Scombroid food poisoning

Scombroid food poisoning
Histamine
Classification and external resources
ICD-10	T61.1
ICD-9	988.0
DiseasesDB	31114
eMedicine	emerg/523

Scombroid food poisoning is a foodborne illness that results from eating spoiled (decayed) fish.^[1] Along with ciguatera, it is listed as a common type of seafood poisoning.^[2]

However, it is often missed because it resembles an allergic reaction. It is most commonly reported with mackerel, tuna, bluefish, mahi-mahi, bonito, sardines, anchovies, and related species of fish that were inadequately refrigerated or preserved after being caught. The syndrome derived its name because early descriptions of the illness noted an association with Scombroidea fish (e.g., large dark meat marine tuna, albacore, mackerel); however, the Centers for Disease Control and Prevention (CDC) have identified other, nonscombroid vectors, such as mahi-mahi and amberjack. Scombroid syndrome can result from inappropriate handling of fish during storage or processing. One of the toxic agents implicated in scombroid poisoning is histidine, which is broken down into histamine. Other chemicals have been found in decaying fish flesh, but their association with scombroid fish poisoning has not been clearly established.

Causes

Unlike many types of food poisoning, this form is not brought about by ingestion of a bacterium or virus.^[1] Histidine exists naturally in many types of fish, and at temperatures above 16°C (60°F) on air contact it is converted to the biogenic amine histamine via the enzyme histidine decarboxylase produced by enteric bacteria including Morganella morganii (this is one reason why fish should be stored at low temperatures). Histamine is not destroyed by normal cooking temperatures, so even properly cooked fish can be affected. Histamine is the main natural chemical responsible for true allergic reactions, so the symptoms produced are those one would expect.

Symptoms

Symptoms are described below. They occur within 10–30 minutes of ingesting the fish and generally are self-limited. People with asthma are more vulnerable to respiratory problems such as wheezing or bronchospasms. However, symptoms may show over two hours after consumption of a spoiled dish. They usually last for about 10 to 14 hours, and rarely exceed one to two days.

Initial

The first signs of poisoning suggest an allergic reaction with the following symptoms:

• facial flushing/sweating
• burning-peppery taste sensations in the mouth and throat
• dizziness
• nausea
• headache
• tachycardia
• cold-like symptoms

Additional symptoms

The above symptoms can advance to:

• facial rash
• torso or body rash: The rash associated with scombroid poisoning is a form of urticaria, but most commonly does not include wheals (patchy areas of skin-swelling also known as hives) that may be seen in true allergies.^[3]
• edema (this is generalized if it occurs at all)
• short-term diarrhea
• abdominal cramps

Severe

In the worst cases, the poisoning may cause:

• blurred vision
• respiratory distress
• swelling of the tongue

In rare cases, the poisoning may result in death. Preliminary results from an autopsy on Noelene and Yvana Bischoff, mother and daughter tourists from Australia who died suddenly in Bali in January 2014, has attributed their deaths to scombroid poisoning.^[4]

Final finding concluded their death caused by scombroid syndrome ^[5]

Treatment

Treatment is in the form of supportive care. If there is light-headedness, the victim should lie with feet partly elevated. If there is severe wheezing, the correct treatment is intramuscular adrenalin, 0.5 -1 mL at dilution in one in one thousand (standard medical emergency kit). An injection of anti-histamine should be given if available. Anti-histamine by mouth is appropriate.

References

External links

• Overview at Clemson University
• Seafood Network Information Center
• Center for Disease Control: Food Poisonings from Marine Toxins
• DermNet reactions/scombroid