Scombroid food poisoning, also known as simply scombroid, is a
foodborne illness
Foodborne illness (also foodborne disease and food poisoning) is any illness resulting from the spoilage of contaminated food by pathogenic bacteria, viruses, or parasites that contaminate food,
as well as prions (the agents of mad cow dis ...
that typically results from eating spoiled fish.
[ Symptoms may include ]flushed skin
Flushing is to become markedly red in the face and often other areas of the skin, from various physiological conditions. Flushing is generally distinguished, despite a close physiological relation between them, from blushing, which is milder, gen ...
, headache, itchiness, blurred vision, abdominal cramps, and diarrhea.[ Onset of symptoms is typically 10 to 60 minutes after eating and can last for up to two days.][ Rarely, breathing problems or an ]irregular heartbeat
Arrhythmias, also known as cardiac arrhythmias, heart arrhythmias, or dysrhythmias, are irregularities in the heartbeat, including when it is too fast or too slow. A resting heart rate that is too fast – above 100 beats per minute in adults ...
may occur.[
Scombroid occurs from eating fish high in ]histamine
Histamine is an organic nitrogenous compound involved in local immune responses, as well as regulating physiological functions in the gut and acting as a neurotransmitter for the brain, spinal cord, and uterus. Since histamine was discovere ...
due to inappropriate storage or processing.[ Fish commonly implicated include ]tuna
A tuna is a saltwater fish that belongs to the tribe Thunnini, a subgrouping of the Scombridae ( mackerel) family. The Thunnini comprise 15 species across five genera, the sizes of which vary greatly, ranging from the bullet tuna (max len ...
, mackerel
Mackerel is a common name applied to a number of different species of pelagic fish, mostly from the family Scombridae. They are found in both temperate and tropical seas, mostly living along the coast or offshore in the oceanic environment.
...
, mahi mahi
The mahi-mahi () or common dolphinfish (''Coryphaena hippurus'') is a surface-dwelling ray-finned fish found in off-shore temperate, tropical, and subtropical waters worldwide. Also widely called dorado (not to be confused with ''Salminus brasil ...
, sardine
"Sardine" and "pilchard" are common names for various species of small, oily forage fish in the herring family Clupeidae. The term "sardine" was first used in English during the early 15th century, a folk etymology says it comes from the It ...
, anchovy
An anchovy is a small, common forage fish of the family Engraulidae. Most species are found in marine waters, but several will enter brackish water, and some in South America are restricted to fresh water.
More than 140 species are placed in 1 ...
, herring
Herring are forage fish, mostly belonging to the family of Clupeidae.
Herring often move in large schools around fishing banks and near the coast, found particularly in shallow, temperate waters of the North Pacific and North Atlantic Oceans, ...
, bluefish
The bluefish (''Pomatomus saltatrix'') is the only extant species of the family Pomatomidae. It is a marine pelagic fish found around the world in temperate and subtropical waters, except for the northern Pacific Ocean. Bluefish are known as ta ...
, amberjack
Amberjacks are Atlantic and Pacific fish in the genus '' Seriola'' of the family Carangidae. They are widely consumed across the world in various cultures, most notably for Pacific amberjacks in Japanese cuisine; they are most often found in th ...
, and marlin
Marlins are fish from the family Istiophoridae, which includes about 10 species. A marlin has an elongated body, a spear-like snout or bill, and a long, rigid dorsal fin which extends forward to form a crest. Its common name is thought to deriv ...
.[ These fish naturally have high levels of ]histidine
Histidine (symbol His or H) is an essential amino acid that is used in the biosynthesis of proteins. It contains an α-amino group (which is in the protonated –NH3+ form under biological conditions), a carboxylic acid group (which is in the d ...
, which is converted to histamine when bacterial
Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were among ...
growth occurs during improper storage.[ Subsequent cooking, smoking, or freezing does not eliminate the histamine.][ Diagnosis is typically based on the symptoms and may be supported by a normal blood ]tryptase
Tryptase (, ) is the most abundant secretory granule-derived serine proteinase contained in mast cells and has been used as a marker for mast cell activation. Club cells contain tryptase, which is believed to be responsible for cleaving the hemagg ...
. If a number of people who eat the same fish develop symptoms, the diagnosis is more likely.[
Prevention is by refrigerating or freezing fish right after it is caught.][ Treatment is generally with ]antihistamines
Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provid ...
such as diphenhydramine
Diphenhydramine (DPH) is an antihistamine and sedative mainly used to treat allergies, insomnia, and symptoms of the common cold. It is also less commonly used for tremor in parkinsonism, and nausea. It is taken by mouth, injected int ...
and ranitidine
Ranitidine, sold under the brand name Zantac among others, is a medication used to decrease stomach acid production. It is commonly used in treatment of peptic ulcer disease, gastroesophageal reflux disease, and Zollinger–Ellison syndrome. ...
.[ ]Epinephrine
Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...
may be used for severe symptoms. Along with ciguatera fish poisoning
Ciguatera fish poisoning (CFP), also known simply as ciguatera, is a foodborne illness caused by eating reef fish whose flesh is contaminated with certain toxins. Such individual fish are said to be ciguatoxic. Symptoms may include diarrhea, vom ...
, it is one of the most common type of seafood poisoning
Many species of fish are caught by humans and consumed as food in virtually all regions around the world. Fish has been an important dietary source of protein and other nutrients throughout human history.
The English language does not have a ...
. It occurs globally in both temperate
In geography, the temperate climates of Earth occur in the middle latitudes (23.5° to 66.5° N/S of Equator), which span between the tropics and the polar regions of Earth. These zones generally have wider temperature ranges throughout t ...
and tropical
The tropics are the regions of Earth surrounding the Equator. They are defined in latitude by the Tropic of Cancer in the Northern Hemisphere at N and the Tropic of Capricorn in
the Southern Hemisphere at S. The tropics are also referred to ...
waters.[ Only one death has been reported.][ The condition was first described in 1799.][
]
Signs and symptoms
Symptoms typically occur within 10–30 minutes of ingesting the fish and generally are self-limited. People with asthma
Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, ...
are more vulnerable to respiratory problems such as wheezing
A wheeze is a continuous, coarse, whistling sound produced in the respiratory airways during breathing. For wheezes to occur, some part of the respiratory tree must be narrowed or obstructed (for example narrowing of the lower respiratory tract ...
or bronchospasm
Bronchospasm or a bronchial spasm is a sudden constriction of the muscles in the walls of the bronchioles. It is caused by the release ( degranulation) of substances from mast cells or basophils under the influence of anaphylatoxins. It causes d ...
s. However, symptoms may show over two hours after eating a spoiled dish. They usually last for about 10 to 14 hours, and rarely exceed one to two days.
Initial
The first signs of poisoning suggest an allergic reaction
Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermati ...
with these symptoms:
* facial flushing/sweating
* burning-peppery taste sensations in the mouth and throat
* dizziness
* nausea
* headache
* tachycardia
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal (su ...
* cold-like symptoms
Additional symptoms
The above symptoms can advance to:
* facial rash
A rash is a change of the human skin which affects its color, appearance, or texture.
A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cr ...
(intense itching may accompany the rash)
* torso or body rash: The rash associated with scombroid poisoning is a form of urticaria
Hives, also known as urticaria, is a kind of skin rash with red, raised, itchy bumps. Hives may burn or sting. The patches of rash may appear on different body parts, with variable duration from minutes to days, and does not leave any long-lasti ...
, but most commonly does not include wheals (patchy areas of skin-swelling also known as hives) that may be seen in true allergies.
* edema
Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area ma ...
(generalized if it occurs at all)
* short-term diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
* abdominal cramps
A cramp is a sudden, involuntary, painful skeletal muscle contraction or overshortening associated with electrical activity; while generally temporary and non-damaging, they can cause significant pain and a paralysis-like immobility of the af ...
Severe
In the worst cases, the poisoning may cause:
* blurred vision
* respiratory distress
* swelling of the tongue
In rare cases, the poisoning may result in death.
Causes
Unlike many types of food poisoning, scombroid form is not brought about by ingestion of a pathogen. Histidine
Histidine (symbol His or H) is an essential amino acid that is used in the biosynthesis of proteins. It contains an α-amino group (which is in the protonated –NH3+ form under biological conditions), a carboxylic acid group (which is in the d ...
is an amino acid
Amino acids are organic compounds that contain both amino and carboxylic acid functional groups. Although hundreds of amino acids exist in nature, by far the most important are the alpha-amino acids, which comprise proteins. Only 22 alpha a ...
that exists naturally in many types of food, including fish. At temperatures above 16 °C (60 °F), histidine is converted to the biogenic amine
A biogenic amine is a biogenic substance with one or more amine groups. They are basic nitrogenous compounds formed mainly by decarboxylation of amino acids or by amination and transamination of aldehydes and ketones. Biogenic amines are organic ...
histamine
Histamine is an organic nitrogenous compound involved in local immune responses, as well as regulating physiological functions in the gut and acting as a neurotransmitter for the brain, spinal cord, and uterus. Since histamine was discovere ...
via the enzyme histidine decarboxylase
The enzyme histidine decarboxylase (, HDC) is transcribed on chromosome 15, region 21.2, and catalyzes the decarboxylation of histidine to form histamine. In mammals, histamine is an important biogenic amine with regulatory roles in neurotransmi ...
produced by symbiotic
Symbiosis (from Greek , , "living together", from , , "together", and , bíōsis, "living") is any type of a close and long-term biological interaction between two different biological organisms, be it mutualistic, commensalistic, or parasi ...
bacteria such as '' Morganella morganii'' (this is one reason why fish should be stored in the freezer). Histamine is not destroyed by normal cooking temperatures, so even properly cooked fish can still result in poisoning. Histamine is the main natural chemical responsible for true allergic reactions, so the symptoms produced are almost identical to a food allergy
A food allergy is an abnormal immune response to food. The symptoms of the allergic reaction may range from mild to severe. They may include itchiness, swelling of the tongue, vomiting, diarrhea, hives, trouble breathing, or low blood pressure ...
. Rarely, cheese
Cheese is a dairy product produced in wide ranges of flavors, textures, and forms by coagulation of the milk protein casein. It comprises proteins and fat from milk, usually the milk of cows, buffalo, goats, or sheep. During productio ...
may be involved.[
]
Diagnosis
Differentiating scombroid from a fish allergy can be difficult, as both present with similar symptoms.[ In scombroid, blood ]tryptase
Tryptase (, ) is the most abundant secretory granule-derived serine proteinase contained in mast cells and has been used as a marker for mast cell activation. Club cells contain tryptase, which is believed to be responsible for cleaving the hemagg ...
is generally normal, while in an allergic reaction, it is elevated.[
]
Prevention
Cooking, smoking, canning, or freezing will not destroy histamine in contaminated fish. Antihistamines may also be taken before eating seafood.[
]
Treatment
Treatment is in the form of supportive care. If light-headedness occurs, a person should lie with feet partly elevated. Antihistamines
Antihistamines are drugs which treat allergic rhinitis, common cold, influenza, and other allergies. Typically, people take antihistamines as an inexpensive, generic (not patented) drug that can be bought without a prescription and provid ...
such as diphenhydramine
Diphenhydramine (DPH) is an antihistamine and sedative mainly used to treat allergies, insomnia, and symptoms of the common cold. It is also less commonly used for tremor in parkinsonism, and nausea. It is taken by mouth, injected int ...
(H1 blockade) and ranitidine
Ranitidine, sold under the brand name Zantac among others, is a medication used to decrease stomach acid production. It is commonly used in treatment of peptic ulcer disease, gastroesophageal reflux disease, and Zollinger–Ellison syndrome. ...
(H2 blockade) together with intravenous fluids
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
may help with mild to moderate symptoms.[ ]Epinephrine
Adrenaline, also known as epinephrine, is a hormone and medication which is involved in regulating visceral functions (e.g., respiration). It appears as a white microcrystalline granule. Adrenaline is normally produced by the adrenal glands and ...
combined with a steroid
A steroid is a biologically active organic compound with four rings arranged in a specific molecular configuration. Steroids have two principal biological functions: as important components of cell membranes that alter membrane fluidity; and ...
may be used for severe symptoms.[
]
History
The syndrome is named after the fish family Scombridae
The mackerel, tuna, and bonito family, Scombridae, includes many of the most important and familiar food fishes. The family consists of 51 species in 15 genera and two subfamilies. All species are in the subfamily Scombrinae, except the butterfly ...
, which includes mackerel
Mackerel is a common name applied to a number of different species of pelagic fish, mostly from the family Scombridae. They are found in both temperate and tropical seas, mostly living along the coast or offshore in the oceanic environment.
...
s, tuna
A tuna is a saltwater fish that belongs to the tribe Thunnini, a subgrouping of the Scombridae ( mackerel) family. The Thunnini comprise 15 species across five genera, the sizes of which vary greatly, ranging from the bullet tuna (max len ...
s, and bonito
Bonitos are a tribe of medium-sized, ray-finned predatory fish in the family Scombridae – a family it shares with the mackerel, tuna, and Spanish mackerel tribes, and also the butterfly kingfish. Also called the tribe Sardini, it consists of ...
s, because early descriptions of the illness noted an association with those species, although nonscombroid fish such as mahi-mahi
The mahi-mahi () or common dolphinfish (''Coryphaena hippurus'') is a surface-dwelling ray-finned fish found in off-shore temperate, tropical, and subtropical waters worldwide. Also widely called dorado (not to be confused with ''Salminus brasil ...
and amberjack
Amberjacks are Atlantic and Pacific fish in the genus '' Seriola'' of the family Carangidae. They are widely consumed across the world in various cultures, most notably for Pacific amberjacks in Japanese cuisine; they are most often found in th ...
may also cause the condition.
Epidemiology
Isolated reports of scombroid food poisoning in humans caused by histamine present in the tissues of stale or rotten scombroid fish, usually tuna, have occurred over the years. In September 2016, authorities in Singapore intercepted canned tuna imported from Thailand after finding high levels of histamine. No human cases were reported. In 2015, seven people at a cafe in Sydney
Sydney ( ) is the capital city of the state of New South Wales, and the most populous city in both Australia and Oceania. Located on Australia's east coast, the metropolis surrounds Sydney Harbour and extends about towards the Blue Mountai ...
became ill after eating John Bull Tuna Chunky Style in safflower oil on tuna salads. The tinned tuna had come from Thailand. The'' Shenzhen Post'' reported that histamine poisoning from scombroid fish happens often in the autumn in Guangdong province
Guangdong (, ), alternatively romanized as Canton or Kwangtung, is a coastal province in South China on the north shore of the South China Sea. The capital of the province is Guangzhou. With a population of 126.01 million (as of 2020) a ...
in China. In August 2013, 26 people in Shenzen were poisoned after eating stale mackerel. Several people became ill after eating tuna sandwiches at a cafe in Edinburgh in Scotland in 2013. The tuna had come from Ghana. In 2011, 20 reports of food poisoning at a Stockholm restaurant were thought to be histamine poisoning in tuna from Senegal. In 2012, UK environmental health authorities in north east Lincolnshire intercepted and destroyed a shipment of tuna from Vietnam after four crew members were reported to have developed symptoms of histamine poisoning. Commercially canned tuna was determined to be the cause of the poisoning of 232 persons in the north-central United States in 1973.
References
External links
Seafood Network Information Center
Center for Disease Control: Food Poisonings from Marine Toxins
*
{{seafood
Toxic effect of noxious substances eaten as food
Fish and humans
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