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Scombroid Fish Poisoning

Scombroid Poisoning


Presentation

  • A review of the features and pathogenesis of the syndrome is presented.[ncbi.nlm.nih.gov]
  • He was diagnosed after presentation of two similar patients with the same epidemiological history.[ncbi.nlm.nih.gov]
  • Headache, tachye to a toxin with histamine-like properties, which is formed because improper refrigeration enables endogenous bacteria to decarboxylate histidine normally present in dark-meat fishes.[ncbi.nlm.nih.gov]
  • Two patients presented to the emergency department. Metilprednisone 1000 mg and ranitidine 150 mg were administered initially.[ncbi.nlm.nih.gov]
  • The authors present a case of a healthy postdoctoral fellow who developed symptoms of scombroid fish poisoning immediately after consuming a salad containing seared tuna.[ncbi.nlm.nih.gov]
Chills
  • Rapid chilling of fish immediately after catch is the most effective measure to prevent scombroid fish poisoning.[epi.publichealth.nc.gov]
  • After being caught, bacteria within the fish begin to convert histidine to histamine and can occur rapidly if fish is not properly chilled. This is what causes the person to become unwell. It is not the consumption of a harmful bacteria or virus.[foodaware.com.au]
  • People should purchase fish from reliable sources and store fish, especially fish of the Scombroid family, at four degree Celsius or below for chilled fish and -18 degree Celsius or below for frozen fish to prevent spoilage.[cfs.gov.hk]
  • Poisoning can occur when certain species of fish are caught in warm water areas and are not chilled promptly/ consistently or at the correct temperature.[entwellbeing.com.au]
Pneumonia
  • Abstract A histamine-producing strain of Klebsiella pneumoniae was isolated from a sample of tuna sashimi implicated in an outbreak of scombroid fish poisoning.[ncbi.nlm.nih.gov]
  • Different kinds of bacteria have been identified including Klebsiella pneumoniae, Proteus morganii, Serratia marcescens and Enterobacter intermedium. Their presence is usually secondary to contamination from handlers.[calpoison.org]
Dyspnea
  • […] pain Pruritus of skin, hives (without wealing or skin swelling) Palpitations, an unusual “thumping, pounding heart sensation” Dizziness, lightheadedness, blurred vision Dry mouth, swelling of tongue and face And rarely chest tightness and possibly even dyspnea[jfsem.org]
Nausea
  • Clinical manifestation consisted of hyperemia, particularly on the face and neck (94.7%), nausea and vomiting (17.0%), abdominal pain (17.0%), pruritus (4.3%), headache and dizziness (4.3%) and diarrhea (3.2%).[ncbi.nlm.nih.gov]
  • After consuming contaminated mussels or clams, a person will most likely experience nausea, vomiting and diarrhea.[disabled-world.com]
  • Symptoms usually develop immediately after eating and can include flushing, hives and itching, nausea, vomiting, diarrhea and, in severe cases, breathing problems.[drweil.com]
  • Facial flushing/sweating, burning-peppery taste sensations in the mouth and throat, dizziness, nausea and headache are all common. People my also suffer stomach cramps, diarrheoa, in severe cases blurred vision and swelling of the tongue may occur.[foodaware.com.au]
  • Spoiled fish, the result of poor food handling practices, can also cause dramatic gastrointestinal symptoms – nausea, vomiting, diarrhea, and abdominal pain.[poison.org]
Vomiting
  • Treatment includes medication to stop the vomiting, IV fluids to replace those lost from vomiting and diarrhea, and in severe cases the drug mannitol to help reduce neurological symptoms such as dizziness, numbness and misperception of cold.[drweil.com]
  • Clinical manifestation consisted of hyperemia, particularly on the face and neck (94.7%), nausea and vomiting (17.0%), abdominal pain (17.0%), pruritus (4.3%), headache and dizziness (4.3%) and diarrhea (3.2%).[ncbi.nlm.nih.gov]
  • […] might receive medication to stop the vomiting, as well as IV fluids to replace lost fluids from vomiting and diarrhea.[disabled-world.com]
  • Moreover, patients are often given IV fluids as they may become dehydrated from vomiting.[emedicinehealth.com]
  • If symptoms continue, your doctor may tell you to take either an antihistamine or a medicine to prevent vomiting, or both.[fairview.org]
Food Poisoning
  • The diagnosis of scombroid fish poisoning could be misdiagnosed as food allergy or bacterial food poisoning if physicians are not aware of such poisoning.[ncbi.nlm.nih.gov]
  • Scombroid food poisoning Other names Scombrotoxin fish poisoning, scombroid syndrome, Seafood Network Information Center Center for Disease Control: Food Poisonings from Marine Toxins DermNet reactions/scombroid[en.wikipedia.org]
  • This type of food poisoning is not caused by a virus or bacteria. Symptoms of scombroid poisoning The symptoms of this particular type of food poisoning appear very quickly. In some cases, they occur within a few minutes of eating the infected fish.[medic8.com]
  • The type of fish implicated in this food poisoning are mainly of the scombroid type; tuna, mackerel, skipjack and albacore. Some non-scombroid fish such as mahimahi, bluefish, anchovies, and herring have been implicated.[outbreaknewstoday.com]
  • More Information Food Poisoning from Marine Toxins[wwwnc.cdc.gov]
Diarrhea
  • Clinical manifestation consisted of hyperemia, particularly on the face and neck (94.7%), nausea and vomiting (17.0%), abdominal pain (17.0%), pruritus (4.3%), headache and dizziness (4.3%) and diarrhea (3.2%).[ncbi.nlm.nih.gov]
  • Symptoms usually develop immediately after eating and can include flushing, hives and itching, nausea, vomiting, diarrhea and, in severe cases, breathing problems.[drweil.com]
  • Symptoms typically include facial flushing, sweating, rash, a burning or peppery taste in the mouth, diarrhea, and abdominal cramps and usually resolve within several hours without medical intervention.[ncbi.nlm.nih.gov]
  • After consuming contaminated mussels or clams, a person will most likely experience nausea, vomiting and diarrhea.[disabled-world.com]
  • Spoiled fish, the result of poor food handling practices, can also cause dramatic gastrointestinal symptoms – nausea, vomiting, diarrhea, and abdominal pain.[poison.org]
Abdominal Cramps
  • The clinical picture is secondary to histamine toxicity, manifested as flushing, headache, palpitations, and abdominal cramps. The diagnosis is established on the basis of these typical clinical manifestations and fish-ingestion history.[ncbi.nlm.nih.gov]
  • Symptoms typically include facial flushing, sweating, rash, a burning or peppery taste in the mouth, diarrhea, and abdominal cramps and usually resolve within several hours without medical intervention.[ncbi.nlm.nih.gov]
  • Symptoms of scombroid poisoning typically include facial flushing, sweating, rash, a burning or peppery taste in the mouth, diarrhea and abdominal cramps. Symptoms usually disappear within several hours without medical intervention.[epi.publichealth.nc.gov]
  • Scombroid Poisoning Symptoms Symptoms of scombroid poisoning generally begin 1 hour after ingestion of the poison and include: Nausea Vomiting Flushing Abdominal cramps Diarrhea Headache.[webmd.com]
  • This can be accompanied by a burning sensation in the mouth, a peppery or metallic taste in the mouth, a pounding headache, abdominal cramps, diarrhea, difficulties breathing, and dizziness.[allergyexpert.us]
Hypotension
  • About 25% had abnormal vital signs; two patients developed hypotension. Treatment was supportive and included mainly H1-antagonists (65.2%) and fluids (13%).[ncbi.nlm.nih.gov]
  • The symptoms include nausea, vomiting, diarrhea, an oral burning sensation or peppery taste, hives, itching, red rash, and hypotension.[ncbi.nlm.nih.gov]
  • When to Seek Medical Care for Scombroid Poisoning A severe or prolonged reaction ( hypotension , shortness of breath, tongue or throat swelling) requires medical treatment as soon as possible; this could be a medical emergency.[emedicinehealth.com]
  • Physical signs may include a diffuse blanching erythema, tachycardia, wheezing and hypotension or hypertension. People with asthma are more vulnerable to respiratory problems such as wheezing or bronchospasm.[entwellbeing.com.au]
  • Beta agonists, epinephrine and intravenous hydration may be administered to treat any serious effects such as angioedema, wheezing or hypotension.[calpoison.org]
Weak Pulse
  • The usual symptoms for scombroid fish poisoning were observed in cases, i.e. flushing (85.9%), headache (83.1%), rapid/weak pulse (59.1%) and diarrhoea (47.9%). Symptoms occurred from within a few minutes to up to 3 h following the meal.[ncbi.nlm.nih.gov]
Flushing
  • Onset of the reaction is usually abrupt and commonly associated with a prominent flush resembling a sunburn.[ncbi.nlm.nih.gov]
  • The clinical picture is secondary to histamine toxicity, manifested as flushing, headache, palpitations, and abdominal cramps. The diagnosis is established on the basis of these typical clinical manifestations and fish-ingestion history.[ncbi.nlm.nih.gov]
  • Symptoms typically include facial flushing, sweating, rash, a burning or peppery taste in the mouth, diarrhea, and abdominal cramps and usually resolve within several hours without medical intervention.[ncbi.nlm.nih.gov]
  • The usual symptoms for scombroid fish poisoning were observed in cases, i.e. flushing (85.9%), headache (83.1%), rapid/weak pulse (59.1%) and diarrhoea (47.9%). Symptoms occurred from within a few minutes to up to 3 h following the meal.[ncbi.nlm.nih.gov]
  • The main clinical manifestations included rash (41%), flushing (37%), gastrointestinal complaints (37%) and headache (30.4%). About 25% had abnormal vital signs; two patients developed hypotension.[ncbi.nlm.nih.gov]
Urticaria
  • The rash is a form of urticaria, but unlike an allergic reaction, there is no wealing (skin swelling).[dermnetnz.org]
  • CLINICAL FEATURES Histamine does not change the smell or appearance of the affected fish Symptoms begin within 10 to 90 minutes after ingestion flushing, rash, urticaria (generally widespread erythema, usually lacking wheals), palpitations, headache,[lifeinthefastlane.com]
  • […] 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[entwellbeing.com.au]
  • About 15 minutes after ingestion all had begun to experience generalised urticaria, palpitations, and felt hot. None had a history of urticaria or hypersensitivity. On arrival three of five patients were tachycardic and tachypnoeic.[emj.bmj.com]
  • Facial flushing and possibly nausea, vomiting, epigastric pain, and urticaria occur within a few minutes of eating and resolve within 24 h. Symptoms are often mistaken for those of a seafood allergy.[merckmanuals.com]
Pruritus
  • Clinical manifestation consisted of hyperemia, particularly on the face and neck (94.7%), nausea and vomiting (17.0%), abdominal pain (17.0%), pruritus (4.3%), headache and dizziness (4.3%) and diarrhea (3.2%).[ncbi.nlm.nih.gov]
  • She also complained of pruritus and a restless feeling. Her face became flushed soon after her meal. Her friend who also ate tuna had similar symptoms. The patient was healthy with no medical problems.[calpoison.org]
  • Abdominal cramps, nausea, vomiting, and diarrhea last 6 to 17 h; then, pruritus, paresthesias, headache, myalgia, reversal of hot and cold sensation, and face pain may occur.[merckmanuals.com]
  • […] acute neurological disease manifested by transient gastrointestinal symptoms (diarrhea, abdominal cramps, and vomiting) occurring within 12 hours of ingestion, followed within hours by neurological symptoms (perioral and limb paresthesia, tooth pain, pruritus[the-travel-doctor.com]
  • Throbbing generalized headache Nausea and vomiting Diarrhea Generalized abdominal cramps, following initial Epigastric pain Pruritus of skin, hives (without wealing or skin swelling) Palpitations, an unusual “thumping, pounding heart sensation” Dizziness[jfsem.org]
Stroke
  • Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation: analysis of pooled data from five randomized controlled trials. ‏ الصفحة 1246 - Barnett HJ, Taylor DW, Eliasziw M et al.[books.google.com]

Workup

Pseudomonas
  • ., Morganella morganii, Escherichia coli, Klebsiella species and Pseudomonas aeruginosa) found in the fish’s cutis and intestines.[lifeinthefastlane.com]

Treatment

  • The treatment was without sequelae and permitted early discharge from the emergency department. A brief review of scombroid fish poisoning and its treatment is provided.[ncbi.nlm.nih.gov]
  • Most cases in these 2 outbreaks received treatment with antihistamines and had rapid and complete recovery.[ncbi.nlm.nih.gov]
  • In Foodborne Diseases, leading authorities present a broad overview of the microbial pathogens and toxins associated with foodborne illness while discussing pathogenicity, clinical epidemiology, diagnosis, and treatment.[books.google.com]
  • In this review, we discuss the epidemiology, pathophysiology, evaluation, and treatment of scombroid disease.[ncbi.nlm.nih.gov]
  • ., respiratory distress, swelling of the tongue and throat, and blurred vision) can occur and require medical treatment with antihistamines. In late 2006, two outbreaks of scombroid fish poisoning occurred, one in Louisiana and one in Tennessee.[ncbi.nlm.nih.gov]

Prognosis

  • Unless complicated with shock or respiratory distress, supportive treatment with antihistamines usually concludes with a good prognosis. Toxin analysis of the fish flesh remains the most important step in approaching a confirmed diagnosis.[ncbi.nlm.nih.gov]
  • Prognosis The symptoms can be extremely uncomfortable but generally are not fatal and resolve within 12 hours [1].[entwellbeing.com.au]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • A wide variety of etiologic agents may be responsible, including toxins, bacteria, viruses, and parasites. It is incumbent on the travel medicine practitioner to advise travelers on ways to avoid seafood poisoning.[the-travel-doctor.com]

Epidemiology

  • He was diagnosed after presentation of two similar patients with the same epidemiological history.[ncbi.nlm.nih.gov]
  • In this review, we discuss the epidemiology, pathophysiology, evaluation, and treatment of scombroid disease.[ncbi.nlm.nih.gov]
  • To determine the source of the outbreaks and to implement control measures, CDC and the state health departments in Louisiana and Tennessee conducted epidemiologic investigations, and the Food and Drug Administration (FDA) conducted traceback investigations[ncbi.nlm.nih.gov]
  • In this article we review the epidemiology of scombroid fish poisoning and its possible relationship to the noncommercial and recreational catch and sale of fish.[ncbi.nlm.nih.gov]
  • An epidemiological investigation was undertaken. Questionnaire interviews were given to persons who ate lunch in the same cafeteria in outbreak 2. The leftover fish were sent for species identification and toxin analysis.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • In this review, we discuss the epidemiology, pathophysiology, evaluation, and treatment of scombroid disease.[ncbi.nlm.nih.gov]
  • Pathophysiology and pharmacokinetics The incubation period for scombroid is relatively short (a few minutes to a few hours). Spoilage bacteria can produce substantial amounts of histamine in fish kept at temperatures above 4 C for 3-5 hours.[calpoison.org]
  • Written by: G eorge Schroeder MD, MS, FACEP, FAAUCM Clinical Assistant Professor of Emergency Medicine UCF College of Medicine, Orlando, Florida Pathophysiology Scombroid ichthyotoxicosis or Scombroid fish poisoning consists of seafood-related food-borne[jfsem.org]

Prevention

  • The only effective method for prevention of scombroid fish poisoning is consistent temperature control of fish at[ncbi.nlm.nih.gov]
  • It is important to recognize the syndrome as an intoxication rather than an allergic reaction in order that the source of the toxin can be identified and further cases prevented. A review of the features and pathogenesis of the syndrome is presented.[ncbi.nlm.nih.gov]
  • Prevention Refrigerate seafood at less than 38 F (3.3 C) to prevent it from spoiling. Don't eat fish that you think may be spoiled or poorly refrigerated. Don't eat fish if it has an unusual peppery bitter taste.[fairview.org]
  • Preventing future scombroid outbreaks will require that fishermen, public health officials, restaurant workers, and medical professionals work together to devise international safety standards and increase awareness of the disease.[ncbi.nlm.nih.gov]

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