Difference between revisions of "Scombroid"

(Background)
 
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==Background==
 
==Background==
*Common in Hawaii, then FL
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*Caused by eating fish which have been improperly stored/refrigerated
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**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>
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**Patient may complain that the fish tasted like pepper, metallic, or bitter
 
*Frequently misdiagnosed as seafood allergy
 
*Frequently misdiagnosed as seafood allergy
*Most of the cases associated with tuna, bluefish, and mahi-mahi
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*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>
**Also herring, mackerel, skip-jack, sardine, and bonito
 
*Bacteria in fish produce produce heat-stable toxins causing histamine release when consumed<ref>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>
 
  
==Clinical Presentation==
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===Causes===
*Fish dish taste metallic, bitter, or peppery<ref>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>
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Ingestion of:
*Starts within one hour of ingestion
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*Fish
**Flushing, warmth, erythematous rash, palpitations, dizziness, diarrhea within 30 min of consumption
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**Tuna
**Severe throbbing headache, blurred vision, dizziness
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**Bluefish
**Significant tachycardia, palpitations, and possible respiratory distress
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**Mahi-mahi
*Usually resolves within 12 hours if untreated and has no long-term sequelae
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**Herring
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**Mackerel
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**Skip-jack
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**Sardine
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**Bonito
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*Swiss cheese (contaminated)
 +
 
 +
==Clinical Features==
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[[File:Hives2010.jpg|thumb|Urticarial rash]]
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*Symptoms generally start within one hour of ingestion, and usually resolves within 12 hours (if untreated)
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*Flushing, warmth, erythematous and urticarial [[rash]], [[palpitations]], [[dizziness]], [[diarrhea]], perioral burning, [[pruritus|itching]], or edema
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*May also see severe throbbing [[headache]], [[blurred vision]], [[tachycardia]], and [[respiratory distress]]
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
{{Template:Acute Allergic DDX}}
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*[[Ciguatera]] - similar clinical presentation, different fish
 +
{{Acute Allergic DDX}}
 +
{{Erythematous rash DDX}}
 +
 
 +
==Evaluation==
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*Generally clinical diagnosis
 +
*Consider if symptoms present in multiple patients who ate same fish
  
==Diagnosis ==
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==Management==
Usually clinical
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*[[Antihistamines]] - give both H1 and H2 antagonists
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*Consider [[epinephrine]], [[albuterol]] if symptoms of respiratory distress
  
==Treatment==
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==Disposition==
*H1 and H2 agonists
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*Typically see a prompt response to treatment with antihistamines
*Epi and albuterol if bronchospasm
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*Generally may be discharged
  
 
==See Also==
 
==See Also==
 
*[[Marine toxins and envenomations]]
 
*[[Marine toxins and envenomations]]
 +
*[[Erythematous rash]]
  
==Source==
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==References==
 
<references/>
 
<references/>
  
[[Category:Derm]]
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[[Category:Dermatology]]
[[Category:Environ]]
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[[Category:Environmental]]

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

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
  2. 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.