Stupid People Tricks: The raw crawfish conundrum

Stupid People Tricks: The raw crawfish conundrum

This is a cautionary tale.

On Memorial Day weekend, 2006, a man ate a live crawfish. Two, to be precise. Why did he eat two live crawfish? He was on a float trip on the Current River, and he was drunk. It's possible his friends were egging him on. People do this. They videotape themselves, and then they post it on YouTube.

The videos have a distressing sameness to them. A young man — it's always a young man — holds the crawfish up to the camera and tries to make it wiggle to prove that it's still alive. If he's the prudent type, he twists the claws off first. If he's more foolhardy, he just bites the head off. Then he chews. He chews for a long time, through layers of shell and tissue. The expression on his face turns doubtful. Does he really want to go through with this? His friends cheer, tell him not to be a pussy. After what seems like forever but is probably more like a minute in real time, he swallows. He opens his mouth and sticks out his tongue. The camera zooms in. In the background, someone comments on the crawfish guts sticking to his lower lip.

Dr. Gary Weil: "Look, they've got pinchers. If you want to eat something, eat a tadpole. It's soft, and it's not infectious."
Kelly Hogan
Dr. Gary Weil: "Look, they've got pinchers. If you want to eat something, eat a tadpole. It's soft, and it's not infectious."

Our protagonist did not star in any of these videos, but he did, as you'll recall, eat two of the suckers. And a couple of months after his float trip, sometime in July 2006, he started to feel sick. He had a fever and a persistent cough. A doctor at his local emergency room decided he had a tick-related infection and prescribed a weeklong round of antibiotics. But this didn't make him feel any better. In fact, he started to feel worse: headaches, night sweats, chills, shortness of breath and a dramatic weight loss.

Eventually, the patient ended up at Barnes-Jewish Hospital, the course of last resort for many patients in Missouri, in the department of infectious diseases, in the care of Dr. Thomas Bailey. Further examination showed that the patient had a buildup of fluid around his lungs and an elevated white cell count, a possible indication of infection.

During the course of the medical-history interview, the patient's wife casually mentioned the two crawfish. ("Once you see [elevated white blood cells], it's a clue, and you start asking about strange things," says Dr. Michael Lane, a colleague of Bailey's.)

Bailey did what anyone in his situation would do: He ran a Google search to look for any connection between an elevated white blood cell count, a buildup of lung fluid and crawfish. He came up with something called paragonimiasis, an infection caused by a parasite that lives in the hearts of crawfish. It's fairly common in China, where it's carried in crabs and spread via a local delicacy called drunken crab in which the raw crustacean is marinated in alcohol. In the United States, however, where people tend to cook their shellfish, there had been a grand total of seven cases reported in humans since 1967.

Bailey consulted a colleague in the infectious-diseases department, Dr. Gary Weil, who specializes in parasites. Almost immediately, they started referring to the crawfish as Ozark sushi, but Weil thought the paragonimiasis diagnosis was far-fetched. For one thing, there weren't any signs of the parasite, such as eggs, in the patient's phlegm. For another, a paragonimiasis test developed by the Centers for Disease Control and Prevention in Atlanta came out negative.

"It could have been pneumonia or an allergy or breathing in a housefly," Weil recalls. "But Bailey seemed pretty convinced."

Bailey was even more convinced after all the patient's symptoms disappeared after two days of treatment with praziquantel, a drug used to kill parasitic worms. A lung biopsy later revealed DNA traces of the parasite, formally known as Paragonimus kellicotti. As it turned out, the reason the CDC test found nothing was because it was checking not for Paragonimus kellicotti but for Paragonimus westermani, its Asian cousin.

The following summer, two more cases of paragonimiasis turned up at Barnes, both in patients who had eaten raw crawfish in the past year. By 2010, Bailey, Weil and Lane had treated five cases in total, and Dr. Scott Folk, a doctor in St. Joseph, had found three more. It was probably less a full-fledged epidemic than a case of the doctors knowing what to look for — "If you've seen it once," says Lane, "it sticks with you" — but it was definitely cause for concern.

Strangely, although the physicians made inquiries in other states, particularly Arkansas and Louisiana, where people eat a lot of crawfish, all the cases were in Missouri. That wasn't the only thing patients had in common.

"You'll notice," Bailey points out, "that all but one of the reported cases so far has been a guy." All but one of the cases involved drinking; the lone exception was a ten-year-old who wanted to prove to his cousins that he could survive in the wild. And, in most of these cases, it wasn't country folk who were dumb enough to chomp down on these crawfish; it was city slickers who find that nothing enhances a weekend float trip like vast quantities of alcohol.

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