Scombroid: Difference between revisions
(Text replacement - "==Clinical Presentation==" to "==Clinical Features==") |
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==Background== | ==Background== | ||
*Caused by eating fish which have been improperly stored/refrigerated | *Caused by eating fish which have been improperly stored/refrigerated | ||
**Bacteria grow and | **Bacteria grow and convert histidine in fish via histidine decarboxylase to histamine and histamine-like substances responsible for symptoms<ref name="Craig">Craig SA, Zich DK: Gastroenteritis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 92:p 1211-1222</ref> | ||
**Patient may complain that the fish tasted like pepper, metallic, or bitter | **Patient may complain that the fish tasted like pepper, metallic, or bitter | ||
*Frequently misdiagnosed as seafood allergy | *Frequently misdiagnosed as seafood allergy | ||
*Most common incidence in US is state of Hawaii, followed by Florida <ref>Nguyen T, Akhtar S. Gastroenteritis. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier Saunders; 2018:(Ch) 84:1129–1149.</ref> | |||
===Causes=== | |||
Ingestion of: | |||
*Fish | |||
**Tuna | |||
**Bluefish | |||
**Mahi-mahi | |||
**Herring | |||
**Mackerel | |||
**Skip-jack | |||
**Sardine | |||
**Bonito | |||
*Swiss cheese (contaminated) | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Hives2010.jpg|thumb|Urticarial rash]] | |||
*Symptoms generally start within one hour of ingestion, and usually resolves within 12 hours (if untreated) | *Symptoms generally start within one hour of ingestion, and usually resolves within 12 hours (if untreated) | ||
*Flushing, warmth, erythematous rash, palpitations, dizziness, diarrhea | *Flushing, warmth, erythematous and urticarial [[rash]], [[palpitations]], [[dizziness]], [[diarrhea]], perioral burning, [[pruritus|itching]], or edema | ||
*May also see severe throbbing headache, blurred vision, tachycardia, and respiratory distress | *May also see severe throbbing [[headache]], [[blurred vision]], [[tachycardia]], and [[respiratory distress]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Ciguatera]] - similar clinical presentation, different fish | *[[Ciguatera]] - similar clinical presentation, different fish | ||
{{ | {{Acute Allergic DDX}} | ||
{{Erythematous rash DDX}} | |||
== | ==Evaluation== | ||
*Generally clinical diagnosis | *Generally clinical diagnosis | ||
*Consider if symptoms present in multiple patients who ate same fish | |||
==Management== | ==Management== | ||
*Antihistamines - give both H1 and H2 antagonists | *[[Antihistamines]] - give both H1 and H2 antagonists | ||
*Consider epinephrine, albuterol if symptoms of respiratory distress | *Consider [[epinephrine]], [[albuterol]] if symptoms of respiratory distress | ||
==Disposition== | ==Disposition== | ||
*Typically see a prompt response to treatment with antihistamines | |||
*Generally may be discharged | *Generally may be discharged | ||
==See Also== | ==See Also== | ||
*[[Marine toxins and envenomations]] | *[[Marine toxins and envenomations]] | ||
*[[Erythematous rash]] | |||
==References== | ==References== | ||
Latest revision as of 20:51, 18 January 2021
Background
- Caused by eating fish which have been improperly stored/refrigerated
- Bacteria grow and convert histidine in fish via histidine decarboxylase to histamine and histamine-like substances responsible for symptoms[1]
- Patient may complain that the fish tasted like pepper, metallic, or bitter
- Frequently misdiagnosed as seafood allergy
- Most common incidence in US is state of Hawaii, followed by Florida [2]
Causes
Ingestion of:
- Fish
- Tuna
- Bluefish
- Mahi-mahi
- Herring
- Mackerel
- Skip-jack
- Sardine
- Bonito
- Swiss cheese (contaminated)
Clinical Features
- Symptoms generally start within one hour of ingestion, and usually resolves within 12 hours (if untreated)
- Flushing, warmth, erythematous and urticarial rash, palpitations, dizziness, diarrhea, perioral burning, itching, or edema
- May also see severe throbbing headache, blurred vision, tachycardia, and respiratory distress
Differential Diagnosis
- Ciguatera - similar clinical presentation, different fish
Acute allergic reaction
- Allergic reaction/urticaria
- Anaphylaxis
- Angioedema
- Anxiety attack
- Asthma exacerbation
- Carcinoid syndrome
- Cold urticaria
- Contrast induced allergic reaction
- Scombroid
- Shock
- Transfusion reaction
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
Evaluation
- Generally clinical diagnosis
- Consider if symptoms present in multiple patients who ate same fish
Management
- Antihistamines - give both H1 and H2 antagonists
- Consider epinephrine, albuterol if symptoms of respiratory distress
Disposition
- Typically see a prompt response to treatment with antihistamines
- Generally may be discharged
See Also
References
- ↑ Craig SA, Zich DK: Gastroenteritis, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 92:p 1211-1222
- ↑ Nguyen T, Akhtar S. Gastroenteritis. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier Saunders; 2018:(Ch) 84:1129–1149.