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Scombroid Fish Poisoning -- New Mexico, 1987

In July 1987, state and local public health officials in New Mexico investigated two cases of scombroid fish poisoning (histamine poisoning) in persons living in Albuquerque. The New Mexico Health and Environment Department was initially consulted by an Albuquerque physician regarding two patients, a husband and wife, who had become ill within 45 minutes after eating dinner. Their symptoms included nausea, vomiting, diarrhea, headache, fever, flushing, and rapid pulse rate. An investigation by the Albuquerque Environmental Health Department found that the couple had shared a meal of grilled mahi mahi, pasta, salad, water, and wine. Their dog had eaten some of the fish and had vomited; however, their daughter, who had eaten no fish, did not become ill. Both of the patients had been treated with Benadryl, activated charcoal, and ipecac in a hospital emergency room. Their symptoms resolved within 36 hours of onset of illness.

Samples of the remaining mahi mahi were sent to the Food and Drug Administration laboratory in Seattle. Histamine was detected in the samples at a ratio of 20 mg/100 g, a level sufficient to cause symptoms (1). Samples from a different shipment of fish were obtained from the store in Albuquerque where the mahi mahi was purchased. These samples yielded histamine levels of 3 mg/100 g of sample and were negative for ciguatera toxin.

The fish had been imported from Taiwan through California and shipped frozen to the Albuquerque distributor, where it was thawed and sold from iced refrigerator cases. The patients had frozen the fish after they bought it. Later, they thawed it for 3 hours at room temperature and then grilled the still icy fish. Reported by: NB Rieder, MD; NI Goertz, RS, JD Hall, DrPH, Albuquerque Environmental Health Dept; M Eidson, DVM, HF Hull, MD, State Epidemiologist, New Mexico Health and Environment Dept. Albuquerque Resident Post, Food and Drug Administration. Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Of all varieties of fish, the scombroid species (tuna, bonito, and mackerel) and certain other dark-meat fish, such as mahi mahi, are the most likely to develop high levels of histamine. When fresh scombroid fish are not continuously iced or refrigerated, bacteria may convert the amino acid histidine, which occurs naturally in the muscle of the fish, to histamine. Since histamine is resistant to heat, cooking the fish generally will not prevent illness. Histamine levels may not be correlated with any obvious signs of decomposition of the fish. Thus, prompt and proper refrigeration or icing from the time the fish is caught until it is preserved, processed, or cooked is essential to prevent scombroid fish poisoning. Antihistamines may be useful for symptomatic treatment.

Because histamine is metabolized by intestinal flora, even large doses of ingested pure histamine usually do not cause symptoms. Thus, although histamine is a marker for fish that could cause scombroid fish poisoning, the actual mechanism for the poisoning must depend on an additional cofactor. Experimental evidence indicates that other substances produced in fish by putrefactive bacteria inhibit the metabolism of histamine and permit its absorption and circulation (2).

References

  1. Bartholomew BA, Berry PR, Rodhouse JC, Gilbert RJ, Murray CK. Scombrotoxic fish poisoning in Britain: features of over 250 suspected incidents from 1976 to 1986. Epidemiol Infect 1987;99:775-82.

  2. Taylor SL. Histamine food poisoning: toxicology and clinical aspects. CRC Crit Rev Toxicol 1986;17:91-128.



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