Fish poisoning can occur after ingestion of various fishes, such as reef fish, puffer fish, improperly processed or canned scombroid species (tuna), and shellfish. The clinical presentation almost universally involves some form of acute gastrointestinal irritation, whereas constitutional, cardiovascular, respiratory, and neurological symptoms arise depending on the type of fish poisoning. Symptoms appear within a few hours in most patients and can range from self-limiting to life-threatening. A properly obtained patient history is crucial for establishing the diagnosis.
Numerous reports in the literature describe cases of fish poisoning occurring due to ingestion of several species, some of the most important being:
Because of the rapid onset of symptoms seen in the mentioned types of fish poisoning, a prompt diagnosis can be life-saving. A proper patient history is the single most important step in the workup. Data regarding recent consumption of fish, the development of similar symptoms in friends or other persons who ate the same food (or have been in the same restaurant) can be crucial for a presumptive diagnosis of intoxication   . The physical examination is an important component of the workup, during which the severity of complaints and their progression should be defined, mainly in order to consider the optimal therapeutic approach. Despite the scarce availability of commercial tests for specific toxins found in fish, recent introduction of novel biochemical tests might be useful for detecting the concentration of ciguatera toxin, histamine, tetrodotoxin, and saxitoxin in respective fish species; this confirming the presumed source     . An assessment of histamine concentration in blood or its metabolites in urine might also be a useful diagnostic tool .