Scombroid Poisoning (Histamine Fish Poisoning)
Tuna, bonito, escolar, skipjack, mackerel, needlefish, saurie, kingfish, wahoo, albacore, amberjack, blue fish, dolphin, mahi mahi, marlin, anchovy, herring, swordfish, Australian ocean salmon, Bombay duck (a kind of dried fish) (Fig 33.12).
Scombroid poisoning is a form of
ichthyosarcotoxicosis (the toxin is contained within the flesh of the fish).
Poisoning occurs from consumption of improperly preserved fish in which the
endogenous histidine has been broken down by bacteria into high levels of
histamine and saurine. Unfortunately, tainted fish may look and smell normal.
Rarely, there is a “sharp” or “peppery” taste. To add insult to injury, even if
such contami-nated fish is subsequently cooked well or smoked, the toxins are
not destroyed.
The CDC (USA) has reported that
scombroid fish poisoning has been most often associated with the consumption of
tuna, mahi-mahi, and bluefish. Immediately after being caught the fish is
generally non-toxic, but toxicity increases as the bacterial count rises.
Scombrotoxin formation can also occur if the fish is improperly refrigerated.
Few
minutes to few hours: Symptoms may develop as early as 5 to 10 minutes after
eating the fish, or be delayed up to 1 to 2 hours. Although most cases are mild
and self-limiting, resolving in 3 to 36 hours, potentially life-threatening
effects have occurred.
·
Manifestations are mostly
histamine-mediated, and comprise erythema of face, urticaria, pruritis, dermal
flushing, diaphoresis, burning sensation of the mouth, dizziness, throbbing
headache, vomiting, diarrhoea, and abdominal cramps.
·
Palpitations are frequently
described.
·
Diarrhoea and vomiting are also
common findings after scombroid poisoning.
·
Tachycardia/bradycardia and
hypotension have been described.
·
Conjunctival irritation, and
angioneurotic facial oedema may develop.
·
In severe cases there may be
bronchospasm and respiratory distress.
Symptoms
usually subside on their own in 6 to 12 hours.
Diagnosis
of scombrotoxicosis:
·
Clinical picture
·
Histamine levels of serum and urine
will be greatly elevated.
·
Detection and quantitation of
histamine in implicated fish flesh is more important. Normal fish has less than
1 mg of histamine per 100 gm of flesh. Illness is usually associated with more
than 100 mg of histamine per 100 gm of flesh (though illness can result from
much less concentrations).
Identification
of contaminated fish:
·
Usually such fish appear normal and
may not either smell or taste bad.
·
Occasionally, the skin may have a
“honeycombed” appearance, or the taste may turn pungent or peppery. Diagnosis
can be confirmed by measuring the histamine level in the fish which may exceed
100 mg%. The maximum acceptable level has been fixed at 50%. The recommended
method of estimating histamine level in fish is capillary electrophoretic
assay.
·
Outlined in Table 33.9.
·
Activated charcoal may be useful in
the early stages.
·
The role of steroids in management
of scombroid poisoning is controversial.
·
Cimetidine has been successful in
patients refractory to conventional antihistamines. It has also been used
success-fully as first-line treatment.
·
To prevent scombroid poisoning, the
fish needs to be continuously frozen, or refrigerated at less than 32°F from
the time the fish is caught until it is prepared for consumption.
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