For farmed pufferfish, which are TTX-free, the muscles, skin, fins and milt may be imported. 

Each import consignment must come with a health certificate from the Japanese authorities, which has detailed information on where the fish were sourced from and prepared. SFA also tests these imported pufferfish for TTX as part of our food surveillance programme.

However, to ensure safety, both the food industry and consumers must play their part

• NEVER consume any pufferfish or related fish, like porcupine fish, that have been caught in the wild and prepared by amateurs. Globally, this is the most common reason for TTX poisonings and deaths. 
• Never consume pufferfish liver and ovaries. These are the organs that accumulate the most TTX. 
• Ask for farm-raised pufferfish over wild-caught ones, as the farm-raised pufferfish are likely to be toxin-free.
• If prepared improperly, pufferfish can be lethal when consumed. 
• Seek immediate medical attention if you feel any discomfort, tingling or paralysis after consuming pufferfish. 

Top tip: The simplest way is to avoid consuming pufferfish entirely.