On further investigation, the Ukrainian immigrants had selected buffalo fish to eat because it either resembled a carp-like fish in their homeland, had scales and white flesh; or was suitable for preparation as gefilte fish.
Following the Haff disease cluster in Louisiana associated with eating boiled crayfish, it was suggested that buffalo fish and crayfish consumed the roots of water hemlock (Cicuta maculata) growing in marshy areas and along shorelines.
It is possible that in some instances in Louisiana and China, crayfish will feed on dying or dead toxic buffalo fish as both species are commercially harvested in the same freshwater environments.
Patients 4 and 5 On June 8, a Ukrainian husband and wife (aged 66 and 58 years, respectively) ate a dish consisting of ground buffalo fish and carp One hour later, the wife vomited.
Patient 6 On August 8, an 87-year-old U S -born man vomited 30 minutes after eating one third of a fried buffalo fish. Twenty-one hours later, he awoke with extreme stiffness and generalized muscle tenderness At a local emergency department, his OK was 2226 IU/L with a OK-MB of 2.1%.
The origin of the buffalo fish eaten by patients 1, 2, 3, and 6 was traced to the same wholesaler in Louisiana who receives fish from approximately 25 fishermen who fish rivers in Louisiana.