Scombroid Toxicity 

  • Author: John D Patrick, MD; Chief Editor: Asim Tarabar, MD   more...
 
Updated: Apr 8, 2010
 

Background

Scombroid fish poisoning (scombrotoxism, scombroid ichthyotoxicosis) is a food-related illness typically associated with the consumption of fish. The syndrome derived its name because early descriptions of the illness noted an association with Scombroidea fish (eg, large dark meat marine tuna, albacore, mackerel); however, the Centers for Disease Control and Prevention (CDC) have identified the largest vector to be nonscombroid fish, such as mahi-mahi and amberjack. One case report documents a large outbreak related to escolar (rudderfish, oilfish) consumption, a species whose high waxy ester content can cause some gastrointestinal symptoms (keriorrhoea) that may overlap with those caused by scombroid poisoning.[1] Epidemiologic data from the CDC suggest that scombroid poisoning is the principal chemical agent type of food-borne disease found in the United States; the second most common is ciguatera poisoning.[2]

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Pathophysiology

Most of the published literature suggests that symptoms are related to the ingestion of biogenic amines, especially histamine; others, like putrescine and cadaverine, may potentiate toxicity.[3]Histamine is produced via bacterial decarboxylation of histidine and is normally present at levels less than 0.1 mg per 100 g of fish. In contrast, samples of fish that produce poisoning contain histamine levels of at least 20-50 mg per 100 g of fish. Serum histamine levels and urinary histamine excretion are elevated in humans with acute illness. Antihistamines (H1- and H2-blockers) have been used with good efficacy and safety to abate or abolish the symptoms.

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Epidemiology

Frequency

United States

Scombroid poisoning is relatively uncommon (although likely highly underreported), making up 5% of food-borne disease outbreaks reported to the CDC. The American Association of Poison Control Centers does not maintain specific data on scombroid poisoning, as noted in its 1998 annual toxic surveillance report.

International

Although scombroid poisoning is more common in nations with a warm water fishing industry, the illness is worldwide in scope. The most commonly implicated fish species are scombroid dark meat fish (eg, tuna, mackerel, skipjack, bonito, marlin) and nonscombroid species, such as mahi-mahi (dolphinfish),amber jack, sardine, yellowtail, herring, and bluefish. Although rare, cases of whitefish scombrotoxism also have been reported.

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Contributor Information and Disclosures
Author

John D Patrick, MD  Assistant Professor of Medicine, Division of Emergency Medicine, Harvard Medical School; Staff, Walk-In Center, Mount Auburn Hospital

John D Patrick, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert L Norris, MD  Professor, Department of Surgery; Chief, Division of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Fred Harchelroad, MD, FACMT, FAAEM, FACEP  Chair, Department of Emergency Medicine, Director of Medical Toxicology, Allegheny General Hospital; Associate Professor, Department of Emergency Medicine, Drexel University College of Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD  Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

References

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  2. Lynch M, Painter J, Woodruff R, Braden C. Surveillance for foodborne-disease outbreaks--United States, 1998-2002. MMWR Surveill Summ. Nov 10 2006;55(10):1-42. [Medline]. [Full Text].

  3. Al Bulushi I, Poole S, Deeth HC, Dykes GA. Biogenic amines in fish: roles in intoxication, spoilage, and nitrosamine formation--a review. Crit Rev Food Sci Nutr. Apr 2009;49(4):369-77. [Medline].

  4. Grinda JM, Bellenfant F, Brivet FG, et al. Biventricular assist device for scombroid poisoning with refractory myocardial dysfunction: a bridge to recovery. Crit Care Med. Sep 2004;32(9):1957-9. [Medline].

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  8. Centers for Disease Control and Prevention. Scombroid fish poisoning associated with tuna steaks--Louisiana and Tennessee, 2006. MMWR Morb Mortal Wkly Rep. Aug 17 2007;56(32):817-9. [Medline]. [Full Text].

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  19. Morii H, Kasama K, Herrera-Espinoza R. Cloning and sequencing of the histidine decarboxylase gene from Photobacterium phosphoreum and its functional expression in Escherichia coli. J Food Prot. Aug 2006;69(8):1768-76. [Medline].

  20. Morrow JD, Margolies GR, Rowland J, Roberts LJ 2nd. Evidence that histamine is the causative toxin of scombroid-fish poisoning. N Engl J Med. Mar 14 1991;324(11):716-20. [Medline].

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An example of a typical scombroid rash, in this case from tuna. Image courtesy of Amanda Oakley, MBChB, FRACP.
An example of a typical scombroid rash, in this case from tuna. Posterior view of the same patient as in the image above. Image courtesy of Amanda Oakley, MBChB, FRACP.
 
 
 
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