Scombroid: Difference between revisions
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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 | **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 | ||
*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> | |||
===Causes=== | ===Causes=== | ||
| Line 19: | Line 20: | ||
==Clinical Features== | ==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 and urticarial [[rash]], [[palpitations]], [[dizziness]], [[diarrhea]], perioral burning, [[pruritus|itching]], or edema | *Flushing, warmth, erythematous and urticarial [[rash]], [[palpitations]], [[dizziness]], [[diarrhea]], perioral burning, [[pruritus|itching]], or edema | ||
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==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
- Symptoms generally start within one hour of ingestion, and usually resolves within 12 hours (if untreated)
- Flushing, warmth, erythematous and urticarial rash, palpitations, dizziness, diarrhea, perioral burning, itching, or edema
- May also see severe throbbing headache, blurred vision, tachycardia, and respiratory distress
Differential Diagnosis
- Ciguatera - similar clinical presentation, different fish
Acute allergic reaction
- Allergic reaction/urticaria
- Anaphylaxis
- Angioedema
- Anxiety attack
- Asthma exacerbation
- Carcinoid syndrome
- Cold urticaria
- Contrast induced allergic reaction
- Scombroid
- Shock
- Transfusion reaction
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
Evaluation
- Generally clinical diagnosis
- Consider if symptoms present in multiple patients who ate same fish
Management
- Antihistamines - give both H1 and H2 antagonists
- Consider epinephrine, albuterol if symptoms of respiratory distress
Disposition
- Typically see a prompt response to treatment with antihistamines
- Generally may be discharged
See Also
References
- ↑ 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
- ↑ 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.