A Local Outbreak of Scombroid Fish Poisoning in Japan

• Published in: Clinical Toxicology Vol. 46; no. 7; p. 621
• Main Authors: Iguchi, S, Sugita, M, Nomura, T, Sekii, H, Ookubo, H, Yamaguchi, N
• Format: Conference Proceeding
• Language: English
• Published: 01-08-2008
• Subjects: Cololabis saira; Enterobacter; Morganella; Thunnus; Vitaceae; Japan; North America
• ISSN: 1556-3650

Background: Despite the frequent consumption of raw fish by the Japanese, only 10 cases of scombroid poisoning occur every year; these cases account for only 0.5% of the total food poisoning cases in Japan. We think that scombroid poisoning is hardly recognized and often misdiagnosed as anaphylactic reaction. We report a small outbreak of scombroid poisoning in Japan. Case Report: Three patients were brought to our hospital in an ambulance. They had developed nausea; general malaise; itching sensation; and rashes immediately after consuming sundried scombroid fish for lunch at the same restaurant Since all the 3 patients presented with their symptoms at the same time and after eating the same food at a restaurant, we suspected scombroid poisoning. In spite of treatments at the outpatient clinic, 2 of the 3 patients (2 women) remained hypotensive; therefore, they were admitted to the intensive care unit Their symptoms disappeared within 2 d of hospitalization; hence, they were discharged. We notified the local public health department of an outbreak of scombroid fish poisoning; a few days later, it was confirmed that sun-dried scombroid fish contained high levels of histamine (160-520 mg/100 g). Case Discussion: Scombroid poisoning occurs due to the consumption of foods containing high levels of histamine (greater than 100 mg/100 g); bacteria (e.g., Morganella sp. or Enterobacter sp.) in the food metabolize histamine to the amino acid histidine. Foods containing histidine include red fish (tuna, scombroid fish, saury, etc.), wine, and cheese. Because the Japanese often consume red fish, we think that scombroid poisoning should occur frequently. To accurately diagnose scombroid poisoning, it is important to recognize scombroid poisoning, which is often manifested by allergy-like symptoms immediately after consuming a specific food. Scombroid poisoning is treated by administering antihistamines and providing supportive care. Conclusion: Presently, raw fish has become a very common food consumed by people worldwide. If allergy-like symptoms appear after consuming raw fish, scombroid poisoning should be suspected and a differential diagnosis should be considered.