A Scombroid Poisoning Causing a Life-Threatening Acute Pulmonary Edema and Coronary Syndrome in a Young Healthy Patient

Department of Experimental and Applied Medicine, University of Brescia, Piazzale Spedali civili, 125100 Brescia, Italy.
Cardiovascular toxicology (Impact Factor: 1.72). 05/2011; 11(3):280-3. DOI: 10.1007/s12012-011-9115-1
Source: PubMed


Scombroid poisoning, also called histamine fish poisoning, is an allergy-like form of food poisoning that represents one of the major problems in seafood safety. It consists in a clinical syndrome associated with consumption of fish and, less frequently, cheese containing high levels of histamine [1, 2]. Usually certain families of dark meat fish are involved, mainly Scombroidae and Scomberesocidae (e.g., tuna, mackerel, skipjack, Bonito, and Cero). Other nonscombroid fish (e.g., mahi-mahi, herring, anchovies, sardines, Australian salmon, swordfish) was also reported to be associated with scombroid fish poisoning [1-5]. High fish histamine concentrations have been found responsible for this kind of poisoning. Histamine and histamine-like substances are generated from histidine by a decarboxylase activity of bacteria such as Proteus, Klebsiella, Aerobacter, Serratia, Enterobacter, and Escherichia coli [6, 7]. The presence of this bacteria and the massive histamine production detected in the fish is usually secondary to contamination of handlers and improper refrigeration [7]. The clinical presentation is generally characterized by flushing, rash, swelling of face or tongue, sweating, headache, dizziness, abdominal cramps, diarrhea, nausea, vomiting, palpitations, respiratory distress, and hypotension. The onset of symptoms generally occurs few minutes after ingestion of contaminated food. Usually the course is selflimiting and antihistamines can be used to relieve symptoms. We report a rare case of a life-threatening scombroid poisoning with myocardial ischemia and acute pulmonary edema after tuna ingestion.

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    • "Bacterial strains known to be capable of histamine production include Escherichia, Enterobacter, Pseudomonas, Salmonella, Shigella, Clostridium, Streptococcus, Lactobacillus, Leuconostoc, Morganella, Photobacterium, Raoultella, and Hafnia [12], [11]. According to [13], [9], [14] and [3], the main clinical manifestations affect the skin (rash, oedema and localized inflammation), the gastrointestinal tract (nausea, vomiting, and diarrhea), the haemodynamic (hypotension) and neurological functions (headache, palpitations, tingling, burning, and itching). Histamine may be involved in the onset of migraine attacks in susceptible subjects and may produce hypertensive crises in patients treated with monoamine oxidase inhibitor-type drugs [15], "
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    ABSTRACT: Considering the forms of mishandling observed among fishmongers, it is needful to investigate the histamine content in commonly available frozen fish in Ibadan markets as a predictor of health hazard to consumers. Seventy-two frozen fish samples comprising two (2) different species: Chub Mackerel (Scomber japonicus) and Sardine (Sardinella eba) purchased from six purposively selected fishmongers each in Bodija and Oja-oba markets were used for this study. Histamine contents and Total Coliform Counts (TCC) were determined. Histamine contents varied with time of the day. Histamine contents of Chub mackerel were higher than the values for Sardine. It may be safer to purchase fish between early hours and midday because the percentage of fish samples that met allowable histamine limit of ≤ 200 mg/kg decreased with time of the day. Also, the percentage of the total fish samples that met the allowable limit was low. This showed poor hygiene practice among the fishmongers as confirmed by the presence of coliform bacteria in all the samples. Since higher percentage of the fish samples in this study was unacceptable for human consumption, there should be routine checking of fish in order to remove implicated products from the market.
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    • "In previous clinical studies, there were similar symptoms described, although with a widespread incidence of diarrhea and skin rash [11] [12] [13]. While scombroid fish poisoning represents a mild illness that is usually resolved with the administration of antihistamine drugs, in severe cases serious complications may develop such as bronchospasm, cardiac and respiratory distress, in more susceptible individuals [14] [15] [16] [17] [18] "
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    ABSTRACT: Background Scombroid syndrome (histamine fish poisoning) includes symptoms and signs caused by biogenic amines, mainly due to histamine-containing food. Methods and results In this report, we describe a 56 year old female who presented in the clinic with symptoms of scombroid syndrome after the ingestion of tuna fish, then gradually developed cardiovascular shock and inferior ST elevation myocardial infarction (STEMI) associated with advanced second grade atrio-ventricular block at the electrocardiogram (ECG) followed by respiratory arrest. Originally, the patient was treated with intravenous fluid infusion, steroids, ranitidine and chlorpheniramine. Following her cardiovascular shock and respiratory arrest, orotracheal intubation was performed and mechanical ventilation was started immediately. The patient was treated with dobutamine and fluid infusion, which has improved her hemodynamic conditions. Emergency cardiac catheterization was performed one hour after the onset of symptoms and coronary angiography did not show a significant coronary artery disease. The clinical picture has improved during the next days, with complete normalization of the ECG. Conclusion Severe symptoms, including myocardial infarction. may occur in cases of scombroid syndrome.
    Central European Journal of Medicine 10/2013; 8(5). DOI:10.2478/s11536-013-0169-2 · 0.15 Impact Factor
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    ABSTRACT: We report a case of anaphylactoid shock with ventricular fibrillation and myocardial necrosis that occurred in a 61-year-old patient twenty minutes after eating cooked fish. An allergic cause was excluded by negative allergic explorations and good tolerance of subsequent fish consumption. A diagnosis of scombroid food poisoning (SFP) was made. SFP results from eating fish spoiled by inadequate refrigeration. The fish becomes contaminated by bacteria which then convert fish muscle histidine into histamine. Typical symptoms of histaminic intoxication include a metallic taste, erythema, sweating, nausea, diarrhea, palpitations, and sometimes facial oedema. Myocardial involvement is rare but not exceptional. SFP is the main differential diagnosis in cases of suspected fish allergy.
    Revue Française d'Allergologie 01/2013; 54(1). DOI:10.1016/j.reval.2013.06.002 · 0.25 Impact Factor
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