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scombroid histamine food poisoning due to spoiled fish

introduction

  • a form of potentially fatal dose related food poisoning due to a build up of chemical toxins due to inadequate refrigeration in certain types of fish such as:
    • Scombroidea fish (eg, large dark meat marine tuna, albacore, skipjack, bonito, marlin)
    • other fish, such as mahi-mahi, amberjack,sardine, yellowtail, herring, and bluefish
  • symptoms are related to the ingestion of biogenic amines, especially histamine which may be present at 20-50 mg per 100 g of fish (compared with the usual levels of < 0.1mg per 100g)
  • histamine is produced via bacterial decarboxylation of histidine
  • scombroid poisoning is the most common chemical agent type of food-borne disease found in the US
  • more common in nations with a warm water fishing industry
  • cooking does not deactivate the toxins
  • it is difficult to detect at risk spoiled fish although some may taste peppery

clinical features

  • degree of symptoms depends upon:
    • concentration of toxins
    • amount of fish ingested
    • how cold the fish was before cooking - thawed surfaces may contain more toxins
    • individual sensitivities to histamines
    • concurrent medications which may interfere with histamine metabolism such as isoniazid (via blockade of GI tract histaminase)
  • onset of symptoms is usually 10-30 minutes after ingestion and are similar to those of anaphylaxis
  • flushing, anxiety, palpitations, headache, oral paraesthesiae
  • abdo pain, nausea, vomiting
  • diffuse, macular, blanching erythema
  • tachycardia
  • wheezing
  • hypotension or hypertension

Dx

  • diagnosis is clinical although a normal serum tryptase within 1-2 hours potentially excludes anaphylaxis as a cause
  • histamine levels in the fish can be measured to confirm diagnosis is needed

Mx

scombroid.txt · Last modified: 2019/06/15 16:03 (external edit)