Case Report

Scombroid Fish Poisoning After Eating Seared Tuna

Authors: Nancy Codori, MD, MPH, Spyridon Marinopoulos, MD, MBA

Abstract

Food safety is an increasing concern to Americans. Recent recalls of peanuts and pistachios, and Food and Drug Administration (FDA) warnings to pregnant women to avoid eating fish have increased government oversight of food processing and handling. Consumers can play an important role in alerting their healthcare providers to food-related illness. Vigilant healthcare providers can notify public health officials to investigate a suspected foodborne illness. The authors present a case of a healthy postdoctoral fellow who developed symptoms of scombroid fish poisoning immediately after consuming a salad containing seared tuna. The successful diagnosis of this case occurred because the patient, physician, city health department and FDA lab collaborated in a coordinated fashion.


Key Points


* A peppery taste noted while eating fish is a sign that the fish is not safe to eat.4


* Freshly caught fish have histamine levels of less than 2 parts per million (ppm). Fish containing histamine levels greater than 20 ppm cause adverse symptoms in people.7


* According to the Food and Drug Administration (FDA), histamine levels between 20 and 50 ppm indicate that the fish has deteriorated. The FDA “action level” for histamine levels in raw, frozen or canned tuna is 50 ppm. A recall of a fish product would occur with a level of 50 ppm or greater.8


* Histamine is the main toxin in scombroid fish poisoning; however, other toxins such as cadaverine and urocanic acid have been implicated as causal agents of scombroid fish poisoning.

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References

1. United States Department of Agriculture [Website for my pyramid]. Available at http://www.mypyramid.gov/2009. Accessed June 14, 2009.
 
2. United States Environmental Protection Agency. Estimated Per Capita Consumption of Fish Consumption in the United States. Washington, DC, United States Environmental Protection Agency, 2002.
 
3. United States Food and Drug Administration, Center for Food Safety and Applied Nutrition Web Site Flyer. Scombroid Poisoning. An Advisory Note, Distributed by Office of Seafood. Maryland, United States Food and Drug Administration, Center for Food Safety and Applied Nutrition, 1989.
 
4. United States Food and Drug Administration, Center for Food Safety and Applied Nutrition. Foodborne Pathogenic Organisms and Natural Toxins Handbook. Maryland, United States Food and Drug Administration, Center for Food Safety and Applied Nutrition, 1992.
 
5. Kaliner M, Shelhamer J, Ottesen EA. Effects of infused histamine: correlation of plasma histamine levels and symptoms. J Allergy Clinl Immunol 1982;69:283–289.
 
6. Centers for Disease Control and Prevention. Surveillance for Foodborne-Disease Outbreaks—United States, 1998—2002. Atlanta, GA, Centers for Disease Control and Prevention. MMWR, November 10, 2006/55 (SS10); 1–34.
 
7. Food and Drug Administration Compliance Policy Guide 7108.24. Decomposition and Histamine—Raw, Frozen Tuna and Mahi-Mahi; Canned Tuna; and Related Species. Washington, DC, Food and Drug Administration, July 1995.
 
8. Lehane L, Olley J. Histamine fish poisoning revisited. Int J Food Microbiol 2000;58:1–37.
 
9. Centers for Disease Control and Prevention. Foodborne Outbreaks due to Confirmed Chemical Etiologies, 2006. Atlanta, Georgia, Centers for Disease Control and Prevention, 2006.