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

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