Difference between revisions of "Scombroid"

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(Background)
 
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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 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 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
*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
 +
*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>
  
==Clinical Presentation==
+
===Causes===
 +
Ingestion of:
 +
*Fish
 +
**Tuna
 +
**Bluefish
 +
**Mahi-mahi
 +
**Herring
 +
**Mackerel
 +
**Skip-jack
 +
**Sardine
 +
**Bonito
 +
*Swiss cheese (contaminated)
 +
 
 +
==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
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*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
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*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
{{Template:Acute Allergic DDX}}
+
{{Acute Allergic DDX}}
 +
{{Erythematous rash DDX}}
  
==Diagnosis==
+
==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
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*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

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.