Scombroid: Difference between revisions

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**Bacteria grow and produce heat-stable toxin that causes histamine release when consumed<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>
**Bacteria grow and produce heat-stable toxin that causes histamine release when consumed<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
*Commonly associated fish include: tuna, bluefish, mahi-mahi, herring, mackerel, skip-jack, sardine, and bonito
*Frequently misdiagnosed as seafood allergy
*Frequently misdiagnosed as seafood allergy
===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==
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==Evaluation==
==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==

Revision as of 14:45, 16 November 2019

Background

  • Caused by eating fish which have been improperly stored/refrigerated
    • Bacteria grow and produce heat-stable toxin that causes histamine release when consumed[1]
    • Patient may complain that the fish tasted like pepper, metallic, or bitter
  • Frequently misdiagnosed as seafood allergy

Causes

Ingestion of:

  • Fish
    • Tuna
    • Bluefish
    • Mahi-mahi
    • Herring
    • Mackerel
    • Skip-jack
    • Sardine
    • Bonito
  • Swiss cheese (contaminated)

Clinical Features

Urticarial rash

Differential Diagnosis

  • Ciguatera - similar clinical presentation, different fish

Acute allergic reaction

Erythematous rash

Evaluation

  • Generally clinical diagnosis
  • Consider if symptoms present in multiple patients who ate same fish

Management

Disposition

  • Typically see a prompt response to treatment with antihistamines
  • Generally may be discharged

See Also

References

  1. 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