Scombroid Fish Poisoning

Agents: Toxic decomposition metabolites collectively called scombrotoxins; the scombro-toxins are not bioaccumulated dinoglagellate or diatom exotoxins.

Toxins: Scombrotoxins = histamine and its primary N-methylhistamine metabolite, saurine. LD50: No known human fatalities. Mechanism: Scombrotoxins form during gut bacteria-catalyzed, normothermic decarbox-ylation (Proteus, Klebsiella, Lactobacillus, E. coli, Enterobacter species) of muscle L-histidine in decomposing finfish dangling on commercial long lines or in underrefrigerated ship holes. Vectors: Paradoxically, non-scombroid fish are the most common food vectors of scombroid poisoning (amberjack, bonito, bluefish, mahi mahi, anchovies, sardines, herrings) > scom-broid fish (albacore, cobia, tuna, mackerel, wahoo).

Incubation: Minutes to 3-4 hours. Symptoms: Sudden warm facial flushing and "sunburn-like" rash, metallic-peppery taste, perioral burning and blistering sensations; then urticaria, pruritus, bronchospasm, palpitations, tachycardia, hypotension; fewer gastrointestinal symptoms of abdominal cramps, nausea, vomiting, and diarrhea.

Diagnosis: Histidine-to-histamine spot indicator tests, thin-layer chromatography (TLC), gas chromatography/mass spectrometry, high serum and urine histamine and saurine levels. Treatment: Severe poisoning—gastric emptying, then AC gut decontamination; otherwise, Hj-and H2-blockers, P-agonists for bronchospasm with wheezing, and consider corticosteroids for allergic bronchospasm and urticaria/pruritus. Prognosis: Symptoms resolve in 12-24 hours even without treatment.

Prevention: Patients on isoniazid (INH), a gastrointestinal histaminase inhibitor, are at increased risk; avoid nonrefrigerated and spoiling (pale gills) deep-sea fish; avoid seafood with histamine levels >50 mg/100 mg fish (FDA); regulate long-line fishing; require mandatory cold-chain (0°C) for all seafood from harvest until cooking/consumption.

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